Continent reservoirs

Area of Science:

• Urology
• Surgical Oncology
• Gastroenterology

Background:

• Cystectomy, the surgical removal of the bladder, necessitates urinary diversion for affected patients.
• Continent urinary diversion represents a significant advancement over traditional methods, aiming to restore normal urinary function and improve quality of life.

Purpose of the Study:

• To evaluate the safety and efficacy of continent urinary diversion in patients who have undergone cystectomy.
• To assess the outcomes of two types of continent urinary diversion: those with a continent stoma and those with urethral anastomosis.

Main Methods:

• A retrospective review of 28 patients who underwent continent urinary diversion at Yale New Haven Hospital over three years.
• Categorization of patients into two groups: those with a continent reservoir and abdominal stoma (n=13) and those with a urethral anastomosis (n=15).
• Inclusion of urodynamic studies to assess bladder function and continence.

Main Results:

• All 28 patients achieved daytime urinary continence.
• Over 50% of patients experienced nighttime continence, with a recent modification showing promise in resolving nocturnal incontinence.
• The majority of patients with urethral anastomosis voided spontaneously.

Conclusions:

• Detubularized intestinal reservoirs are a safe and effective method for achieving continent urinary diversion in selected patients post-cystectomy.
• Continent urinary diversion significantly improves urinary control and quality of life for patients following bladder removal.
• Ongoing modifications to reservoir construction may further enhance outcomes, particularly regarding nocturnal continence.