Continence and urodynamic parameters of continent urinary reservoirs: Comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments

Objectives. To compare the urodynamic parameters and continence rates among five different continent urinary reservoirs. Methods. Continent urinary reservoirs were constructed in 40 patients with an average age of 60 years (range 23 to 81). Twenty-three had orthotopic ne obladders ("neobladders"), and in 17 the reservoirs exited by way of an abd ominal wall stoma as "stomal urinary reservoirs." In the neobladders, the d etubularized segment was ileum (Hautmann) in 5, ileocecal (Mainz) in 8, sig moid in 4, and gastric in 6. In the stomal urinary reservoirs, the segment was ileocecal in ii (Mainz) and right colon in 6 (Indiana). Urodynamic stud ies were performed at a mean of 9.1 months. Results. Stomal urinary reservoirs had the best continence rates (Indiana p ouch 100%, Mainz pouch 91%). Neobladder continence rates were as follows: H autmann, 80%; Mainz, 75%; sigmoid, 50%; and gastric, 33%. Day and night inc ontinence rates were nearly identical. Compared with the other pouches, gas tric and sigmoid reconstructions had the smallest capacity, were the least compliant, and were the most contractile. Conclusions. Stomal urinary reservoirs using ileocecal valve and right colo n, with or without-an overlying patch of ileum, provide similar excellent r esults. Continence approached 100% in compliant patients without the need f or revision. Patients with neobladders were less continent, although those with ileal or ileocecal configurations still had very good continence rates . Neobladders of sigmoid or stomach can be used when necessary, but with gr eater incontinence rates. This poorer continence can be explained by the de creased capacity, decreased compliance, and a tendency toward high pressure spikes despite detubularization. (C) 1999, Elsevier Science Inc.