Cl. Hugonnet et al., Urethral sensitivity and impact on urinary continence in patients with ileal bladder substitute after cystectomy, J UROL, 165(5), 2001, pp. 1502-1505
Purpose: After cystectomy and ileal bladder substitution, sensitivity in th
e membranous urethra correlates with postoperative urinary continence. We d
etermine whether sensitivity is decreased only in the most proximal part of
the urethra or also more distally in the bulbar urethra, which would give
some indication as to which nerves may be injured during radical. cystopros
tatectomy.
Materials and Methods: The sensory threshold for electrical stimulation was
measured with double ring electrodes in the membranous urethra, and 2.5 cm
. distally to it in 41 men after cystectomy and ileal bladder substitution,
and in a control group of 29 men.
Results: The mean sensory threshold plus or minus standard deviation of the
membranous urethra was 9 +/- 2 mA. in the control group compared to 26 +/-
11 mA. in the postoperative group (p <0.001). Mean sensory threshold 2.5 c
m. distal to the membranous urethra was 8 +/- 3 versus 9 +/- 3 mA, in the c
ontrol and postoperative groups, respectively inot significant). Patients w
ith daytime continence had a mean threshold of 22 +/- 8 mA, in the membrano
us urethra compared to 38 +/- 11 mA. in those who were incontinent (p <0.00
4) and a threshold of 8 +/- 3 mA, 2.5 cm, distal to the membranous urethra
compared to 8 +/- 2 mA. in those who were incontinent (not significant).
Conclusions: After cystectomy and ileal bladder substitution, urethral sens
itivity 2.5 cm, distal to the membranous urethra is unaffected by surgery a
nd does not correlate with postoperative continence. In contrast, a decreas
ed sensitivity ill the membranous urethra correlates with an increased risk
of postoperative incontingence. Preservation of sensitivity in the membran
ous urethra seems to be an important factor for achieving continence after
cystectomy and ileal bladder substitution, and does not seem to be dependen
t on the extrapelvic portion of the pudendal nerve.