Urinary retention after orthotopic neobladder substitution in females

Urinary retention is a common complication after orthotopic neobladder urinary diversion. We reviewed a case series of women who underwent neobladder creation and discuss anatomical findings, and urinary retention etiology and prevention.

We retrospectively reviewed the records of all orthotopic neobladder urinary diversions in female patients performed at our institution from 1999 through 2010. We abstracted baseline clinical and demographic characteristics, operative information, and postoperative clinical, urodynamic, imaging and secondary procedure followup. We defined urinary retention as the need for intermittent catheterization.

We identified 21 female patients who underwent neobladder diversion. Median age at cystectomy was 62 years (range 43 to 77). Median followup was 3 years (range 3 to 138 months). Of the patients 14 underwent ileocolic diversion, 6 underwent Studer ileal diversion and 1 underwent preservation of a right colon augmentation. All patients underwent prior or concurrent hysterectomy. In 2 patients with a history of genitourinary tuberculosis neobladder-vaginal fistulas developed postoperatively and they were excluded from analysis. Of the 19 female patients with a neobladder included in analysis 7 (36.8%) experienced urinary retention requiring clean intermittent catheterization. Associated abnormalities included neocystocele formation in 6 cases, anastomotic stricture in 1 and progressive neurological disease in 1. Upon straining the average neobladder descent was approximately 2 cm and the average change in the neocystourethral angle in patients with neocystoceles was 18 degrees. Of the patients 11 (57.9%) had a nonobstructive voiding pattern.

Urinary retention in female patients with a neobladder can be functional, anatomical or multifactorial. In our series common anatomical findings associated with urinary retention were neocystocele formation and urethral kinking.