Micturition after cystoplasty.

In patients with advanced carcinoma of the bladder not involving the trigone, radical total cystectomy with bladder replacement (replacement cystoplasty) using either the colon, ileum or stomach can be performed. In male patients, the prostatic urethra is always included in the resection so that the extent of radical surgery is not compromised. Thus the neobladder is anastomosed to the membranous urethra in these patients. In patients with contracted tuberculous bladder, the neobladder is anastomosed to the trigone after subtotal cystectomy (augmentation cystoplasty). The pattern of micturition is studied in 32 patients with cystoplasty after cystectomy. Emptying of the neobladder is achieved and completed mainly by abdominal straining rather than by the spontaneous contraction of the gastrointestinal segment, as evidenced by cystometric studies. The stomach generates high pressures during its peristaltic contractions but this could be a disadvantage during the early postoperative period particularly in the females, as urinary incontinence may result. In the majority of patients, micturition takes place every 2 to 3 hours with full urinary continence during the waking hours. However, in patients after radical total cystectomy, incontinence of urine during deep sleep is inevitable. No differences of voiding pattern, bladder capacity and residual urine volume are noted when either the colon, ileum or stomach is used for cystoplasty.