Identification and management of emptying failure in male patients with orthotopic neobladders after radical cystectomy for bladder cancer.
OBJECTIVE
To treat neobladder emptying failure after radical cystectomy in patients with bladder cancer. The etiology of neobladder emptying failure should be identified.


METHODS
We analyzed the outcome of neobladder emptying in 231 male patients who received neobladder reconstruction after radical cystectomy. The clinical characteristics, urodynamic evaluation, and treatment information were collected from all patients with emptying failure.


RESULTS
The total occurrence of neobladder emptying failure was 37 of 231 (16%). Emptying failure was a result of mechanical obstruction in 25 (10.8%) patients; obstructions were caused by strictures of the neobladder-urethral anastomosis (13 cases, 5.6%), anterior urethral strictures (3 cases, 1.2%), obstructive mucosal valves (2 cases, 0.9%), primary cystolithiasis (1 case, 0.4%), mucus plugs (2 cases, 0.9%), urethral tumor recurrence (2 cases, 0.9%), and pelvic tumor recurrence (2 cases, 0.9%). In 21 of 25 patients with mechanical obstructions, bladder function was completely recovered via an endourological approach. However, in 12 of patients with dysfunctional voiding, 3 patients presented higher compliance of neobladder. Two patients were found with a narrower posterior urethral angle. Eventually, 10 patients of 12 with dysfunctional voiding performed intermittent self-catheterization.


CONCLUSIONS
The obstructive outlet was the primary cause of emptying failure in neobladders. Most of the patients with mechanical obstructions could obtain satisfactory neobladder emptying by a minimally invasive surgical approach. However, nearly all the patients with dysfunctional voiding will have to receive clean intermittent catheterization until the mechanisms causing failure are better understood.
Ji
Huixiang
H
Section of Urological Oncology, Urology Institute of People Liberation Army, Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China.
Pan
Jinhong
J
Shen
Wenhao
W
Wu
Xiaojun
X
Zhang
Jiahua
J
Fang
Qiang
Q
Li
Xin
X
Yan
Junan
J
Li
Xuemei
X
Song
Bo
B
Chen
Zhiwen
Z
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*; D016055:Urinary Retention / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*