The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution

Continence after orthotopic bladder substitution may be influenced by characteristics of the reservoir and of the sphincter mechanism. Autonomic innervation probably contributes to pressure generation by the sphincter mechanism at rest. We therefore examined the effect of nerve sparing cystectomy technique on continence in 165 consecutive men who underwent cystectomy and construction of an ileal low pressure reservoir and were followed regarding continence for at least 3 months postoperatively.

Nerve sparing was attempted bilaterally in 20 men, unilaterally in 96 and not at all in 49. Patients were followed prospectively and completed regular voiding diaries, including details of continence. Postoperative sexual potency was ascertained by questionnaire. The effects of attempted nerve sparing and of age on continence were examined in Kaplan-Meier models and in Cox's proportional hazards models.

Median times to continence during the day and at night for all men were 3 and 9 months, respectively. Continence differed significantly between patients with attempted nerve sparing and no attempt at nerve sparing (day, p = 0.003 and night, p = 0.001, log rank test) and between men less than 65 years old and those older than 65 (day, p = 0.037 and night, p = 0.005, log rank test). In the multivariate analysis, attempted nerve sparing was significantly associated with improved continence by day (t = 1.96) and by night (t = 1.98).

These data suggest that attempted nerve sparing is associated with improved urinary continence after orthotopic bladder substitution.