THE EFFECT OF NERVE SPARING CYSTECTOMY TECHNIQUE ON POSTOPERATIVE CONTINENCE AFTER ORTHOTOPIC BLADDER SUBSTITUTION

Purpose: Continence after orthotopic bladder substitution may be influ enced by characteristics of the reservoir and of the sphincter mechani sm. Autonomic innervation probably contributes to pressure generation by the sphincter mechanism at rest. We therefore examined the effect o f nerve sparing cystectomy technique on continence in 165 consecutive men who underwent cystectomy and construction of an ileal low pressure reservoir and were followed regarding continence for at least 3 month s postoperatively. Materials and Methods: Nerve sparing was attempted bilaterally in 20 men, unilaterally in 96 and not at all in 49. Patien ts were followed prospectively and completed regular voiding diaries, including details of continence. Postoperative sexual potency was asce rtained by questionnaire. The effects of attempted nerve sparing and o f age on continence were examined in Kaplan-Meier models and in Cox's proportional hazards models. Results: Median times to continence durin g the day and at night for all men were 3 and 9 months, respectively. Continence differed significantly between patients with attempted nerv e sparing and no attempt at nerve sparing (day, p = 0.003 and night, p = 0.001, log rank test) and between men less than 65 years old and th ose older than 65 (day, p = 0.037 and night, p = 0.005, log rank test) . In the multivariate analysis, attempted nerve sparing was significan tly associated with improved continence by day (t = 1.96) and by night (t = 1.98). Conclusions: These data suggest that attempted nerve spar ing is associated with improved urinary continence after orthotopic bl adder substitution.