Mechanisms of incontinence and retention after orthotopic neobladder diversion.
OBJECTIVE
To define the mechanism of incontinence and retention after orthotopic neobladder diversion.


METHODS
The results of urodynamic and endoscopic evaluations were assessed in 19 patients (15 men and 4 women). Mean age and postoperative follow-up were 58.3 years and 19.6 months, respectively. Seventeen patients (15 men, 2 women) presented with the sole complaint of nocturnal incontinence, and 2 women presented with retention. Evaluations included voiding and continence history, pelvic examination (for women), postvoid residual, uroflowmetry, triple-lumen video-urodynamic study, and cystourethroscopy.


RESULTS
Among patients with incontinence, 11 (65%) were found to have a primary failure-to-store problem as a result of either reservoir or sphincter failure. Four patients (24%) had a primary failure-to-empty problem, and 2 (11%) had features of both. The predominant etiology of voiding difficulty was the inability to relax the external urethral sphincter adequately during Valsalva's maneuver. Of the 2 women who presented with retention, one had obstructing mucosal folds at the neobladder opening and both demonstrated anterior vaginal wall prolapse on pelvic examination.


CONCLUSIONS
The mechanism of incontinence and retention after orthotopic neobladder diversion can vary. Carefully performed urodynamic and endoscopic assessments can define the underlying etiology and may serve as a guide for proper treatment selection.
Park
J M
JM
Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Montie
J E
JE
D000328:Adult; D000368:Aged; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014547:Urinary Diversion / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology; D016055:Urinary Retention / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics