Urodynamic and Clinical Aspects of Ileal Low Pressure Bladder Substitutes

Abstract

Twenty-three patients with an ileal bladder substitute formed after cystectomy for invasive bladder cancer were evaluated clinically and urodynamically between 3 and 38 months post-operatively. The urodynamic measurements were compared with the clinical findings. After re-education of the patients' voiding habits the mean voiding volumes of the bladder substitutes stabilised 6-9 months post-operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or twice at night. The maximum functional capacity (maximum voiding volume) was about 490 ml. Ninety-one per cent of the patients were continent during the day 18 months after the operation and 82% were continent during the night. Micturition was problem-free with an average maximum flow of 25 ml/s and an average micturition time of 50 s. The mean voiding volume of ileal bladder substitutes was 50% of the measured cystometric capacity; the maximum functional capacity (= max. micturition volume) was 80% of the cystometric capacity. The average basal pressure was < 20 cm H2O from the third post-operative month onwards. Eleven of the 23 patients had contractions in the bladder substitute (average at 30 cm H2O) at 55-76% of the maximum cystometric capacity or at approximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences. If the patients were shown how to increase the functional capacity of a reservoir made from only 40 cm of ileum, the clinical results were excellent.

Summary of 10 years' experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment

“…On the other hand, a reservoir made from 10 cm less of bowel, i.e., from 30 cm instead of 40 cm (left) would be too small and the pressure too high if it were filled to capacity, particularly at night namically proven low-basal-pressure characteristics (Fig. 7a) [5,8] as well as nerve-sparing dissection of the prostate [42] and cystectomy with preservation of the pelvic plexus and its autonomic fibers to the membranous urethra [6,13] and an attempt to preserve a maximally possible length of membranous urethra, urinary continence is not perfect in all patients. In contrast to patients treated by radical prostatectomy, patients with an orthotopic intestinal bladder substitute have no detrusorsphincteric reflex, which increases the closing pressure in the membranous urethra in response to rising intravesical pressure [30].…”

“…The urethral catheter is left on free drainage for 2 more days before it is removed; further details have been reported elsewhere [35,36]. After catheter removal, the patients were instructed to void every 2 h, first in a sitting position, by relaxing the pelvic floor, and, if necessary, by abdominal straining [5]. The patients were encouraged to drink 2-3 1 of fluid per day and to ensure sufficient salt intake to avoid a salt-loss syndrome due to hypoosmolar urine in the ileal bladder substitute and to reduce the risk of acidosis from hypovolemia [20].…”

Functional and Urodynamic Characteristics of Camey II Meal Neobladder

“…That is a daytime frequency of 3-5 times with satisfactory con tinence and a mean voiding volume around 350 ml. Dur ing sleep, patients should have to awake to void once or twice [4], To overcome the deficits, Camcv modified his tech nique by the use of a detubularized ileal segment [2], The nighttime continence rate improved to 78% and 96% of the patients could stay dry in the daytime. Most patients achieved continence within 3-4 months following the operation [1,2], There are several methods of construction of the reser voir after detubularization of the ileum [ 1,[4][5][6]; however, there is no significant difference in the surgical morbidity, continence rate and urodynamic results among all these methods [1,2,[4][5][6][7], The patient's compliance and willing ness to become actively involved in the postoperative re education and training courses are even more important.…”

“…Most patients achieved continence within 3-4 months following the operation [1,2], There are several methods of construction of the reser voir after detubularization of the ileum [ 1,[4][5][6]; however, there is no significant difference in the surgical morbidity, continence rate and urodynamic results among all these methods [1,2,[4][5][6][7], The patient's compliance and willing ness to become actively involved in the postoperative re education and training courses are even more important. A well-trained patient may void quite well in spite of a poor urodynamic result [4,7], In our study, the daytime continence rate (93%) is compatible with the data reported previously (table 3). The mean interv al from surgery to achievement of com plete daytime continence was 3 months.…”

“…Clinical and functional results of the orthotopic bladder substitution Camey ct al. [2] Ramon et al [1] Present study Casanova et al [4] Porru ct al. [5] Melchior ct al.…”