Korean J Urol.  2007 Jan;48(1):12-17. 10.4111/kju.2007.48.1.12.

Voiding Pattern and Incontinence after Orthotopic Ileal Neobladder in Male Patients

• Nam JS
• Cho ST
• Lee YG

• KMID: 1915014
• DOI: http://doi.org/10.4111/kju.2007.48.1.12

Abstract

PURPOSE
To report the voiding pattern and continence stati in male patients having undergone a radical cystectomy and orthotopic bladder substitution. MATERIALS AND MATHODS: Between March 2000 and June 2005, 20 men with advanced bladder cancer had a radical cystoprostatectomy and urinary diversion via an ileal orthotopic bladder substitution. The voiding pattern and continence stati were assessed using patient interviews, frequency- volume charts and pad tests at 1, 3, 6, 9 and 12 months after catheter removal.
RESULTS
The mean age and follow-up were 60.5 years (41-72) and 34.1 months (12-69), respectively. Neobladder substitution was performed with an ileum in all patients. 17 patients had reconstruction with a Studer neobladder and 3 with a W-pouch Hautmann. All patients had transitional cell carcinoma (TCC) and their tumor stages ranged from T1G3 to T4aN1M0. The frequency of voiding ranged from 4 to 12 times during the day, and 0 to 5 times during the night, with a mean maximum neobladder capacity of 336ml (200-620) and maximum flow rate of 24.6ml/sec (12-46) 12 months after removal of the catheter. No patient required intermittent self-catheterization. All-time continence rates were 15, 30, 65 and 85%, and all-time incontinence rates were 55, 25, 10 and 5% at 1, 3, 6 and 9 months after catheter removal, respectively.
CONCLUSIONS
Orthotopic bladder substitution has an excellent functional outcome over time, resulting in high daytime and nighttime continence rates within 9 months of catheter removal.

Keyword

Bladder neoplasms, Urinary incontinence, Urinary reservoirs; continent

MeSH Terms

Carcinoma, Transitional Cell
Catheters
Colonic Pouches
Cystectomy
Follow-Up Studies
Humans
Ileum
Male*
Urinary Bladder
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1 Continence patterns at the time of removal and 3, 6, 9 and 12 months after catheter removal in 20 patients.

Reference

1. Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950. 30:1511–1521.

2. Camey M, Le Duc A. L'entero-cystoplastie avec cystoprostectomie totale pour cancer de la vessie. Ann Urol. 1979. 13:114–123.

3. Chen KK, Chang LS, Chen MT. Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy. J Urol. 1991. 146:311–315.

4. Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol. 1999. 161:422–428.

5. Studer UE, Danuser H, Hochreiter W, Springer JP, Turner WH, Zingg EJ. Summary of 10 years' experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment. World J Urol. 1996. 14:29–39.

6. Kulkarni JN, Pramesh CS, Rathi S, Pantvaidya GH. Long-term results of orthotopic neobladder reconstruction after radical cystectomy. BJU Int. 2003. 91:485–488.

7. Lee JY, Kim SW, Park WJ, Chung KU, Lee SJ, Jung SE, et al. Computed tomographic appearance of orthotopic neobladder: correlation with voiding pattern. Korean J Urol. 2001. 42:1140–1145.

8. Mikuma N, Hirose T, Yokoo A, Tsukamoto T. Voiding dysfunction in ileal neobladder. J Urol. 1997. 158:1365–1368.

9. Constantinides C, Manousakas T, Chrisofos M, Giannopoulos A. Orthotopic bladder substitution after radical cystectomy: 5 years of experience with a novel personal modification of the ileal s pouch. J Urol. 2001. 166:532–537.

10. Arai Y, Taki Y, Kawase N, Terachi T, Kekehi T, Okada T, et al. Orthotopic ileal neobladder in male patients: functional oucomes of 66 cases. Int J Urol. 1999. 6:388–392.

11. Studer UE, Zingg EJ. Ileal orthotopic bladder substitutes. What we have learned from 12 years' experience with 200 patients. Urol Clin North Am. 1997. 24:781–793.

12. Rogers E, Scardino PT. A simple ileal substitute bladder after radical cystectomy: experience with a modification of the Studer pouch. J Urol. 1995. 153:1432–1438.

13. Meyer JP, Drake B, Boorer J, Gillatt D, Persad R, Fawcett D. A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: initial results. BJU Int. 2004. 94:1317–1321.

14. Studer UE, Danuser H, Merz VW, Springer JP, Zingg EJ. Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J Urol. 1995. 154:49–56.

15. Casanova GA, Springer JP, Gerber E, Studer UE. Urodynamic and clinical aspects of ileal low pressure bladder substitutes. Br J Urol. 1993. 72:728–735.

16. Elmajian DA, Stein JP, Esrig D, Freeman JA, Skinner EC, Boyd SD, et al. The Kock ileal neobladder: updated experience in 295 male patients. J Urol. 1996. 156:920–925.

17. Park JM, Montie JE. Mechanisms of incontinence and retention after orthotopic neobladder diversion. Urology. 1998. 51:601–609.

18. Skolarikos A, Deliveliotis C, Alargof E, Ferakis N, Protogerou V, Dimopoulos C. Modified ileal neobladder for continent urinary diversion: functional results after 9 years of experience. J Urol. 2004. 171:2298–2301.

19. Hinmann F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol. 1988. 139:519–523.

20. el-Bahnasawy MS, Gomha MA, Shaaban AA. Urethral pressure profile following orthotopic neobladder: differences between nerve sparing and standard radical cystectomy techniques. J Urol. 2006. 175:1759–1763.

21. Turner WH, Danuser H, Moehrle K, Studer UE. The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. J Urol. 1997. 158:2118–2122.

22. Sevin G, Soyupek S, Armagan A, Hoscan MB, Oksay T. Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results. BJU Int. 2004. 94:355–359.

23. Colding-Jorgensen M, Poulsen AL, Steven K. Mechanical characteristics of tubular and detubularised bowel for bladder substitution: theory, urodynamics and clinical results. Br J Urol. 1993. 72:586–593.

24. Stein JP, Grossfeld GD, Freeman JA, Esrig D, Ginsberg DA, Cote RJ, et al. Orthotopic lower urinary tract reconstruction in women using the Kock ileal neobladder: updated experience in 34 patients. J Urol. 1997. 158:400–405.

25. Stenzl A, Colleselli K, Bartsch G. Update of urethra-sparing approaches in cystectomy in women. World J Urol. 1997. 15:134–138.

26. Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G. Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol. 1995. 154:2044–2049.