Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments

Authors
RICHARD A. SANTUCCICHOAL H. PARKMICHAEL E. MAYOPAUL H. LANGE
Department
Dept. of Urology (비뇨의학)
Issue Date
1999
Citation
Urology, Vol.54(2) : 252-257, 1999
ISSN
0090-4295
Abstract
Objectives. To compare the urodynamic parameters and continence rates among five different continent urinary reservoirs. 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.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34793
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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Full Text
https://www.sciencedirect.com/science/article/pii/S0090429599000989?via%3Dihub
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