Voiding dysfunction of sigmoid neobladder in women: A comparative study with men

Objective: We compared results of urodynamic testing in male and female pat ients with sigmoid neobladders following radical cystectomy to determine fa ctors important to voiding status, especially in women. Methods: Continence status, urodynamics by pressure-flow measurements, and neocystograms were evaluated in 14 male and 9 female patients. Results: Of 14 male patients, 11 (78.6%) showed acceptable urinary continen ce during the day, as did all of the 9 female patients. At night, 6 of the 14 men and 6 of the 9 women were continent with or without voiding at regul ar intervals. All 14 male patients could void volitionally during the follo w-up period. In contrast, 1 of 9 female patients required clean intermitten t catheterization to manage the large amount of residual urine. Her neocyst ourethral angle was 90 degrees and pelvic descent of the bladder (pouchocel e) was observed. The intrareservoir pressure at maximal flow was significan tly lower in female than in male patients (p < 0.05). The ratio of abdomina l pressure to intrareservoir pressure did not differ significantly between males and females. Abdominal straining generated most of the intrareservoir pressure. An increase in intrareservoir pressure was associated with urina ry flow, but the magnitude of pressure did not correlate with the peak urin ary flow. Conclusion:The location of the neobladder and avoidance of angulation at it s outlet are important for obtaining good voiding after the reconstruction of neobladder in women, but the intrareservoir pressur is less critical. Co pyright (C) 2001 S. Karger AG, Basel.