Orthotopic Ileal Neobladder in Females: Impact of the Urethral Resection Line on Functional Results |
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Authors: | R E Hautmann R de Petriconi K Kleinschmidt H-W Gottfried J E Gschwend |
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Institution: | (1) Faculty of Medicine, University of Ulm, Ulm, Germany, DE |
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Abstract: | We present our functional experience with orthotopic bladder replacement in female patients dependent on the urethral resection
line. Between November 1986 and July 1998 42 women underwent orthotopic urinary tract reconstruction with an ileal neobladder
at our institution: 26 patients underwent radical cystectomy (RCx) with subsequent ileal anastomosis to the urethra, and 16
underwent simple cystectomy (SCx) with preservation of the bladder neck. Fourteen of 22 patients following RCx and 3 of 14
patients following bladder neck-sparing cystectomy void naturally. Clean intermittent catheterization is necessary in 8 of
22 and 11 of 14 patients, respectively. Perfect continence with no pads at 1 year postoperatively was achieved in 15 of 18
evaluable patients following RCx and 10 of 11 patients following bladder neck sparing. Incontinence requiring one or more
pads is present in 3 of 18 patients and 1 of 11 patients, respectively. Subjectively satisfactory continence was achieved
in 16 of 18 patients following RCx and in all patients following bladder neck-sparing surgery. Our conclusions are that radical
cystectomy as well as a bladder neck-sparing cystectomy does provide satisfactory functional results in the majority of patients.
However, the urethral resection line does slightly influence the rate of incontinence as well as the requirement for intermittent
catheterization. RCx does translate into a lesser requirement for CIC, whereas bladder neck sparing results in slightly better
continence rates. |
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Keywords: | :Female – Functional results – Ileal neobladder – Orthotopic lower urinary tract reconstruction |
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