You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
No AccessJournal of UrologyAdult urology1 May 2007

Bowel Dysfunction After Transposition of Intestinal Segments Into the Urinary Tract: 8-Year Prospective Cohort Study

    View All Author Information


    Bowel function may be disturbed after intestinal segments are transposed into the urinary tract to reconstruct or replace the bladder. In 1997 our group was the first to report major bowel dysfunction in a cohort of such patients. Up to 42% of those who were asymptomatic preoperatively described new bowel symptoms postoperatively including explosive diarrhea, nocturnal diarrhea, fecal urgency, fecal incontinence and flatus leakage. We now describe bowel symptoms in this same cohort 8 years later (2005).

    Materials and Methods:

    A total of 116 patients were evaluable. Of the remaining 37 from the original study 30 had died, 5 no longer wished to be involved and 2 could not be located. Patients were asked to complete postal questionnaires identical to those used in the first followup, assessing the severity of bowel symptoms and quality of life using 2 validated instruments. Responses were compared with those from the original study. The Nottingham Health Profile quality of life scores were also compared to age and sex matched norms.


    There were 96 patients (83%) who completed 8-year followup questionnaires, including 43 after ileal conduit diversion (group 1), 17 after clam enterocystoplasty for overactive bladder (group 2), 18 after bladder reconstruction for neurogenic bladder dysfunction (group 3) and 18 with bladder replacement for nonneurogenic causes (group 4). High prevalence rates of bowel symptoms persisted with no statistically significant differences between the 2 times. Of those with symptoms in 2005, approximately 50% had reported similar symptoms in 1997. Patients treated with clam enterocystoplasty (group 2) still reported the highest prevalence (59%) of troublesome diarrhea with 1 in 2 on regular antidiarrheal medication. They also had high rates of fecal incontinence (47%), fecal urgency (41%) and nocturnal bowel movement (18%), and a large number reported a moderate or severe adverse effect on work (36%), social life (50%) and sexual activity (43%). High rates were also reported by patients with neurogenic bladder dysfunction, including 50% with troublesome diarrhea. This symptom was reported by 19% after ileal conduit and by 17% after bladder replacement for nonneurogenic causes. The impact of bowel symptoms on everyday activities and quality of life persisted, remaining most severe after clam enterocystoplasty, with 24% regretting undergoing the procedure because of subsequent bowel symptoms.


    After more than 8 years, operations involving transposition of intestinal segments continue to be associated with high rates of bowel symptoms which impact everyday activities. These are particularly troublesome following enterocystoplasty for overactive bladder and bladder reconstruction for neurogenic bladder dysfunction. These risks should influence patient selection and potential patients should be warned before undergoing surgery.


    • 1 : Bowel dysfunction after bladder reconstruction. J Urol1998; 159: 1470. LinkGoogle Scholar
    • 2 : Is orthotopic bladder replacement the new gold standard?: Evidence from a systematic review. J Urol2005; 174: 21. LinkGoogle Scholar
    • 3 : Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. Cochrane Database Syst Rev2003; 1. CD003306. Google Scholar
    • 4 : Morbidity and quality of life in patients with orthotopic and heterotopic continent urinary diversion. Urology1998; 51: 51. Crossref, MedlineGoogle Scholar
    • 5 : Bowel function after urinary diversion. World J Urol2004; 22: 210. Google Scholar
    • 6 : Further characterisation of the ‘ileal brake’ reflex in man–effect of ileal infusion of partial digests of fat, protein, and starch on jejunal motility and release of neurotensin, enteroglucagon, and peptide YY. Gut1988; 29: 1042. Google Scholar
    • 7 : Fat-induced ileal brake in the dog depends on peptide YY. Gastroenterology1996; 110: 1491. Google Scholar
    • 8 : Bile acid malabsorption: a complication of conduit surgery. Br J Urol1989; 64: 485. Google Scholar
    • 9 : Bile acid dysfunction after clam enterocystoplasty. Br J Urol1995; 76: 169. Google Scholar
    • 10 : General health measurements. In: Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press1987: 285. Google Scholar
    • 11 : The Nottingham Health Profile User’s Manual. Manchester, England: Galen Research1993. Google Scholar
    • 12 : A case-control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder. Br J Urol1997; 79: 865. Google Scholar
    • 13 : Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. Br J Urol1995; 76: 551. Crossref, MedlineGoogle Scholar
    • 14 : Bowel problems after enterocystoplasty. Br J Urol1997; 79: 328. Google Scholar
    • 15 : Time after surgery, symptoms and well-being in survivors of urinary bladder cancer. BJU Int2003; 91: 325. Google Scholar
    • 16 : Distressful symptoms after radical cystectomy with urinary diversion for urinary bladder cancer: a Swedish population-based study. Eur Urol2001; 40: 151. Google Scholar
    • 17 : Symptom documentation in cancer survivors as a basis for therapy modifications. Acta Oncol2002; 41: 244. Google Scholar
    • 18 : Response to treatment of detrusor instability in relation to psychoneurotic status. Br J Urol1990; 66: 486. Google Scholar
    • 19 : Bladder smooth muscle dysfunction in patients with irritable bowel syndrome. Gut1986; 27: 1014. Google Scholar
    • 20 : Pelvic floor physiology in women with faecal incontinence and urinary symptoms. Br J Surg1995; 82: 173. Google Scholar
    • 21 : Simultaneous dynamic electromyographic proctography and cystometrography. Br J Surg1993; 80: 115. Google Scholar