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Continence after radical cystoprostatectomy and total bladder replacement: a urodynamic analysis.
M E Gasparini1, F Hinman, J C Presti
1Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
The Journal of Urology
|December 11, 1992
Summary
Preserving the urethral sphincter during radical prostatectomy and cystoprostatectomy with ileal neobladder reconstruction is key for urinary continence. Careful surgical technique ensures optimal outcomes for patients undergoing these procedures.
Area of Science:
- Urology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Urinary incontinence is a significant concern following radical prostatectomy and radical cystoprostatectomy with continent diversion.
- Preservation of the urethral sphincteric mechanism is crucial for maintaining continence.
Purpose of the Study:
- To evaluate the urodynamic parameters and continence outcomes in patients undergoing radical cystoprostatectomy with continent urethral diversion (ileal neobladder) and radical prostatectomy.
- To assess the impact of modified surgical techniques aimed at preserving periurethral tissue on urethral function and continence.
Main Methods:
- Urodynamic evaluation was conducted in 10 patients with ileal neobladder and 13 patients after radical prostatectomy.
- Surgical modifications focused on optimizing preservation of periurethral tissue at the prostatic apex under direct vision.
Main Results:
- 90% of patients with ileal neobladder achieved complete continence, with one experiencing moderate nocturnal incontinence.
- No significant differences were observed in mean functional urethral length or maximal urethral closure pressure between the two groups.
- The urethral sphincteric mechanism was well preserved in both patient cohorts.
Conclusions:
- Continence after radical cystoprostatectomy with continent diversion and radical prostatectomy relies on both the urethral sphincteric mechanism and a compliant reservoir.
- Minimizing urinary incontinence after ileal neobladder reconstruction is achievable through meticulous preservation of the distal urethral sphincter.