Urodynamic studies in patients undergoing bladder replacement surgery.

A high incidence of nocturnal incontinence has been a problem in patients undergoing continent urinary diversion when intact bowel segments are used. Detubularization has been advocated to solve this problem. Fifteen patients underwent continent urinary diversions and 4 underwent bladder augmentation with a variety of intestinal segments. Detubularization of the right colon anastomosed to the urethra was used in the first 3 patients, all of whom experienced nocturnal incontinence. Urodynamic studies showed high pressure contractions of the intestinal pouch of 60 to 100 cm. water pressure after the pouch was filled with 50 to 150 cc fluid. Incorporation of an ileal patch into the detubularized segment of colon was effective in reducing these pressures to 15 to 60 cm. water. This method reduced but did not eliminate the incidence of nocturnal incontinence. It is suggested that other factors may account for this problem.