Management of Male Voiding Dysfunction after Radical Cystectomy and Neobladder Reconstruction

Abstract

At centers orthotopic bladder substitution (OBS) is the preferred method of urinary diversion following radical cystectomy (RC). Daytime and nighttime incontinence (UI) are reported in up to 13 % and 28 % of cases, respectively. SUI is the most common reason for daytime leakage, while an absent vesicourethral reflex with reduced external sphincter tone is associated with nighttime UI. A PubMed search disclosed a paucity of data for any treatment modality, the absence of prospective randomized trials and the existence of few retrospective case reports or small case series with limited follow up. Conservative management has limited value. Pharmacologic treatment for enuresis is effective in select OBS patients, while the off label use of Duloxetine for SUI seems promising. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT system in mild stress UI. The need of intermittent self catheterisation (ISC) after slings seems to be very high. Implantation of the artificial urinary sphincter AMS 800 (AUS) is the standard treatment for severe stress (UI). AUS is a relatively safe, effective continence procedure for patients with OBS and severe SUI. Complication rate, urinary symptoms, and quality of life of these patients as determined by validated questionnaires are acceptable.