VOIDING FUNCTION IN WOMEN WITH ORTHOTOPIC NEOBLADDER DIVERSION

Abstract

INTRODUCTION AND OBJECTIVE: To evaluate patients with orthotopic bladder substitution for benign causes in terms of indications, complications as well as the functional outcome. METHODS: Between April 1986 and January 2006, 73 patients (57males and16females) with mean age 41.5 years (29-56 years) underwent simple cystectomy and orthotopic bladder substitution for management of contracted bladders(62) or complex vesicovaginal fistulae (11) . The prostate and seminal vesicles were preserved in men with removal of a core of the prostate. Ileal W neobladders were applied for 37 patients and Urethral Hemi-Kock pouch for 36. . Patients were followed for a period ranged from 18 up to 243 months (mean 94.5 ± 43 months). All patients were evaluated for continence status. Pouchometry and urethral pressure profile were performed in 38 patients . Potency and fertility were verified in eligible male patients. Late sequalae after urinary diversion were assessed especially what is concerning upper tract function and configuration RESULTS: Poucho-prostatic anastomotic strictures were diagnosed in 11 men ( 19.3% ) and were managed endoscopically. Twelve patients (12.4%) developed chronic retention and were maintained on CIC. Out of the other 61 patients, 45 (73.8%) were continent day and night while 16 (26.2%) showed various degrees of nocturnal enuresis. Urodynamic studies showed high volume low pressure reservoirs in those patients with chronic retention and low urethral closure pressure in those with enuresis. Potency was preserved in 54 out of 61 eligible men(88.5%) and fertility in 9 out of 21(42.8%). Out of 138 evaluated renal units (8 patients had solitary kidney),122 showed stable kidney function and configuration. The other 16 units (11.6 % ) showed various degrees of deterioration due to obstruction ( 3), pyelonephritis (7) or chronic retention (6).Pouch stones were encountered in 12 cases (16.4% ). CONCLUSIONS: Simple cystectomy and orthotopic substitution is a viable option of management of benign bladder diseases . Relatively high incidence of chronic retention is anticipated necessitating regular follow-up for early diagnosis and management. Potency and fertility could be preserved in a good proportion of male patients.