Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments
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- Park, Choal Hee
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- Objectives. To compare the urodynamic parameters and continence rates among ﬁve different continent
Methods. Continent urinary reservoirs were constructed in 40 patients with an average age of 60 years
(range 23 to 81). Twenty-three had orthotopic neobladders (“neobladders”), and in 17 the reservoirs exited
by way of an abdominal wall stoma as “stomal urinary reservoirs.” In the neobladders, the detubularized
segment was ileum (Hautmann) in 5, ileocecal (Mainz) in 8, sigmoid in 4, and gastric in 6. In the stomal
urinary reservoirs, the segment was ileocecal in 11 (Mainz) and right colon in 6 (Indiana). Urodynamic
studies were performed at a mean of 9.1 months.
Results. Stomal urinary reservoirs had the best continence rates (Indiana pouch 100%, Mainz pouch 91%).
Neobladder continence rates were as follows: Hautmann, 80%; Mainz, 75%; sigmoid, 50%; and gastric,
33%. Day and night incontinence rates were nearly identical. Compared with the other pouches, gastric and
sigmoid reconstructions had the smallest capacity, were the least compliant, and were the most contractile.
Conclusions. Stomal urinary reservoirs using ileocecal valve and right colon, with or without an overlying
patch of ileum, provide similar excellent results. Continence approached 100% in compliant patients without
the need for revision. Patients with neobladders were less continent, although those with ileal or ileocecal
conﬁgurations still had very good continence rates. Neobladders of sigmoid or stomach can be used when
necessary, but with greater incontinence rates. This poorer continence can be explained by the decreased
capacity, decreased compliance, and a tendency toward high pressure spikes despite detubulariza-
tion. UROLOGY 54: 252–257, 1999. © 1999, Elsevier Science Inc.
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