There are no guidelines for evaluation and management of incontinence in women with orthotopic neobladder. We propose a treatment algorithm based on our experience treating this patient population.
Women with orthotopic neobladder diversion and surgery for incontinence between 1/1/1995 to 1/1/2014 were identified. Charts were reviewed for management, outcomes, and complications within 30 days of surgery.
At this institution, 12 women with orthotopic neobladder diversion had surgery for incontinence between 1995 and 2014. 6 (50%) had undiagnosed neovesicovaginal fistula. 3 (50%) women had successful fistula repair. 12 bulking agent injections were performed in 6 (50%) women. Outcomes per injection showed 1 (8%) remained dry, 9 (75%) had transient improvement, 1 (8%) had immediate failure, and 1 (8%) developed a secondary fistula. 4 transobturator slings and 4 pubovaginal slings were placed in 6 (50%) patients. 1 (17%) was dry and 1 (17%) was improved. At median follow up 22.9 (IQR 11.1, 46.4) months, 6 (50%) were dry or improved and 6 (50%) had no improvement in leakage. Of the 6 (50%) women who were dry or improved, 2 (17%) achieved planned intermittent catheterization after surgery, and 2 (17%) had an ileal conduit conversion.
Bulking agents have low long term efficacy and carry the risk of fistula formation. Efficacy of tension-free sling placement is low; continence requires an obstructing sling. Counseling should include acceptance of multiple procedures which may be necessary to obtain continence and consideration of conduit diversion.
The Journal of urology. 2016 Jun 08 [Epub ahead of print]
George C Bailey, Andrew Blackburne, Matthew J Ziegelmann, Deborah J Lightner
Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: .