[Overcontinence in females after orthotopic replacement of the urinary bladder]

Treatment results were analysed for 27 patients (mean age 53 +/- 7 years) after orthotopic urinary diversion (by the method of Studer, Hautmann) following radical cystectomy. Radical cystectomy was performed without nerve preservation in all the patients. Overcontinence was detected in 4 (26.6%) of 15 patients who had undergone urinary diversion by a conventional method. At the average, residual urine was 220 ml. The modified operation for prevention of urine retention was made in 12 subsequent cystectomies. Neobladder topography was studied with MR imaging (MRI) of the pelvic organs and videoroentgenoreservoiroscopy, urodynamic examination was combined with electromyography of the pelvic base muscles. MRI has found that in patients without retention the reservoir was above linea pubbo-coccigeus both at rest and voiding. In patients with overcontinence at rest topographic details by MRI did not differ from those in patients without retention but in stress reservoir changed position. The modification proposed allows one to avoid change in reservoir position and to prevent formation of acute urethra-reservoir angle. Thus, the cause of retention (overcontinence) of the continent orthotopic intestinal neobladder is eliminated.