title: Orthotopic ileal bladder substitution in women: factors influencing urinary incontinence and hypercontinence.
abstract: BACKGROUND
  Urinary incontinence or the inability to void spontaneously after ileal orthotopic bladder substitution is a frequent finding in female patients.
  
  
  OBJECTIVE
  To evaluate how hysterectomy and nerve sparing affect functional outcomes and whether these relate to pre- and postoperative urethral pressure profile (UPP) results.
  
  
  METHODS
  Prospectively performed pre- and postoperative UPPs of 73 female patients who had undergone cystectomy and bladder substitution were correlated with postoperative voiding and continence status.
  
  
  METHODS
  Outcome analyses were performed with the Kruskal-Wallis test, Wilcoxon-Mann-Whitney, or two-group post hoc testing with the Bonferroni correction. Chi-square or Fisher exact tests were applied for the categorical data.
  
  
  CONCLUSIONS
  Of postoperatively continent or hypercontinent patients, 22 of 43 (51.2%) had the uterus preserved; of incontinent patients, only 4 of 30 (13.3%, p<0.01) had the uterus preserved. Of postoperatively continent or hypercontinent patients, 27 of 43 patients (62.8%) had bilateral and 15 of 43 (34.9%) had unilateral attempted nerve sparing. In incontinent patients, 11 of 30 (36.7%) had bilateral and 16 of 30 (53.3%) had unilateral attempted nerve sparing (p=0.02). When compared with postoperatively incontinent patients, postoperatively continent patients had a longer functional urethral length (median: 32mm vs 24mm; p<0.001), a higher postoperative urethral closing pressure at rest (56cm H2O vs 35cm H2O; p<0.001) as well as a higher preoperative urethral closing pressure at rest (74cm H2O vs 47.5cm H2O; p=0.01). The main limitation was the limited number of patients.
  
  
  CONCLUSIONS
  In female patients undergoing radical cystectomy and bladder substitution, preservation of the uterus and attempted nerve sparing results in better functional outcomes. The preoperative UPPs correlate with postoperative voiding and continence status and may predict which patients are at a higher risk of functional failure after bladder substitution.
  
  
  RESULTS
  If preservation of the urethra's innervation is not possible during cystectomy, poor functional results with bladder substitutes are likely.
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gross
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Meierhans Ruf
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Meissner
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Ochsner
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland. Electronic address: urs.studer@insel.ch.
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015653:Cystectomy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019738:Surgically-Created Structures / Q000009:adverse effects*; D016896:Treatment Outcome; D014521:Urethra / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics
keywords: Hypercontinence; Hysterectomy; Incontinence; Nerve sparing; Orthotopic ileal bladder substitution; Urethral pressure profile