Mechanisms of incontinence and retention after orthotopic neobladder diversion.

摘要

OBJECTIVES: To define the mechanism of incontinence and retention after orthotopic neobladder diversion. METHODS: The results of urodynamic and endoscopic evaluations were assessed in 19 patients (15 men and 4 women). Mean age and postoperative follow-up were 58.3 years and 19.6 months, respectively. Seventeen patients (15 men, 2 women) presented with the sole complaint of nocturnal incontinence, and 2 women presented with retention. Evaluations included voiding and continence history, pelvic examination (for women), postvoid residual, uroflowmetry, triple-lumen video-urodynamic study, and cystourethroscopy. RESULTS: Among patients with incontinence, 11 (65%) were found to have a primary failure-to-store problem as a result of either reservoir or sphincter failure. Four patients (24%) had a primary failure-to-empty problem, and 2 (11%) had features of both. The predominant etiology of voiding difficulty was the inability to relax the external urethral sphincter adequately during Valsalva's maneuver. Of the 2 women who presented with retention, one had obstructing mucosal folds at the neobladder opening and both demonstrated anterior vaginal wall prolapse on pelvic examination. CONCLUSIONS: The mechanism of incontinence and retention after orthotopic neobladder diversion can vary. Carefully performed urodynamic and endoscopic assessments can define the underlying etiology and may serve as a guide for proper treatment selection.