URODYNAMIC AND CLINICAL ASPECTS OF ILEAL LOW-PRESSURE BLADDER SUBSTITUTES

Twenty-three patients with an ileal bladder substitute formed after cy stectomy for invasive bladder cancer were evaluated clinically and uro dynamically between 3 and 38 months post-operatively. The urodynamic m easurements were compared with the clinical findings. After re-educati on of the patients voiding habits the mean voiding volumes of the blad der substitutes stabilised 6-9 months post-operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or t wice at night. The maximum functional capacity (maximum voiding volume ) was about 490 ml. Ninety-one per cent of the patients were continent during the day 18 months after the operation and 82% were continent d uring the night. Micturition was problem-free with an average maximum flow of 25 ml/s and an average micturition time of 50 s. The mean void ing volume of ileal bladder substitutes was 50% of the measured cystom etric capacity; the maximum functional capacity (= max. micturition vo lume) was 80% of the cystometric capacity. The average basal pressure was < 20 cm H2O from the third post-operative month onwards.'Eleven of the 23 patients had contractions in the bladder substitute (average a t 30 cm H2O) at 55-76% of the maximum cystometric capacity or at appro ximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences. If the patients were shown h ow to increase the functional capacity of a reservoir made from only 4 0 cm of ileum, the clinical results were excellent.