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Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement
B Goldwasser1, W Månsson, T Davidsson
1Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
The Journal of Urology
|March 1, 1991
Summary
Men undergoing cystoprostatectomy with colonic bladder replacement achieve daytime continence. Nocturnal incontinence in some patients may stem from altered sacral reflexes, not solely reservoir pressure or urethral function.
Area of Science:
- Urology
- Gastroenterology
- Nephrology
Background:
- Cystoprostatectomy with bladder replacement is a complex procedure.
- Maintaining urinary continence, especially nocturnally, remains a challenge post-surgery.
Purpose of the Study:
- To evaluate urodynamic parameters in men after cystoprostatectomy and colonic bladder reconstruction.
- To identify factors contributing to urinary incontinence in these patients.
Main Methods:
- Urodynamic evaluation was conducted in 13 men 4-18 months post-cystoprostatectomy.
- Assessment included bladder filling, urethral pressure, flow rates, and residual volumes.
Main Results:
- Patients demonstrated daytime continence; 3 experienced nocturnal incontinence requiring management.
- Maximal flow rates were normal but intermittent; cystoplasty contractions were reduced or absent in most.
- Urethral closure pressure remained normal, with no significant changes observed post-operatively.
Conclusions:
- Low-pressure reservoirs and preserved urethras are crucial for continence.
- Absence of normal sacral reflexes post-cystoprostatectomy is a significant factor in nocturnal incontinence.