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Related Experiment Videos

Bowel dysfunction after bladder reconstruction

J N'Dow1, H Y Leung, C Marshall

  • 1Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.

The Journal of Urology
|April 29, 1998
PubMed
Summary

Patients undergoing enterocystoplasty for detrusor instability face a high risk of new bowel dysfunction. These symptoms significantly impact patient satisfaction with the urinary reconstruction procedure.

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Area of Science:

  • Urology
  • Gastroenterology
  • Surgical Reconstruction

Background:

  • Intestinal segments are utilized in various urinary reconstructions, potentially leading to altered bowel function.
  • The specific causes and prevalence of post-reconstruction bowel disturbances remain incompletely understood across different patient cohorts.

Purpose of the Study:

  • To investigate the incidence and characteristics of bowel dysfunction following intestinal segment use in urinary reconstruction.
  • To compare bowel symptom development across different reconstructive procedures: bladder replacement, continent diversion, enterocystoplasty for idiopathic detrusor instability, and ileal conduit diversion.

Main Methods:

  • A cohort study evaluating 71 patients post-ileal conduit diversion and 82 post-bladder reconstruction.
  • Bladder reconstruction subgroups included clam enterocystoplasty for detrusor instability (28), neurogenic bladder (26), and non-neuropathic conditions (28).

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  • Assessment included preoperative and postoperative bowel symptom severity (defecation frequency, nocturnal diarrhea, flatus leakage, fecal urgency/incontinence, explosive diarrhea) and quality of life.

    • Main Results:

    • Postoperative bowel symptoms developed in 42% of previously asymptomatic patients after bladder reconstruction.
    • Clam enterocystoplasty for detrusor instability showed the highest incidence (54%) of new and severe bowel symptoms compared to other groups.
    • Patients with detrusor instability undergoing enterocystoplasty experienced significantly higher rates of nocturnal bowel movements, flatus leakage, fecal urgency, and fecal incontinence (p <0.01).

    Conclusions:

    • Enterocystoplasty for idiopathic detrusor instability poses a significant risk for developing substantial bowel symptoms.
    • The emergence of new bowel symptoms post-enterocystoplasty is strongly linked to diminished patient satisfaction with the surgical outcome.