Urodynamic and clinical aspects of ileal low pressure bladder substitutes.
Twenty-three patients with an ileal bladder substitute formed after cystectomy for invasive bladder cancer were evaluated clinically and urodynamically between 3 and 38 months post-operatively. The urodynamic measurements were compared with the clinical findings. After re-education of the patients' voiding habits the mean voiding volumes of the bladder substitutes stabilised 6-9 months post-operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or twice at night. The maximum functional capacity (maximum voiding volume) was about 490 ml. Ninety-one per cent of the patients were continent during the day 18 months after the operation and 82% were continent during the night. Micturition was problem-free with an average maximum flow of 25 ml/s and an average micturition time of 50 s. The mean voiding volume of ileal bladder substitutes was 50% of the measured cystometric capacity; the maximum functional capacity (= max. micturition volume) was 80% of the cystometric capacity. The average basal pressure was < 20 cm H2O from the third post-operative month onwards. Eleven of the 23 patients had contractions in the bladder substitute (average at 30 cm H2O) at 55-76% of the maximum cystometric capacity or at approximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences. If the patients were shown how to increase the functional capacity of a reservoir made from only 40 cm of ileum, the clinical results were excellent.
Casanova
G A
GA
Department of Urology, University of Berne, Switzerland.
Springer
J P
JP
Gerber
E
E
Studer
U E
UE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics