Hypercontinence in Women after Orthotopic Neobladder Diversion
Introduction: There is a great debate about the cause of the higher incidence of hypercontinence in women undergoing orthotopic diversion after cystectomy in relation to men.
Methods: A total of 39 females with orthotopic diversion were studied: 21 from the Theodore Bilharz Research Institute (TBRI), and 18 from the University of South Florida at Tampa (USF). Nerve preservation was attempted in all cases. Cystectomy was done with a cut across the bladder neck in the TBRI cases, while the urethral cut in the USF cases was done across the proximal urethra.
Results: Hypercontinence was found in 38% (8 of 21) of TBRI patients and in 16% (3 of 18) of USF patients. Urodynamic evaluation was done in 10 of the TBRI cases, and it was comparable to other series regarding pouch capacity (mean = 500 ml), pouch pressure (mean = 17 cm H2O at capacity), maximum urethral pressure (mean = 67 cm H2O), and maximum urethral closure pressure (mean = 49.2 cm H2O).
Conclusion: The relaxation of the striated sphincter and the contraction of the longitudinal smooth muscle opens the way for micturition. The loss of this normal coordinated reflex leads to the presence of a urethra with a fixed tone that does not open with trials of evacuation. As men and women have an intact striated sphincter, the higher incidence of hypercontinence in females compared to males is due to the presence of the extra tone of the urethral smooth muscles. This study proves that the more urethral length left, the higher the incidence of hypercontinence because more smooth muscle tone is faced during micturition. Nerve preservation has no impact because the coordinated detrusor urethral smooth muscle action is lost.
Keywords: Women, Orthotopic diversion, Hypercontinence
Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt,
To Cite this Article: Ismail MAA, Wishahi MM, Elsherbeeny M, Sewallam TA, Lockhart J. Hypercontinence in Women after Orthotopic Neobladder Diversion. UIJ. In Press. doi:10.3834/uij.1944-5784.2008.12.05