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Neobladder Voiding Function in Men

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • Published:
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Abstract

Following construction of an orthotopic neobladder, the lower urinary tract manifests an altered function. The voiding mechanism in neobladder patients is non-physiologic. To ensure acceptable continence and protect the upper urinary tract, careful patient selection and surgical expertise are required. Although functional qualities of the orthotopic reservoir often remain stable over time, long-term follow-up is necessary as distinct complications are an ever-present concern.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. COUVELAIRE R. Substitute ileal reservoir following total cystectomy in the male. J Urol Medicale Chir. 1951;57(6):408–17.

    CAS  PubMed  Google Scholar 

  2. Kock NG, Nilson AE, Nilsson LO, Norlén LJ, Philipson BM. Urinary diversion via a continent ileal reservoir: clinical results in 12 patients. J Urol. 1982;128(3):469–75.

    CAS  PubMed  Google Scholar 

  3. Hendren WH. Historical perspective of the use of bowel in urology. Urol Clin N Am. 1997;24(4):703–13.

    Article  CAS  Google Scholar 

  4. Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2013;63(1):45–57.

    Article  PubMed  Google Scholar 

  5. Thurairaja R, Studer UE. How to avoid clean intermittent catheterization in men with ileal bladder substitution. J Urol. 2008;180(6):2504–9.

    Article  CAS  PubMed  Google Scholar 

  6. Yossepowitch O, Dalbagni G, Golijanin D, Donat SM, Bochner BH, Herr HW, et al. Orthotopic urinary diversion after cystectomy for bladder cancer: implications for cancer control and patterns of disease recurrence. J Urol. 2003;169(1):177–81.

    Article  PubMed  Google Scholar 

  7. Hautmann RE, Abol-Enein H, Lee CT, Mansson W, Mills RD, Penson DF, et al. Urinary diversion: how experts divert. Urology. 2015;85(1):233–8.

    Article  PubMed  Google Scholar 

  8. Hautmann RE, Herr HW, Pruthi RS, Aron M. Robotic radical cystectomy—is the diversion the Achilles’ heel? J Urol. 2014;192(6):1601–3.

    Article  PubMed  Google Scholar 

  9. Satkunasivam R, Santomauro M, Chopra S, Plotner E, Cai J, Miranda G, et al. Robotic intracorporeal orthotopic neobladder: urodynamic outcomes, urinary function, and health-related quality of life. Eur Urol. 2015.

  10. Sidi AA, Reinberg Y, Gonzalez R. Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty. J Urol. 1986;136(6):1201–4.

    CAS  PubMed  Google Scholar 

  11. Cheng C, Whitfield HN. Cystoplasty: tubularisation or detubularisation? Br J Urol. 1990;66(1):30–4.

    Article  CAS  PubMed  Google Scholar 

  12. Hinman F. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol. 1988;139(3):519–23.

    PubMed  Google Scholar 

  13. Koraitim MM, Atta MA, Foda MK. Orthotopic bladder substitution in men revisited: identification of continence predictors. J Urol. 2006;176(5):2081–4.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. Colding-Jørgensen M, Poulsen AL, Steven K. Mechanical characteristics of tubular and detubularised bowel for bladder substitution: theory, urodynamics and clinical results. Br J Urol. 1993;72(5 Pt 1):586–93.

    Article  PubMed  Google Scholar 

  16. Paananen I, Ohtonen P, Perttilä I, Jonsson O, Edlund C, Wiklund P, et al. Functional results after orthotopic bladder substitution: a prospective multicentre study comparing four types of neobladder. Scand J Urol Nephrol. 2014;48(1):90–8.

    Google Scholar 

  17. Shah AP, Mevcha A, Wilby D, Alatsatianos A, Hardman JC, Jacques S, et al. Continence and micturition: an anatomical basis. Clin Anat. 2014;27(8):1275–83.

    Article  PubMed  Google Scholar 

  18. Hugonnet CL, Danuser H, Springer JP, Studer UE. Decreased sensitivity in the membranous urethra after orthotopic ileal bladder substitute. J Urol. 1999;161(2):418–21.

    Article  CAS  PubMed  Google Scholar 

  19. Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E. Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol. 1995;153(2):337–41.

    Article  CAS  PubMed  Google Scholar 

  20. Zvara P, Carrier S, Kour NW, Tanagho EA. The detailed neuroanatomy of the human striated urethral sphincter. Br J Urol. 1994;74(2):182–7.

    Article  CAS  PubMed  Google Scholar 

  21. Hollabaugh RS, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997;49(3):426–34.

    Article  PubMed  Google Scholar 

  22. Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G. Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol. 1995;154(6):2044–9.

    Article  CAS  PubMed  Google Scholar 

  23. Schlomm T, Heinzer H, Steuber T, Salomon G, Engel O, Michl U, et al. Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol. 2011;60(2):320–9.

    Article  PubMed  Google Scholar 

  24. Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179(5):1683–9. This paper clearly explains the outlet structure and its influence on continence.

    Article  PubMed  Google Scholar 

  25. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Park JM, Bloom DA, McGuire EJ. The guarding reflex revisited. Br J Urol. 1997;80(6):940–5. This paper clearly explains the various parts of the guarding reflex and clarifies the continence mechanism in patients after neobladder construction.

    Article  CAS  PubMed  Google Scholar 

  27. Catarin MVG, Manzano GM, Nóbrega JAM, Almeida FG, Srougi M, Bruschini H. The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study. J Urol. 2008;180(6):2527–31.

    Article  PubMed  Google Scholar 

  28. Hugonnet CL, Danuser H, Springer JP, Studer UE. Urethral sensitivity and the impact on urinary continence in patients with an ileal bladder substitute after cystectomy. J Urol. 2001;165(5):1502–5.

    Article  CAS  PubMed  Google Scholar 

  29. Steers WD. Voiding dysfunction in the orthotopic neobladder. World J Urol. 2000;18(5):330–7.

    Article  CAS  PubMed  Google Scholar 

  30. Madersbacher S, Studer UE. Contemporary cystectomy and urinary diversion. World J Urol. 2002;20(3):151–7.

    PubMed  Google Scholar 

  31. Hautmann RE, Volkmer BG, Schumacher MC, Gschwend JE, Studer UE. Long-term results of standard procedures in urology: the ileal neobladder. World J Urol. 2006;24(3):305–14.

    Article  PubMed  Google Scholar 

  32. Strasser H, Tiefenthaler M, Steinlechner M, Bartsch G, Konwalinka G. Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet. 1999;354(9182):918–9.

    Article  CAS  PubMed  Google Scholar 

  33. Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW, et al. Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol. 2004;172(4 Pt 1):1323–7.

    Article  PubMed  Google Scholar 

  34. Gilbert SM, Wood DP, Dunn RL, Weizer AZ, Lee CT, Montie JE, et al. Measuring health-related quality of life outcomes in bladder cancer patients using the Bladder Cancer Index (BCI). Cancer. 2007;109(9):1756–62.

    Article  PubMed  Google Scholar 

  35. Koraitim MM, Atta MA, Foda MK. Desire to void and force of micturition in patients with intestinal bladders. J Urol. 1996;155(4):1214–6.

    Article  CAS  PubMed  Google Scholar 

  36. Casanova GA, Springer JP, Gerber E, Studer UE. Urodynamic and clinical aspects of ileal low pressure bladder substitutes. Br J Urol. 1993;72(5 Pt 2):728–35.

    Article  CAS  PubMed  Google Scholar 

  37. Simon J, Bartsch G, Küfer R, Gschwend JE, Volkmer BG, Hautmann RE. Neobladder emptying failure in males: incidence, etiology and therapeutic options. J Urol. 2006;176(4 Pt 1):1468–72. discussion 1472. This paper emphasizes the importance of meticulous continence analysis and measurements.

    Article  CAS  PubMed  Google Scholar 

  38. Mikuma N, Hirose T, Yokoo A, Tsukamoto T. Voiding dysfunction in ileal neobladder. J Urol. 1997;158(4):1365–8.

    Article  CAS  PubMed  Google Scholar 

  39. Smith E, Yoon J, Theodorescu D. Evaluation of urinary continence and voiding function: early results in men with neo-urethral modification of the Hautmann orthotopic neobladder. J Urol. 2001;166(4):1346–9.

    Article  CAS  PubMed  Google Scholar 

  40. Colombo R, Pellucchi F, Moschini M, Gallina A, Bertini R, Salonia A, et al. Fifteen-year single-centre experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients. World J Urol. 2015.

  41. El Bahnasawy MS, Osman Y, Gomha MA, Shaaban AA, Ashamallah A, Ghoneim MA. Nocturnal enuresis in men with an orthotopic ileal reservoir: urodynamic evaluation. J Urol. 2000;164(1):10–3.

    Article  PubMed  Google Scholar 

  42. Jakobsen H, Steven K, Stigsby B, Klarskov P, Hald T. Pathogenesis of nocturnal urinary incontinence after ileocaecal bladder replacement. Continuous measurement of urethral closure pressure during sleep. Br J Urol. 1987;59(2):148–52.

    Article  CAS  PubMed  Google Scholar 

  43. Light JK. Continence mechanisms following continent urinary diversion and orthotopic bladder replacement. Prog Clin Biol Res. 1991;370:83–92.

    CAS  PubMed  Google Scholar 

  44. Park JM, Montie JE. Mechanisms of incontinence and retention after orthotopic neobladder diversion. Urology. 1998;51(4):601–9.

    Article  CAS  PubMed  Google Scholar 

  45. Simma-Chiang V, Ginsberg DA, Teruya KK, Boyd SD. Outcomes of artificial urinary sphincter placement in men after radical cystectomy and orthotopic urinary diversions for the treatment of stress urinary incontinence: the University of Southern California experience. Urology. 2012;79(6):1397–401.

    Article  PubMed  Google Scholar 

  46. Barre PH, Herve JM, Botto H, Camey M. Update on the Camey II procedure. World J Urol. 1996;14(1):27–8.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    CAS  PubMed  Google Scholar 

  48. 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.

    Article  CAS  PubMed  Google Scholar 

  49. 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 427–8.

  50. 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.

    Article  CAS  PubMed  Google Scholar 

  51. Parekh DJ, Gilbert WB, Smith JA. Functional lower urinary tract voiding outcomes after cystectomy and orthotopic neobladder. J Urol. 2000;163(1):56–8. discussion 58–9.

  52. Madersbacher S, Möhrle K, Burkhard F, Studer UE. Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol. 2002;167(5):2052–7.

    Article  PubMed  Google Scholar 

  53. Sevin G, Soyupek S, Armağan A, Hoşcan MB, Oksay T. Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results. BJU Int. 2004;94(3):355–9.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Dr. Ginsberg reports grants and personal fees from Allergan and grants from Medtronic, outside the submitted work; Dr. Rosenberg has nothing to disclose.

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.

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Authors and Affiliations

  1. Keck School of Medicine of USC, Los Angeles, CA, USA

    David A. Ginsberg

  2. Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA

    David A. Ginsberg

  3. Fellow in Female Pelvic Medicine and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA

    Shilo Rosenberg

Authors
  1. David A. Ginsberg
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  2. Shilo Rosenberg
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Correspondence to Shilo Rosenberg.

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This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction

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Ginsberg, D.A., Rosenberg, S. Neobladder Voiding Function in Men. Curr Bladder Dysfunct Rep 10, 404–410 (2015). https://doi.org/10.1007/s11884-015-0333-4

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  • DOI: https://doi.org/10.1007/s11884-015-0333-4

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