Introduction and Objectives
The principles of continent urinary diversion are based on forming a reservoir of satisfying capacity, low pressure with as less as possible surface area, to reduce the risk of metabolic disorders and to obtain a favorable 24 hour voiding frequency, good capacity and small post-voiding urine residual (PVR). The standard techniques most often propose creating a pouch made of 40–60 cm of the terminal ileum. In time, there is an enlargement of the pouch capacity and PVR which results in numerous complications.
Material and Methods
Prospective and partially retrospective clinical study was designed to compare the pouch volume, the post voided residual (PVR) volume, continence, voiding frequency, maximal flow rate, acidosis and vitamin B12 deficiency 15.8 months following the operation between two groups: group I – 47 pts with a standard dimensioned pouch made of 50–70 cm of terminal ileum, and group II – 44 pts with a small pouch made using 25–35 cm of the terminal ileum. Patients were given questionnaires about voiding frequency, subjective feeling and satisfaction with continence with scale: 1 – full incontinence, 2 – unsatisfactory continence with two or more changing of pads or underwear during 24 h, 3 – satisfactory continence with one changing of pad or underwear because of continence and 4 – full continence. T-test, U test and Kolmogorov-Smirnov test were used for data analysis.
The evaluation was performed after 15.8 (14–16) months following the operation. The average age of the patients was 66.2 years. 87.91% patients were male and 12.09% were female. We used 30.78±3.77 cm of terminal ileum for creating a smaller pouch average capacity of 467 (300–710) ml with PVR 36.5 (0–147) ml, compared with 58.17±6.87 cm of terminal ileum for creating a standard dimension pouch average 832 (480–2050) ml with PVR 72.0 (0–570) (P < 0.001). 93.18% of patients with small pouch have achieved full day continence, while in the group with larger pouch 93.62% of the patients were continent during the day. Night continence was noticed at 84.09% of the patients with smaller pouch and 85.11% of the patients with larger pouch (P > 0.05). 24 hr voiding frequency in the group with smaller pouch was 6.5 vs.6.0 in the group with standard dimensioned pouch (P > 0.05). We found higher maximal flow rate in group with smaller pouch: 20.3 ml/s vs. 11.7 ml/s. We registered acidosis in 25.00% pts with smaller pouch vs. 44.68% pts with larger pouch (P > 0.05). Neither one patient in both group had vitamin B12 deficiency.
We found that 15.8 months following the surgery, smaller pouch achieved excellent capacity, satisfying continence, smaller PVR, equal 24 h voiding frequency and higher flow rate than larger pouch.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.