Evaluation of urinary continence and voiding function: Early results in men with neo-urethral modification of the Hautmann orthotopic neobladder

Purpose: At our institution we use the Hautmann orthotopic bladder replacem ent with a chimney and neo-urethral modification. A neo-urethral tube allow s tension-free intestino-urethral anastomosis, thus providing application o f this procedure for patients who may otherwise not qualify due to the inab ility of the small bowel to reach the urethra. However, this neo-urethral t ube may also enhance continence by providing significant intra-abdominal ur ethral length. Conversely, such a modification may be associated with a hig her degree of urinary retention. Early evaluation and reporting on the resu lts of this procedure appear warranted. Materials and Methods: From April 1996 to March 2000, 14 consecutive male p atients underwent cystoprostatectomy and urinary reconstruction with Hautma nn repair using chimney and neo-urethral modifications. We performed a retr ospective analysis of urinary function and continence with data obtained fr om patient questionnaires completed preoperatively and at each postoperativ e office visit. The examining physician chart notes were reviewed for infor mation about urinary retention. The American Urological Association symptom score and voiding bother index were used to assess urinary function and bo ther, respectively. Urinary continence was defined as the complete absence of any form of urinary leakage protection. Results: Of the 14 patients 12 were completely continent day and night, wit h a median followup of 17 months. There were 2 patients who wore pads less than 7 months after surgery. Improvement of urinary continence appeared to continue up to 12 months postoperatively. Despite this encouraging effect, when our data were compared to the published literature, we noted a somewha t increased incidence of patients requiring clean intermittent catheterizat ion to manage significant post-void urinary residuals. We had no patients w ith urethro-intestinal strictures who required clean intermittent catheteri zation. Conclusions: The neo-urethral tube modification appears to have a significa nt and favorable impact on urinary continence while seeming to be associate d with a trend towards an increased rate of chronic urinary retention. Long er followup will be required to determine whether this higher rate of chron ic urinary retention will remain stable or change with time.