Surgical modifications can prevent the anatomical factors that appear to be the cause of chronic urinary retention after radical cystectomy and orthotopic bladder substitution. Investigators from the Urology and Nephrology Center of the Faculty of Medicine at Mansoura University in Mansoura, Egypt, studied 136 women who underwent standard radical cystectomy and orthotopic substitution for organ-confined bladder cancer.
Technical modifications were made to the procedure in the last 37 cases in an attempt to avoid the development of chronic urinary retention.
One hundred of the patients were available for follow-up at a mean 36 months after the procedure.
Sixteen of the women were experiencing chronic retention. Videourodynamics revealed that retention was the result of the pouch falling back in the wide pelvic cavity, which caused acute angulation of the posterior pouch-urethral junction. Most of the women also had herniation of the pouch wall through the prolapsed vaginal stump.
The pelvic floor, rhabdosphincter, and urethra were all normal. Electromyography showed complete pelvic floor silence during voiding.
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