Abstract
Patients who undergo radical cystectomy for bladder cancer require reconstruction of the lower urinary tract. Orthotopic neobladder in carefully selected patients offers a more physiologic way of voiding. However, daytime and nighttime incontinence are commonly seen in male and female patients following surgery. Evaluation of incontinence requires careful history and physical exam to differentiate stress urinary incontinence from neobladder-vaginal fistula or poorly compliant neobladder with hypercontinence. Treatment of incontinence in patients with ONB may include: placement of retropubic sling, artificial urinary sphincter, or repair of fistula when present.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113(1):11–23. Lee reference, provides excellent summary of various types of urinary diversion, complications and outcomes in a review format.
Gschwend JE. Bladder substitution. Curr Opin Urol. 2003;13(6):477–82.
Stenzl A, Holtl L. Orthotopic bladder reconstruction in women–what we have learned over the last decade. Crit Rev Oncol Hematol. 2003;47(2):147–54.
Anderson CB, Cookson MS, Chang SS, Clark PE, Smith Jr JA, Kaufman MR. Voiding function in women with orthotopic neobladder urinary diversion. J Urol. 2012;188(1):200–4. Anderson reference, Large retrospective review of women undergoing cystectomy and neobladder; specifically discusses voiding dysfunction (day & night-time incontinence) as well as hypercontinence.
Steers W. Voiding dysfunction in the orthotopic neobladder. World J Urol. 2000;18:330.
Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol. 2005;173(4):1318–22.
Ali-el-Dein B, Shaaban AA, Abu-Eideh RH, el-Azab M, Ashamallah A, Ghoneim MA. Surgical complications following radical cystectomy and orthotopic neobladders in women. J Urol. 2008;180(1):206–10. discussion 10.
Lee CT, Hafez KS, Sheffield JH, Joshi DP, Montie JE. Orthotopic bladder substitution in women: nontraditional applications. J Urol. 2004;171(4):1585–8.
Bartsch G, Daneshmand S, Skinner EC, Syan S, Skinner DG, Penson DF. Urinary functional outcomes in female neobladder patients. World J Urol. 2014. doi:10.1007/s00345-013-1219-8. Bartsch reference, Utilizes BCI to assess largest investigated cohort of women who underwent neobladder and found no preoperative predictors related to HRQOL after surgery.
Ahmadi H, Skinner EC, Simma-Chiang V, Miranda G, Cai J, Penson DF, et al. Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol. 2013;189(5):1782–8.
Madersbacher S, Mohrle K, Burkhard F, et al. Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol. 2002;167:2052.
Keszthelyi A, Majoros A, Nyirady P, Mayer P, Bach D, Romics I. Voiding symptoms and urodynamic findings in patients with modified ileal neobladde. Pathol Oncol Res. 2009;15(3):307–13.
Stein JP, Penson DF, Lee C, Cai J, Miranda G, Skinner DG. Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol. 2009;181(5):2052–8. discussion 8-9.
Granberg CF, Boorjian SA, Crispen PL, Tollefson MK, Farmer SA, Frank I, et al. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int. 2008;102(11):1551–5.
Carrion R, Arap S, Corcione G, Ferreyra U, Neyra Argote G, Cantor A, et al. A multi-institutional study of orthotopic neobladders: functional results in men and women. BJU Int. 2004;93(6):803–6.
Barre PH, Herve JM, Botto H, Camey M. Update on the Camey II procedure. World J Urol. 1996;14(1):27–8.
Cancrini A, De Carli P, Pompeo V, Fattahi H, Lamanna L, Giuseppe C, et al. Lower urinary tract reconstruction following cystectomy: experience and results in 96 patients using the orthotopic ileal bladder substitution of Studer et al. Eur Urol. 1996;29(2):204–9.
Elmajian DA, Stein JP, Esrig D, Freeman JA, Skinner EC, Boyd SD, et al. The Kock ileal neobladder: updated experience in 295 male patients. J Urol. 1996;156(3):920–5.
Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol. 1999;161(2):422–7. discussion 7-8.
Steven K, Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol. 2000;164(2):288–95.
Abol-Enein H, Ghoneim MA. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol. 2001;165(5):1427–32.
Sevin G, Soyupek S, Armagan A, Hoscan MB, Oksay T. Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results. BJU Int. 2004;94(3):355–9.
Stein JP, Dunn MD, Quek ML, Miranda G, Skinner DG. The orthotopic T pouch ileal neobladder: experience with 209 patients. J Urol. 2004;172(2):584–7.
Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol. 2004;22(3):157–67.
Daneshmand S, Bartsch G. Improving selection of appropriate urinary diversion following radical cystectomy for bladder cancer. Expert Rev Anticancer Ther. 2011;11(6):941–8.
Kim SO, Kim JS, Kim HS, Hwang EC, Oh KJ, Kwon D, et al. Age related change of nocturia in women. Int Neurourol J. 2010;14(4):245–9.
Hautmann RE, Paiss T, de Petriconi R. The ileal neobladder in women: 9 years of experience with 18 patients. J Urol. 1996;155(1):76–81.
Puppo P, Introini C, Calvi P, Naselli A. Prevention of chronic urinary retention in orthotopic bladder replacement in the female. Eur Urol. 2005;47(5):674–8. discussion 8.
Finley DS, Lee U, McDonough D, Raz S, deKernion J. Urinary retention after orthotopic neobladder substitution in females. J Urol. 2011;186(4):1364–9.
Rapp DE, O'Connor RC, Katz EE, Steinberg GD. Neobladder-vaginal fistula after cystectomy and orthotopic neobladder construction. BJU Int. 2004;94(7):1092–5. discussion 5.
Chang SS, Cole E, Cookson MS, Peterson M, Smith Jr JA. Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results. J Urol. 2002;168(4 Pt 1):1442–5.
Tunuguntla HS, Manoharan M, Gousse AE. Management of neobladder-vaginal fistula and stress incontinence following radical cystectomy in women: a review. World J Urol. 2005;23(4):231–5.
Jindal T, Mukherjee S, Mandal SN, Karmakar D. Transobturator taping for the treatment of incontinence after neobladder reconstruction. Female Pelvic Med Reconstr Surg. 2013;19(4):245–6.
Quek ML, Ginsberg DA, Wilson S, Skinner EC, Stein JP, Skinner DG. Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women. J Urol. 2004;172(1):219–21.
Wilson S, Quek ML, Ginsberg DA. Transurethral injection of bulking agents for stress urinary incontinence following orthotopic neobladder reconstruction in women. J Urol. 2004;172(1):244–6.
Tchetgen MB, Sanda MG, Montie JE, Faerber GJ. Collagen injection for the treatment of incontinence after cystectomy and orthotopic neobladder reconstruction in women. J Urol. 2000;163(1):212–4.
Vainrib M, Simma-Chiang V, Boyd SD, Ginsberg DA. Potential risk factors and outcomes of artificial urinary sphincter placement after radical cystectomy and orthotopic neobladder urinary diversion. Neurourol Urodyn. 2013;32(7):1010–3.
Martins FE, Boyd SD. Artificial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: are they less favorable candidates? J Urol. 1995;153(4):1188–93.
Manunta A, Guille F, Patard JJ, Lobel B. Artificial sphincter insertion after radiotherapy: is it worthwhile? BJU Int. 2000;85(4):490–2.
Gousse AE, Madjar S, Lambert MM, Fishman IJ. Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results. J Urol. 2001;166(5):1755–8.
Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177(3):1021–5.
Kumar A, Litt ER, Ballert KN, Nitti VW. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence–what do patients choose? J Urol. 2009;181(3):1231–5.
Bauer RM, Gozzi C, Hubner W, Nitti VW, Novara G, Peterson A, et al. Contemporary management of postprostatectomy incontinence. Eur Urol. 2011;59(6):985–96.
Compliance with Ethical Guidelines
Conflicts of Interest
Ellen Goldmark and David Ginsberg declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goldmark, E., Ginsberg, D. Evaluation, Treatment and Management of Urinary Incontinence in Patients with Orthotopic Neobladder. Curr Bladder Dysfunct Rep 9, 102–107 (2014). https://doi.org/10.1007/s11884-014-0236-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-014-0236-9