The Urodynamic Characteristics in Various Bladder Reconstructions with a Detubularized Ileal Segment

Abstract

Bladder reconstruction using detubularized intestinal segment has been a well established procedure. Although urodynamic changes in enterocystoplasty and neobladder have been widely reported, there is little information with respect to the comparison among various methods of bladder reconstruction. Herein we compared the physiological changes in three different bladder reconstructions including 6 augmentation cystoplasties, 11 Kock pouches, and 7 urethral neobladders constructed by a detubularized terminal ileal segment of the same length. The augmentation cystoplasties had the largest bladder capacity soon after removal of the catheter, Kock pouches ranked second, and urethral neobladders the last. The order was the same in the increase of bladder compliance and the decrease of peristaltic pressure. However, all bladder reconstructions became stable within 6 months and the final bladder capacity and compliance showed no significant difference in the 12 month follow-up. Bladder outlet resistance is believed to play the most important role in their physiological development. We conclude that the detubularized terminal ileum is an ideal bowel segment for any kind of bladder reconstructions. For a segment of 40 cm ileum, a final capacity of 500 to 600 ml can be achieved as long as the outlet resistance is adequate.