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Incontinence after augmentation cystoplasty and internal diversion.
1Yale University School of Medicine, New Haven, Connecticut.
The Urologic Clinics of North America
|May 1, 1991
Summary
Continent urinary diversions rely on reservoir pressure, outflow resistance, and detubularization for continence. Low-pressure ileal neobladders achieve high continence rates, but nocturnal incontinence can occur due to low urethral pressure.
Area of Science:
- Urology
- Surgical Innovation
Background:
- Continent urinary diversions are complex surgical procedures.
- Achieving and maintaining continence is a primary goal in urinary diversion.
Purpose of the Study:
- To review the principles of continence in urinary diversions.
- To identify factors contributing to incontinence after neobladder creation.
Main Methods:
- Analysis of published data on continent urinary diversions.
- Review of personal surgical experience with detubularized ileal pouches.
Main Results:
- Continence depends on reservoir pressure, outflow resistance, and detubularization.
- Detubularized ileal pouches result in low reservoir pressures (<20 cm H2O).
- Approximately 85% of patients with low-pressure ileal neobladders achieve complete continence, with nocturnal incontinence reported in a minority.
Conclusions:
- Understanding factors like reservoir contractions and urethral sphincter tone is key to improving continent urinary diversion outcomes.
- Refining neobladder construction can enhance continence and patient quality of life.