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Urodynamic studies in patients undergoing bladder replacement surgery.

B Lytton1, D F Green

  • 1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

The Journal of Urology
|June 1, 1989
PubMed
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Nocturnal incontinence is common after continent urinary diversion using bowel segments. Modifying detubularized colon with an ileal patch reduced pouch pressures but did not fully resolve incontinence, suggesting other contributing factors.

Area of Science:

  • Urology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Continent urinary diversion using intact bowel segments frequently leads to nocturnal incontinence.
  • Detubularization techniques are explored to mitigate this complication.

Purpose of the Study:

  • To evaluate the efficacy of detubularization and ileal patch incorporation in managing nocturnal incontinence following continent urinary diversion.
  • To assess the impact of these surgical modifications on intestinal pouch pressures.

Main Methods:

  • Fifteen patients underwent continent urinary diversions and four had bladder augmentation.
  • Initial detubularization of the right colon anastomosed to the urethra was performed.
  • Subsequent modifications involved incorporating an ileal patch into the detubularized colon segment.

Related Experiment Videos

  • Urodynamic studies were conducted to measure intestinal pouch pressures.

    • Main Results:

    • The initial detubularization technique resulted in high pouch pressures (60-100 cm H2O) and nocturnal incontinence in all three patients.
    • Incorporating an ileal patch effectively reduced pouch pressures (15-60 cm H2O).
    • While pressure reduction was observed, nocturnal incontinence was only reduced, not eliminated.

    Conclusions:

    • Detubularization of the colon with an ileal patch is effective in reducing high-pressure contractions in the intestinal pouch.
    • This technique partially mitigates nocturnal incontinence but does not completely resolve it.
    • Additional factors beyond pouch pressure may contribute to persistent nocturnal incontinence after urinary diversion.