INTRODUCTION: Hypercontinence following orthotopic bladder diversion occurs in up to 40% of female patients. Its cause is still debated. The purpose of the study was to compare the histological makeup of specimens biopsied from the urethroileal junction and proximal urethra in female patients with normal voiding patterns and hypercontinence following orthotopic diversion.
METHODS: The participants were 11 females who had received orthotopic diversion after radical cystectomy with a Hautmann small intestinal neobladder. One year after the surgery, 5 patients were normally voiding without significant residual and 6 patients were hypercontinent (defined as voiding with > 150 mL residual urine or inability to void). All patients had cystoscopy and biopsy from the urethroileal junction and proximal urethra. A specially configured transurethral resection loop with a very small V-shaped tip was used to minimize the biopsy. The specimens were subjected to hematoxylin and eosin stain for light microscopy and processed for electron microscopy examination. Specimens from the 2 groups were compared for: (1) presence or absence of smooth muscle fibers, their number, and their orientation; (2) presence or absence of nerve fibers and their number.
RESULTS: Examination of the specimens from both groups showed only areas of connective tissue with scattered myelinated nerve fibers and smooth muscle fibrils. No obvious difference was found between patients with normal voiding characteristics and patients with hypercontinence regarding the number or orientation of smooth muscle fibers or nerve fibers.
CONCLUSION: The high incidence of hypercontinence in females undergoing cystectomy and orthotopic diversion could not be attributed to a difference in histological architecture in the area of the urethroileal anastomosis and the proximal urethra in this small sample. The level of urethral resection appears to be the primary evidence-supported cause of this condition.
Mohamed Ismail, Mohamed Wishahi, Takek Swellam, Soheir Mansy, Hoda Yehia
Submitted August 16, 2010 - Accepted for Publication September 15, 2010
KEYWORDS: Hypercontinence; Females; Orthotopic diversion
CORRESPONDENCE: Dr. Mohamed Ismail, Department of Urology, Theodore Bilharz Research Institute, 12311 Giza, PO Box 30, Giza, Egypt ( ).
CITATION: UroToday Int J. 2010 Oct;3(5).
doi:10.3834/uij.1944-5784.2010.10.10