title: Bowel function remains subjectively unchanged after ileal resection for construction of continent ileal reservoirs.
abstract: BACKGROUND
  Construction of a continent catheterizable urinary reservoir or an orthotopic bladder substitute requires substantial bowel resection, which can cause changes in bowel transit time. The reported incidence of chronic diarrhea after ileocecal resection is about 20%. Studies assessing bowel function after resection of 55-60 cm of ileum without compromising the ileocecal valve are scarce, and long-term results have not been reported.
  
  
  OBJECTIVE
  Prospective assessment of possible changes in bowel function (eg, stool frequency, diarrhea) and the potential impact on quality of life in patients with resection of small bowel for urinary diversion.
  
  
  METHODS
  A total of 82 patients who underwent radical cystectomy, extended lymph node dissection, orthotopic ileal bladder substitution, or heterotopic continent cutaneous urinary diversion with a follow-up >1 yr after surgery were prospectively evaluated. Patients who had a neurogenic bladder disorder, had undergone previous radiotherapy, or had not completed the questionnaire were excluded from the study. The validated Gastrointestinal Quality of Life Index was completed by the patients preoperatively and at 3, 12, and 24 mo postoperatively. Five points concerning bowel function (frequent bowel movement, urgent bowel movement, diarrhea, constipation, or uncontrolled stool loss) were assessed, and the median scores were compared pre- and postoperatively.
  
  
  CONCLUSIONS
  Most patients (≥ 80%) were rarely or never troubled by frequent or urgent bowel movements, diarrhea, constipation, or uncontrolled stool loss preoperatively. In the case of stool frequency, a remarkable shift from rarely to never was observed postoperatively at 3, 12, and 24 mo. Scores for constipation and uncontrolled stool loss remained unchanged throughout the whole time period. For urgent bowel movements the median preoperative score of 4 decreased to 3 at 3 mo and 12 mo and returned to 4 at 24 mo. For diarrhea the preoperative score of 4 decreased to 3 at 3 mo and 24 mo and remained at 4 after 12 mo.
  
  
  CONCLUSIONS
  No relevant changes in bowel movements were found after resection of 55-60 cm of ileum if the terminal ileum and the ileocecal valve were left intact.
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Berry
authors.initials: B
authors.lastname: Fung
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Katharina
authors.initials: K
authors.lastname: Haeni
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D039021:Colonic Pouches / Q000009:adverse effects; D003248:Constipation / Q000209:etiology; D015653:Cystectomy; D003672:Defecation; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007082:Ileum / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects