Skip to main content

Advertisement

SpringerLink
Log in

Voiding Dysfunction After Neobladder Urinary Diversion

  • Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Radical cystectomy and urinary diversion remains the gold standard treatment for patients with high risk or muscle invasive bladder cancer. Despite the fact that a majority of patients are eligible for orthotopic neobladder, over 85% of patients receive incontinent urinary diversions, primarily over concerns for complications or postoperative voiding dysfunction. In this review, we explore the incidence, etiology, and treatment of voiding dysfunction after orthotopic neobladder creation in male and female patients.

Recent Findings

Voiding dysfunction after orthotopic neobladder consists of urinary incontinence and urinary retention. Both are well-recognized potential sequelae, but occur more commonly in female patients. Recent studies have characterized voiding dysfunction as a dynamic problem that improves with time. While treatment options are limited, several techniques exist to minimize the risks of voiding dysfunction after orthotopic neobladder.

Summary

Despite excellent functional outcomes in the majority of patients, concerns over voiding dysfunction after orthotopic neobladder may in part explain the disparity in receipt of incontinent versus continent urinary diversions. More prospective and patient-reported studies of voiding outcomes are required and newer more effective treatment options for voiding dysfunction are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

  1. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO Guideline. J Urol. 2016;196(4):1021–9.

    PubMed  Google Scholar 

  2. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. 2017;198(3):552–9.

    PubMed  PubMed Central  Google Scholar 

  3. 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.

    PubMed  Google Scholar 

  4. Hautmann RE. Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder? Current urology reports. 2000;1(3):173–9.

    CAS  PubMed  Google Scholar 

  5. Ashley MS, Daneshmand S. Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy. BJU Int. 2010;106(5):654–7.

    PubMed  Google Scholar 

  6. Nagele U, Anastasiadis AG, Stenzl A, Kuczyk M. Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results. World J Urol. 2012;30(6):725–32.

    PubMed  Google Scholar 

  7. Cerruto MA, D’Elia C, Siracusano S, Gedeshi X, Mariotto A, Iafrate M, et al. Systematic review and meta-analysis of non RCT’s on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol : J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2016;42(3):343–60.

    CAS  Google Scholar 

  8. • Farber NJ, Faiena I, Dombrovskiy V, Tabakin AL, Shinder B, Patel R, et al. Disparities in the use of continent urinary diversions after radical cystectomy for bladder cancer. Bladder Cancer (Amsterdam, Netherlands). 2018;4(1):113–20. This study used the National Inpatient Sample to show the disproportionate rate of incontinent urinary diversions performed in the United States.

    Google Scholar 

  9. • Lin-Brande M, Nazemi A, Pearce SM, Thompson ER, Ashrafi AN, Djaladat H, et al. Assessing trends in urinary diversion after radical cystectomy for bladder cancer in the United States. Urol Oncol. 2019;37(3):180.e1-.e9. This study used the National Cancer Database to show that the rate of continent diversions is decreasing even in high volume and academic centers.

    Google Scholar 

  10. 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 follow-up. J Urol 1999;161(2):422–427; discussion 7-8.

  11. 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.

    CAS  PubMed  Google Scholar 

  12. Lee KS, Montie JE, Dunn RL, Lee CT. Hautmann and Studer orthotopic neobladders: a contemporary experience. J Urol. 2003;169(6):2188–91.

    PubMed  Google Scholar 

  13. 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.

    PubMed  Google Scholar 

  14. Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. J Urol. 2006;176(1):161–6.

    PubMed  Google Scholar 

  15. •• Clifford TG, Shah SH, Bazargani ST, Miranda G, Cai J, Wayne K, et al. Prospective evaluation of continence following radical cystectomy and orthotopic urinary diversion using a validated questionnaire. J Urol. 2016;196(6):1685–91. Recent paper using patient-reported outcomes to show that continence after neobladder is dynamic and improves over time with excellent functional outcomes at 12 to 18 months.

    PubMed  Google Scholar 

  16. Stein JP, Grossfeld GD, Freeman JA, Esrig D, Ginsberg DA, Cote RJ, et al. Orthotopic lower urinary tract reconstruction in women using the Kock ileal neobladder: updated experience in 34 patients. J Urol. 1997;158(2):400–5.

    CAS  PubMed  Google Scholar 

  17. Anderson CB, Cookson MS, Chang SS, Clark PE, Smith JA Jr, Kaufman MR. Voiding function in women with orthotopic neobladder urinary diversion. J Urol. 2012;188(1):200–4.

    PubMed  Google Scholar 

  18. •• Gross T, Meierhans Ruf SD, Meissner C, Ochsner K, Studer UE. Orthotopic ileal bladder substitution in women: factors influencing urinary incontinence and hypercontinence. Eur Urol. 2015;68(4):664–71. Prospective study of female patients receiving neobladder that showed the importance of preservation of the uterus and nerves in attaining continence.

    PubMed  Google Scholar 

  19. 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.

    CAS  PubMed  Google Scholar 

  20. Studer UE, Danuser H, Merz VW, Springer JP, Zingg EJ. Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J Urol. 1995;154(1):49–56.

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  22. Marim G, Bal K, Balci U, Girgin C, Dincel C. Long-term urodynamic and functional analysis of orthotopic “W” ileal neobladder following radical cystectomy. Int Urol Nephrol. 2008;40(3):629–36.

    PubMed  Google Scholar 

  23. Skolarikos A, Deliveliotis C, Alargof E, Ferakis N, Protogerou V, Dimopoulos C. Modified ileal neobladder for continent urinary diversion: functional results after 9 years of experience. J Urol. 2004;171(6 Pt 1):2298–301.

    PubMed  Google Scholar 

  24. 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. 2016;69(2):247–53.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  26. 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.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  28. 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.

    PubMed  Google Scholar 

  29. Hubner WA, Trigo-Rocha F, Plas EG, Tanagho EA. Urethral function after cystectomy: a canine in vivo experiment. Urol Res. 1993;21(1):45–8.

    CAS  PubMed  Google Scholar 

  30. 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.

    CAS  PubMed  Google Scholar 

  31. Walsh PC. The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy. J Urol. 2007;177(5):1632–5.

    PubMed  Google Scholar 

  32. Bhatta Dhar N, Kessler TM, Mills RD, Burkhard F, Studer UE. Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients. Eur Urol. 2007;52(4):1006–14.

    PubMed  Google Scholar 

  33. • Voskuilen CS, van de Putte EE F, Perez-Reggeti JI, van Werkhoven E, Mertens LS, van Rhijn BWG, et al. Prostate sparing cystectomy for bladder cancer: a two-center study. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2018;44(9):1446–52. Contemporary multi-center study reporting functional and oncologic outcomes after prostate sparing cystectomy and neobladder.

    Google Scholar 

  34. Stein JP, Hautmann RE, Penson D, Skinner DG. Prostate-sparing cystectomy: a review of the oncologic and functional outcomes. Contraindicated in patients with bladder cancer. Urol Oncol. 2009;27(5):466–72.

    PubMed  Google Scholar 

  35. • Gregg JR, Emeruwa C, Wong J, Barocas DA, Chang SS, Clark PE, et al. Oncologic outcomes after anterior exenteration for muscle invasive bladder cancer in women. J Urol. 2016;196(4):1030–5. Retrospective study reporting on risk factors for pelvic organ involvement in females at the time of radical cystectomy that may preclude reproductive organ sparing surgery.

    PubMed  Google Scholar 

  36. Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S. Reproductive organ involvement in female patients undergoing radical cystectomy for urothelial bladder cancer. J Urol. 2012;188(6):2134–8.

    PubMed  Google Scholar 

  37. 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.

    PubMed  Google Scholar 

  38. • Loh-Doyle JC, Ashrafi A, Nazemi A, Ghodoussipour S, Thompson E, Wayne K, et al. Dual prosthetic implantation after radical cystoprostatectomy and neobladder: outcomes of the inflatable penile prosthesis and artificial urinary sphincter in bladder cancer survivors. Urology. 2019;127:127-32. Large series that showed the feasibility of dual prosthetic implantation after cystectomy and neobladder in male patients.

    PubMed  Google Scholar 

  39. Finley DS, Lee U, McDonough D, Raz S, deKernion J. Urinary retention after orthotopic neobladder substitution in females. J Urol 2011;186(4):1364–1369.

    PubMed  Google Scholar 

  40. Simon J, Bartsch G Jr, Kufer 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 72.

    CAS  PubMed  Google Scholar 

  41. Ji H, Pan J, Shen W, Wu X, Zhang J, Fang Q, et al. Identification and management of emptying failure in male patients with orthotopic neobladders after radical cystectomy for bladder cancer. Urology. 2010;76(3):644–8.

    PubMed  Google Scholar 

  42. Gotoh M, Mizutani K, Furukawa T, Kinukawa T, Ono Y, Ohshima S. Quality of micturition in male patients with orthotopic neobladder replacement. World J Urol. 2000;18(6):411–6.

    CAS  PubMed  Google Scholar 

  43. Porru D, Madeddu G, Campus G, Montisci I, Caddemi G, Scarpa RM, et al. Urodynamic analysis of voiding dysfunction in orthotopic ileal neobladder. World J Urol. 1999;17(5):285–9.

    CAS  PubMed  Google Scholar 

  44. Nesrallah LJ, Srougi M, Dall’Oglio MF. Orthotopic ileal neobladder: the influence of reservoir volume and configuration on urinary continence and emptying properties. BJU Int. 2004;93(3):375–8.

    CAS  PubMed  Google Scholar 

  45. Daneshmand S. Urinary Diversion: Springer; 2017.

  46. • Zyczkowski M, Muskala B, Kaletka Z, Bryniarski P, Nowakowski K, Bogacki R, et al. Sacrocolpopexy with polypropylene tape as valuable surgical modification during cystectomy with orthotopic ileal bladder: functional results. Biomed Res Int. 2015;2015:306191. Small prospective study with results suggesting improved functional outcomes with prophylactic sacrocolpopexy at the time of cystectomy and neobladder in females.

    PubMed  PubMed Central  Google Scholar 

  47. Torzsok P, Bauer S, Forstner R, Sievert KD, Janetschek G, Zimmermann R. Laparoscopic radical cystectomy and ileal neobladder for muscle invasive bladder cancer in combination with one stage prophylactic laparoscopic sacrospinal fixation to avoid future pelvic organ prolapse. J Endourol Case Rep. 2016;2(1):59–61.

    PubMed  PubMed Central  Google Scholar 

  48. Bartsch G, Simon J, Gschwend Juergen E, Hautmann Richard E, Volkmer BG. 51: Subneovesical obstruction in men with an ileal neobladder: incidence, etiology and therapeutic options. J Urol. 2004;171(4S):14.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Urology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA

    Saum Ghodoussipour & Siamak Daneshmand

Authors
  1. Saum Ghodoussipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Siamak Daneshmand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Siamak Daneshmand.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Cancer-Associated Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghodoussipour, S., Daneshmand, S. Voiding Dysfunction After Neobladder Urinary Diversion. Curr Bladder Dysfunct Rep 15, 38–43 (2020). https://doi.org/10.1007/s11884-019-00573-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-019-00573-0

Keywords

Search

Navigation