Evaluation of urinary continence in the Hautmann neobladder

Objective: The Hautmann neobladder is a bladder replacement technique frequ ently proposed after total cystectomy for bladder cancel: The objective of this prospective study was to evaluate the patients' urinary continence aft er this operation, based on clinical and urodynamic data. Materials and Methods: The functional assessment was based on 26 patients f rom a series of 45 consecutive Hautmann bladder replacements performed betw een February 1994 and May 1999. These 26 nonselected patients (21 men and 5 women) with a mean age of 56 years (range: 38-68) accepted the principle o f functional assessment of continence at visits held 1, 3, 6 and 12 months postoperatively including clinical interview, urodynamic studies and fibros copy. Only one patient presented with preoperative stress incontinence, The mean follow-up of these 26 patients was 22 months (range: 10-60). Three pa tients, including two women, died from progression of their bladder tumour at the 12th, 20th and 32nd postoperative months. Results: Urodynamic studies showed a mean maximum capacity of the ileal res ervoir of 420 ml (range: 316-571), a maximum filling pressure of 15 cmH2O ( range: 2-24) and a maximum urethral closure pressure of 49 cmH2O (range: 31 -74). According to the et evaluation criteria used, the satisfactory contin ence rates, as assessed by the patients were 62%, 77%, 84.6% during the day and 42%, 615%, 77% at night, at 3, 6 and 12 months, respectively Conclusion: The Hautmann neobladder ensures satisfactory diurnal and noctur nal urinary continence in more than 75% of cases after the 6th postoperativ e month. Continence is an evolving parameter especially during the first po stoperative year. The selection of patients in good general condition and m otivated for management of their new urinary situation remains an essential prerequisite to obtain a good functional result.