Voiding dysfunction of sigmoid neobladder in women: a comparative study with men

We compared results of urodynamic testing in male and female patients with sigmoid neobladders following radical cystectomy to determine factors important to voiding status, especially in women.

Continence status, urodynamics by pressure-flow measurements, and neocystograms were evaluated in 14 male and 9 female patients.

Of 14 male patients, 11 (78.6%) showed acceptable urinary continence during the day, as did all of the 9 female patients. At night, 6 of the 14 men and 6 of the 9 women were continent with or without voiding at regular intervals. All 14 male patients could void volitionally during the follow-up period. In contrast, 1 of 9 female patients required clean intermittent catheterization to manage the large amount of residual urine. Her neocystourethral angle was 90 degrees and pelvic descent of the bladder (pouchocele) was observed. The intrareservoir pressure at maximal flow was significantly lower in female than in male patients (p<0.05). The ratio of abdominal pressure to intrareservoir pressure did not differ significantly between males and females. Abdominal straining generated most of the intrareservoir pressure. An increase in intrareservoir pressure was associated with urinary flow, but the magnitude of pressure did not correlate with the peak urinary flow.

The location of the neobladder and avoidance of angulation at its outlet are important for obtaining good voiding after the reconstruction of neobladder in women, but the intrareservoir pressure is less critical.