Urodynamic features of the gastric pouch after radical cystectomy and the relationship to oral intake

Purpose: We studied the motility of orthotopic bladder substitution with st omach (gastric pouch) in adults with bladder cancer and the effect of oral intake as measured on urodynamics. We also investigated the probable relati onship between continence and sensitivity of the proximal urethra. Antichol inergic medication effects on pouch motility were tested. Materials and Methods: Six patients with a gastric pouch were questioned ab out quality of life 6 to 43 months after surgery, and examined urodynamical ly before and after oral intake. During the examination the proximal urethr a (directly under the anastomosis between the pouch and urethra) was electr ically stimulated to determine sensitivity. We tried to inhibit the perista ltic contractions with 20 mg. butylscopolamine intravenously. Results: The main difference before and after oral intake was the onset tim e of peristaltic contractions. After eating the contractions began at; a lo wer filling volume, which was statistically significant. There were no or i nsignificant differences in capacity and urodynamic parameters. We were suc cessful in inhibiting the peristaltic contractions with anticholinergic med ication. Conclusions: The gastric pouch is a valuable bladder substitute with suffic ient volume, antireflux characteristics, satisfactory continence rate and a dequate voiding behavior. Oral intake causes motor activity of the gastric pouch at a lower fill volume than fasting during urodynamic investigation. Anticholinergic medication may be useful for inhibiting peristalsis in the gastric pouch.