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Current Bladder Dysfunction Reports

, Volume 8, Issue 4, pp 358–366 | Cite as

Management of Stress Urinary Incontinence in the Neobladder Patient

  • Melissa R. KaufmanEmail author
Reconstructed Bladder Function and Dysfunction (L Westney, Section Editor)

Abstract

Considering the intent for provision of near-normal urinary function with an orthotopic diversion, issues with voiding dysfunction and urinary incontinence manifest substantial impact on quality of life for neobladder patients. Following appropriate functional and anatomic evaluation, often employing cystoscopy and urodynamics, multiple treatment strategies are available for treatment of stress incontinence in this complex patient population. Conservative modalities including pelvic floor physical therapy, behavioral therapies, and general education regarding neobladder diversion are foremost. Pharmacologic therapies may be suitable in select circumstances. Minimally invasive treatments such as transurethral bulking agents can provide improvement for women with stress incontinence following orthotopic diversion; however the risk profile may preclude use in many patients. Midurethral tape technologies, including transobturator and single incision slings, represent a comparatively recent iteration of implements to be considered. The pitfalls of fascial pubovaginal sling include navigation of complex anatomy combined with a high rate of urinary retention. In men, artificial urinary sphincter continues to exemplify an effective continence procedure following neobladder diversion with only a modestly elevated complication profile in these high risk patients. Male sling technologies are additionally gaining appreciation as an option for treatment of sphincteric dysfunction following orthotopic neobladder and forgo several drawbacks associated with artificial sphincter placement.

Keywords

Orthotopic neobladder Stress urinary incontinence Artificial urinary sphincter Urethral bulking agents Pubovaginal sling Management Treatment 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Melissa R. Kaufman has received payment for development of educational presentations (including service on speakers bureaus) from Allergan, Astellas Pharma, and Cook MyoSite.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by the author. With regard to the author’s research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

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