Volume capacity and pressure characteristics of the continent ileal bladder substitute after radical cystectomy evaluated by continuous urodynamic monitoring

Our study includes 18 patients, who performed urodynamic investigation and extramural ambulatory urodynamic monitoring (e.a.m.) 9-36 months after cystoprostatectomy for bladder carcinoma and bladder substitution with a detubularized ileal segment as described by Studer. Fifteen patients were continent by day and three were incontinent during the night to a degree that necessitated the use of a condom catheter. The residual urine was over 100 ml in 4 patients, and it was low or absent in the remainder. Micturition was achieved by straining, with a maximum flow rate of 15 ml per second or higher, except in three patients; the pattern was intermittent. The incidence of nocturnal incontinence was 55.5%. The urethral pressure profile showed hypotonia in three patients, with a maximum urethral closure pressure <40 cm H20. During e.a.m. neobladder pressure ranged between 0 and 25 cm H20, and exceeded 35 cm H20 in only two patients who complained of daytime and nocturnal urgency and occasional incontinence. The urodynamic features of the neobladder in patients who underwent radical cystoprostatectomy and bladder replacement with a detubularized ileal segment indicate low pressure at high-level filling. The patient should be instructed to void at regular intervals and follow a careful training, in order to achieve the best recovery after surgery to obtain continence and to prevent overdistension of the neobladder.