Reconstruction of the Lower Urinary Tract in Women after Cystectomy

Summary

Background.
The first extirpation of the urinary bladder on account of malignant papilomatosis was carried outby Karel Pawlik in 1889 as the first one in the world. At present cystectomy is indicated usually because of aninfiltrating carcinoma of the urinary bladder. The objective of the present paper is, based on anatomical investigations,elaboration of a surgical technique of creating a orthotopic neovesica following cystectomy sparing a functionalfemale urethra.Methods and Results. In 1993-1998 32 women were operated within the age bracket of 32-72 years witha confirmed infiltration carcinoma of the urinary bladder. The authors describe in detail their own surgical technique.Day continence was achieved in 20 patients. Twelve patients suffer from stress incontinence. Eight patients havea post-micturition residue of 250-300 ml calling for a combination of medicamentous treatment and autocatheteri-zation. The capacity of the neovesicle is the cause of nycturia: 21 patients must micturate once or twice during thenight. Urodynamic studies did not reveal significant differences between patients with chronic post-miction residuesand without residues. Also the mean functional length of the urethra was in both groups similar (27 mm in patientswith a residue and 26.2 mm in patients without a residue).Conclusions. The elaborated surgical technique of cystectomy and creation of a neovesica makes a good qualityof the patients’ life possible.

Key words:
carcinoma of the urinary bladder, orthotopic neovesicle, cystectomy, incontinence.