Urodynamic And Functional Characteristics Of Orthotopic Continent Ileal N-bladder

Objective: The object of this study is to evaluate the urodynamic and functional characteristics of 26 patients who had undergone orthotopic continent ileal N-bladder replacement after radical cystectomy and to provide urodynamic proof for this technique's improvement.Patients and Methods: We examined the urodynamic characteristics and symptoms of 26 patients who had undergone orthotopic continent ileal N-bladder replacement following cystoprostatectomy from Aug. of 1999 to Aug of 2003. Urodynamics were obtained a mean of 11 months (range 3 to 24) after construction of the neobladder and it was performed in all patients to determine neobladder capacity, filling and voiding pressures,urethral pressure profile,peak and mean urinary flow and postvoid residual urine. The patients were also asked about continence and the overall degree of satisfaction.Results: The neobladders demonstrated good compliance for the storage of urine, with a mean basal pressure of less than 15 cm. water at volumes of less than 400 cc and of 22.4 cm. water (range 1 to 72) at 100% capacity. Phasic neobladder contractions were present during filling cystometrography. The mean pressure of contractions was less than 40 cm. water at lower and higher volumes. The mean post-void residual is 42 ml. Of all the patients 3 had post-void residuals of greater than 150 ml(mean 176 ml), while 23 had a mean post-void residual of 37 ml(range 0 to 120 ml). Mean maximum urethral closure pressure was 71 cm . water (range 32 to 140cm). Mean functional urethral length was 3.5 cm(range 1.4 to 5.7cm). Average voided volume was 270 ml (range 170 to 440 ml) and mean voiding interval was 189 minutes(range115 to 340 minutes), with an average daily urinary volume of 2456ml. Daytime continence was attained in 24 of 26 patients (92.3%), while 17 (65.4%)attained nighttime continence. Of these 17 patients 15 (82%) had to void at least twice at night to stay dry. Daytime incontinent patients had decreased neobladder compliance at high volumes compared to daytime continent patients (p < 0.05) but there was no difference in the maximal urethral closure pressure or the pressure of phasic contractions between these 2 groups. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. Patients with poor emptying ability (defined as a post-void residual of more than 150 cc) had increased neobladder compliance relative to those with good emptying ability. Most patients can emptied bladder completely by Valsalva's maneuver.Through interviews and questionnaires we can find the neobladder' function attain stable at 4.5 months after its reconstruction.Conclusions: We conclude that an orthotopic continent ileal N-bladder constructed shorter ileum than other similar operations. Urodynamic and functional outcome proves that it has an adequate capacity at low pressures with a satisfactory continence rate. Our data suggest that although it is not a complication-free procedure, we advocate its use when possible.