Orthotopic ileal bladder substitute after radical cystectomy: urodynamic features.

Urodynamic investigation was performed in 12 men, 3 to 8 months after cystoprostatectomy for bladder cancer and bladder substitution, using a detubularized ileal segment as described by Studer-Zingg. All patients underwent a standard urodynamic evaluation and extramural ambulatory urodynamic monitoring (e.a.m.). Ten patients were continent by day and 3 were incontinent during the night to a degree that necessitated use of a condom catheter. Three patients awakened every 3 hours to void and 6 had to void 1-2 times nightly. The residual urine was over 100 ml in 3 patients; it was low or absent in the remainder. Micturition was achieved by straining, with a maximum flow rate of 13 ml per second or greater, except in 2 patients. In 2 patients a urethral narrowing was found at the urethro-ileal anastomosis, and in 1 of them an incoordination between the neobladder and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehabilitation. The incidence of nocturnal incontinence was 56.6%. In 2 patients urethral pressure profile revealed hypotonia, with a maximum urethral closure pressure (MUCP) < 45 cm H2O. During e.a.m. study pressure values in the neobladder usually ranged below 15 cm H2O and exceeded 35 cm H2O in only 1 patient who complained of daytime and nocturnal incontinence. Neobladder compliance was normal in all cases. In order to achieve a complete rehabilitation after operation, the patient should be instructed to follow a careful training in order to prevent overdistention of the neobladder by voiding at regular intervals and to obtain continence.