Continent orthotopic urinary diversion in female patients: Early Mayo Clinic experience

Objective: To review our initial experience with orthotopic neobladder urinary diversion in female patients. Material and Methods: We reviewed the clinical characteristics, operative reports, and pathologic results of five female patients who underwent radical or simple cystectomy and continent orthotopic urinary diversion. Perioperative morbidity, postoperative daytime and nighttime continence, renal function, need for protective pads, and self-catheterization were documented. All urodynamic and upper urinary tract imaging studies were reviewed. Results: Follow-up has ranged from 9 to 18 months in these initial patients. Thus far, all five women have achieved acceptable daytime continence, and four of five women have achieved nighttime continence. Only one patient augments volitional voiding with intermittent self-catheterization. Complications consisted of urinary retention in one patient and development of a urinary tract and bladder calculus, which necessitated cystolitholapaxy, in another patient. Neobladder capacities have ranged from 400 to 600 mL with voided volumes up to 300 mL. Only one patient has had a substantial residual urine volume (300 mL). All upper urinary tract imaging studies have shown stable function, and urodynamic studies have revealed high-compliance, large-volume neobladder capacities in all patients. Conclusion: Bladder replacement pouches designed from detubularized bowel are gaining widespread acceptance among urologists and their patients. Although these operations have previously been limited to men because of concerns about cancer-involved margins and continence after cystectomy in female patients, recent advances in the knowledge of female pelvic anatomy and neurovascular innervation of the bladder neck and proximal urethra have facilitated nerve-preserving radical cystectomy in women that allows continence and volitional voiding through the urethra.