This article is part of the Topical Collection on Post-Prostatectomy and Acquired Voiding Dysfunction
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Incontinence after orthotopic bladder substitution (OBS) post-radical cystectomy can be devastating for the patient and its treatment a challenge for the physician. The aim of this narrative review was to summarize the available evidence on treatment options for incontinence after OBS and to facilitate deciding on treatment strategies.
Despite good continence rates after OBS, incontinence remains an issue and treatment poses a challenge for which limited evidence exists.
Treatment of incontinence therapy after orthotopic bladder substitution (OBS) post-radical cystectomy currently remains a challenge with limited evidence to aid treatment decisions. After a sound patient assessment and exclusion of anatomical or underlying problems, conservative management including pelvic floor muscle training is generally considered the first line of therapy. Drugs can be used as second-line therapy in specific cases, before refraining to third-line surgical options.
Alfred Witjes J, Lebret T, Comperat EM, Cowan NC, De Santis M, Bruins HM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2017;71(3):462–75. https://doi.org/10.1016/j.eururo.2016.06.020.
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. https://doi.org/10.1016/s0022-5347(06)00573-8.
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. https://doi.org/10.1007/s00345-006-0105-z.
Furrer MA, Roth B, Kiss B, Nguyen DP, Boxler S, Burkhard FC, et al. Patients with an orthotopic low pressure bladder substitute enjoy long-term good function. J Urol. 2016;196(4):1172–80. https://doi.org/10.1016/j.juro.2016.04.072.
Hinman F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol. 1988;139(3):519–23.
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.
Furrer MA, Studer UE, Gross T, Burkhard FC, Thalmann GN, Nguyen DP. Nerve-sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution, which becomes even more apparent over time. BJU Int. 2018;121(6):935–44. https://doi.org/10.1111/bju.14123.
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. https://doi.org/10.1016/j.eururo.2015.05.015.
•• Veskimae E, Neuzillet Y, Rouanne M, MacLennan S, Lam TBL, Yuan Y, et al. Systematic review of the oncological and functional outcomes of pelvic organ-preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU Int. 2017;120(1):12–24. https://doi.org/10.1111/bju.13819. Recent systematic review providing a detailled overview on oncological and functional outcomes after radical cystectomy comparing pelvic organ preserving and standard radical cystectomy.
Rouanne M, Legrand G, Neuzillet Y, Ghoneim T, Cour F, Letang N, et al. Long-term women-reported quality of life after radical cystectomy and orthotopic ileal neobladder reconstruction. Ann Surg Oncol. 2014;21(4):1398–404. https://doi.org/10.1245/s10434-013-3458-8.
el-Bahnasawy MS, Osman Y, Gomha MA, Shaaban AA. Persistent and occasional nocturnal enuresis in orthotopic urinary diversion: is there a urodynamic difference? BJU Int. 2005;96(9):1373–7. https://doi.org/10.1111/j.1464-410X.2005.05852.x.
Ali-El-Dein B, Gomha M, Ghoneim MA. Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women. J Urol. 2002;168(2):587–92.
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. https://doi.org/10.1097/01.ju.0000132153.30662.60.
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.
•• Bailey GC, Blackburne A, Ziegelmann MJ, Lightner DJ. Outcomes of surgical management in patients with stress urinary incontinence and/or neovesicovaginal fistula after orthotopic neobladder diversion. J Urol. 2016;196(5):1478–83. https://doi.org/10.1016/j.juro.2016.06.009. A recent study reporting on the outcomes of surgical management of incontinence in women with an orthotopic neobladder.
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. https://doi.org/10.1097/01.ju.0000132149.63834.33.
Badawy AA, Saleem MD, Abolyosr A, Abuzeid AM. Transobturator vaginal tape (inside-out) for stress urinary incontinence after radical cystectomy and orthotopic reconstruction in women. Arab J Urol. 2012;10(2):182–5. https://doi.org/10.1016/j.aju.2012.02.010.
O'Connor RC, Kuznetsov DD, Patel RV, Galocy RM, Steinberg GD, Bales GT. Artificial urinary sphincter placement in men after cystectomy with orthotopic ileal neobladder: continence, complications, and quality of life. Urology. 2002;59(4):542–5.
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. https://doi.org/10.1016/j.urology.2012.02.006.
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. https://doi.org/10.1002/nau.22345.
El-Bahnasawy MS, Shaaban H, Gomha MA, Nabeeh A. Clinical and urodynamic efficacy of oxybutynin and verapamil in the treatment of nocturnal enuresis after formation of orthotopic ileal neobladders. A prospective, randomized, crossover study. Scand J Urol Nephrol. 2008;42(4):344–51. https://doi.org/10.1080/00365590701832726.
Zhang YG, Song QX, Song B, Zhang DL, Zhang W, Wang JY. Diagnosis and treatment of urinary incontinence after prthotopic ileal neobladder in China. Chin Med J. 2017;130(2):231–5. https://doi.org/10.4103/0366-6999.198012.
- Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy
Marc P. Schneider
Fiona C. Burkhard
- Springer US
Neu im Fachgebiet Urologie
Meistgelesene Bücher in der Urologie
Mail Icon II