DESIRE TO VOID AND FORCE OF MICTURITION IN PATIENTS WITH INTESTINAL NEOBLADDERS

Purpose: We attempted to determine how patients with an orthotopic bla dder perceive the desire to void and the force achieved to evacuate th e bladder. Materials and Methods: A total of 24 men who had undergone post-cystectomy bladder substitution (ileocecal in 12, sigmoid in 6 an d ileal in 6) was evaluated subjectively and objectively by pressure-f low study 1 to 3 years postoperatively. Results: Desire to void was fe lt at the base of the penis or in the perineum by 20 men (83%). Abdomi nal pressure contributed to intra-reservoir pressure by 51 to 54% in i leocecal, 20 to 24% in sigmoid and 23 to 25% in ileal neobladders. Con clusions: Patients perceive the desire to void when drops of urine lea k into the proximal urethra from an overfilled neobladder. Urine is ev acuated mainly by abdominal straining for ileal neobladders, mainly by contraction for sigmoid neobladders, and by approximately equal contr ibutions of contraction and straining for ileocecal neobladders.