TOTAL AND IMMEDIATE DAYTIME AND NIGHTTIME CONTINENCE WITH A RIGHT COLONIC NEOBLADDER—WHAT MAKES IT POSSIBLE? AN 11-YEAR FOLLOWUP
Abstract
Purpose:
We report the long-term functional results of the colonic neobladder and provide the physiological and urodynamic foundations for them.
Materials and Methods:
From March 1993 to February 2004, 38 patients with cystectomy received a neobladder constructed from detubularized, remodeled right colon and intact cecum following our design at the urology service at our institution. Most patients underwent urodynamics and videourodynamics as postoperative followup. We defined total continence as not using any protection whatsoever (neither pads nor a night alarm), which was immediate upon removing the urethral catheter.
Results:
A total of 37 patients achieved total daytime continence immediately and the remaining 1 was totally continent after 30 days (100%). Nighttime continence was total and immediate in 36 patients (92%) and satisfactory in 2. Micturition was immediate, satisfactory and total in 37 patients with an average maximum flow of more than 26 ml per second. The patient who did not achieve micturition required clean intermittent catheterization. Videourodynamic studies revealed that continence resulted from the low pressure developed in the large capacity reservoir (more than 600 ml) and from intact intestine haustral contractions, which ejected urine toward the detubularized and remodeled area. In turn, micturition was attained through a combination of abdominal wall tension and mass contractions of the nondetubularized segment, which generated a pressure of more than 100 cm.
Conclusions:
The functional results of this new neobladder are significantly greater than those achieved with other procedures already described in the literature because of the different way in which it functions.
References
- 1 : Milking action: a new functional concept of a different orthotopic neobladder: 4 years followup.. J Urol1998; 160: 1274. Link, Google Scholar
- 2 : Remodeled right colon: an alternative urinary reservoir.. J Urol1987; 138: 730. Link, Google Scholar
- 3 : Selection of intestinal segments for bladder substitution; physical and physiological characteristics.. J Urol1988; 139: 519. Link, Google Scholar
- 4 : Kock pouch bladder replacement.. Urol Clin North Am1991; 18: 641. Google Scholar
- 5 : The hemi-Kock ileocystoplasty: a versatile procedure in reconstructive urology.. J Urol1992; 147: 1248. Link, Google Scholar
- 6 : Bladder reconstruction with bowel after radical cystectomy.. World J Urol1992; 10: 11. Google Scholar
- 7 : The ileal orthotopic bladder.. J Urol1995; 45: 185. Google Scholar
- 8 : Pathophysiology of urinary incontinence after radical prostatectomy.. J Urol1990; 143: 975. Link, Google Scholar
- 9 : Early and late cystometry of detubularized and nondetubularized intestinal neobladder: new observation and physiological correlates.. J Urol1995; 154: 1700. Link, Google Scholar
- 10 : Desire to void and force of micturition in patients with intestinal neobladder.. J Urol1996; 155: 1214. Link, Google Scholar
- 11 : The Kock ileal neobladder: updated experience in 295 male patients. J Urol1996; 156: 920. Link, Google Scholar
- 12 : The ileal neobladder: complications and functional results in 363 patients after 11 years of followup.. J Urol1999; 161: 422. Link, Google Scholar
- 13 : Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment.. J Urol1995; 154: 49. Link, Google Scholar
- 14 : The T pouch: an orthotopic ileal neobladder incorporating a serosal lined ileal antireflux technique.. J Urol1998; 159: 1836. Link, Google Scholar
- 15 : The colonic orthotopic bladder.. Urology1995; 45: 190. Google Scholar
- 16 : The Le Bag orthotopic urinary diversion. J Urol1996; 156: 926. Google Scholar
- 17 : Modified ileal neobladder for continent urinary diversion: functional results after 9 years of experience.. J Urol2004; 171: 2298. Link, Google Scholar
- 18 : Cystometric properties of ileum and right colon after bladder augmentation, substitution, or replacement.. J Urol1987; 138: 1007. Link, Google Scholar
- 19 : Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty.. J Urol1986; 136: 1201. Link, Google Scholar
From the Department of Surgery, Urology Division, Hospital Dr. José Penna, Bahía Blanca, Argentina
