Impact of the prostatic apex on continence and urinary flow in patients with intestinal neobladders

Objective To determine the impact of preserving the prostatic apex on continence and urinary now in patients with post-cystectomy intestinal bladder substitutes. Patients and methods A total of 38 male patients underwent radical cystectomy for bladder carcinoma and construction of a neobladder from ileum [9], sigmoid [9] or an ileocaecal segment [20]. The intestinal reservoir was anastomosed to the membranous urethra in 25 patients and to the apical prostatic capsule in 13. A subjective evaluation of urinary continence, uroflowmetry and urethral pressure profilometry were performed 1-3 years after surgery. Results The only variable which showed a significant difference between patients with and without preservation of the prostatic apex was the functional profile length (P<0.05. Conversely, there was no statistically significant difference in the continence result, peak now rate and maximum urethral pressure between these two groups. However, there was a significant difference (P<0.05) in peak now rate among the three versions of neobladder in patients with a preserved prostatic apex (9.4 mL/s in ileal vs 15.8 mL/s in sigmoid and ileocaecal segments). Conclusion Preservation of the prostatic apex does not improve urinary continence in patients with intestinal neobladders and may present an element obstructing the evacuation of ileal bladders.