Continence after total bladder replacement: urodynamic analysis of the ileal neobladder.
Since April 1986 we have carried out 103 bladder substitutions with the ileal neobladder; 91 of these were performed after radical cystectomy in males (group 1) and 12 after subtotal bladder resection (group 2); 55 patients in group 1 and 8 in group 2 were followed up by long-term urodynamic investigations and by a questionnaire concerning micturition patterns and continence at home 3 months post-operatively. The maximum bladder capacity was approximately 770 ml with an absolute intravesical pressure of 23 to 30 cm H2O. Intravesical pressure waves with a mean amplitude of 20 cm H2O were found in 38% of patients in group 1 and 25% in group 2; 61% of these patients were asymptomatic. The results showed that 85% of patients were continent by day and by night. We attribute this to our operative technique: the ileal loop is folded 4 times in a "W" or "M" shape to achieve complete detubularisation of the bowel and the external urethral sphincter is carefully preserved. Altogether, these data show the ileal neobladder technique to be a reliable and safe method of bladder substitution.
Bachor
R
R
Department of Urology, University of Ulm, West Germany.
Frohneberg
D
D
Miller
K
K
Egghart
G
G
Hautmann
R
R
D015653:Cystectomy; D006801:Humans; D007082:Ileum / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000517:prevention & control; D014563:Urodynamics