Functional bladder replacement after radical cystectomy in the female: experimental investigation of a new concept

We investigated the possibility of forming a continent surrogate bladder for female patients with the (ileo-) cecal pouch and the in situ appendix as a neo-urethra. Five female mongrel dogs were used for an acute animal model. Cuff electrodes were placed around the pelvic and pudendal nerve under general anesthesia and urethral pressures in response to stimulation were recorded. Baseline data were obtained, a nerve-sparing cystectomy was carried out, and the pressure response to stimulation was reassessed. The pressures obtained with pelvic nerve stimulation ranged from 20 to 35 cm H2O (average 28 cm H2O) before and from 10 to 30 cm H2O (average 25 cm H2O) after cystectomy. Urethral pressure changes secondary to pudendal nerve stimulation remained nearly unchanged after cystectomy. Four female human cadavers were used to demonstrate a technique of nerve-sparing cystectomy, comparable to that for male patients. Preservation of the nerves supporting the urethra and the pelvic floor can be achieved by careful preparation close to the bladder in the region between the uterine and vaginal arteries and in the distal perivesical area. The autonomic nerve fibers appear to be protected by the perivesical vascular plexus. As it is not necessary to perform an anastomosis in the true pelvis when using this method, the procedure appears comparatively straightforward. The continence mechanisms of the pelvic floor would not be affected by sutures and subsequent scarring.