[The S-bladder--a complete continent antireflux functional replacement of the bladder sphincter muscle function]

The S-bladder, developed on the basis of the Parks S-pouch, is a continent ileourethrostomy with antireflux implantation of the ureters via a nipple valve. It provides a low-pressure reservoir with a large capacity and allows voiding in the natural way by means of abdominal straining. Reflux is reliably prevented by use of the antireflux nipple valve already familiar from the Kock pouch. If continence during day and night cannot be achieved with the distal sphincter mechanism alone an artificial sphincter can be implanted at the bulbous urethra in men and around the urethral stump in women. Since 1986 16 patients have received S bladders following cystectomy, and implantation of an artificial urinary sphincter has been necessary in 7. All patients are continent by both day and night. The overall complication rate has been low. For 15 patients it is possible to empty the bladder solely by abdominal straining, while in 4 cases additional self-catheterization is necessary. In most cases the urine remains sterile, and gross electrolyte disturbances and acidosis have never been observed. Our indications were: bladder carcinoma in men (T1-2NoMo) with carcinoma-free prostatic urethra, nonfunctional neurogenic bladder, and shrunken bladder following infection or radiation. Psychological acceptance of the procedure, which allows natural voiding with no kind of abdominal wall stoma even after cystectomy, has been excellent.