Orthotopic neobladder (ONB) has become the standard of care after radical cystectomy (RC) in select women with muscle invasive bladder cancer. Although it allows volitional voiding through the normal urethra as in normal individuals, it is still associated with substantial risk of urinary complications that adversely affect patients' health related quality of life (HRQOL). Chronic urinary retention (CUR) is one of the major functional problems after RC and ONB especially in women. The incidence in women ranges from 10 to 58% of cases with intermediate and short term follow up. However, the explanation of this common problem is still controversial. Complete or partial autonomic denervation of the urethra was accused for this complication. Our group proved that lack of back support and posterior sagging of the pouch is the cause of developing CUR. They proposed a certain modifications to provide back support to the pouch. These modifications included preservation of the round ligaments and their use to suspend the vaginal stump, back support of the pouch by omentum, preservation of the peritoneum covering the anterior rectal wall and suspension of the pouch near its doom to the back of the rectus muscle.
We tried to assess the long-term cumulative incidence of CUR after RC and ONB in women, risk factors and the impact of this technical modification. The incidence of CUR was 24%. We found that the incidence of CUR increased overtime after the procedure with newly developed cases even after ten years of follow up. Diabetes mellitus was associated with 2.4 folds risk of developing CUR (p= 0.01). Genital- sparing cystectomy (preservation of the uterus and ovaries) and the technical modification decreased the likelihood of CUR development by 9.3 and 2.1 folds, respectively.
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Written By: Mohamed H Zahran, MSc,MD, Urology and Nephrology Center, Mansoura University, Egypt
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