BOWEL DYSFUNCTION AFTER BLADDER RECONSTRUCTION

Purpose: Bowel function may be disturbed after intestinal segments are used in urinary reconstruction. The etiology of this condition and it s incidence in different patient groups is unclear. We studied the inc idence of bowel disturbance in patients who underwent bladder replacem ent, continent diversion, enterocystoplasty for idiopathic detrusor in stability and ileal conduit diversion. Materials and Methods: We evalu ated 71 patients after ileal conduit diversion and 82 after bladder re construction, including clam enterocystoplasty for detrusor instabilit y in 28, neurogenic bladder dysfunction in 26 and nonneuropathic condi tions in 28. We noted the severity of symptoms, such as frequency of d efecation, nocturnal diarrhea, flatus leakage, fecal urgency, fecal in continence and explosive diarrhea, as well as quality of life. Results : Of the patients who underwent bladder reconstruction 24% had symptom s of bowel dysfunction preoperatively and 42% of those who were asympt omatic preoperatively described new bowel symptoms postoperatively. Th ese symptoms were most common and severe in 54% of patients after clam enterocystoplasty for detrusor instability compared to 26% with neuro pathy, 14% with a nonneuropathic condition and 15% with an ileal condu it. Compared to those in other groups patients who underwent enterocys toplasty for detrusor instability had a significantly higher incidence of nocturnal bowel movements (18 versus less than 4%, p < 0.01), flat us leakage (29 versus less than 8%, p < 0.01), fecal urgency (39 versu s less than 12%, p < 0.001) and fecal incontinence (32 versus less tha n 16%, p < 0.001). The length of ileum used for clam enterocystoplasty was only slightly greater than that used for ileal conduit operations (25 versus 18 cm.). Of the patients who underwent enterocystoplasty f or detrusor instability 29% regretted undergoing the procedure due to subsequent bowel symptoms. Conclusions: After enterocystoplasty for de trusor instability patients are at risk of significant bowel symptoms. The development of new bowel symptoms was associated with poor patien t satisfaction.