Reconstruction of the Lower Urinary Tract in Women after Cystectomy
Jarolím L., Babjuk M.,
Naňka O., Hanuš T., Janský M.,
Povýšil C., Dvořáček J.
Background. The first extirpation of the urinary bladder on account of malignant papilomatosis was carried out
by Karel Pawlik in 1889 as the first one in the world. At present cystectomy is indicated usually because of an
infiltrating carcinoma of the urinary bladder. The objective of the present paper is, based on anatomical investigations,
elaboration of a surgical technique of creating a orthotopic neovesica following cystectomy sparing a functional
Methods and Results. In 1993-1998 32 women were operated within the age bracket of 32-72 years with
a confirmed infiltration carcinoma of the urinary bladder. The authors describe in detail their own surgical technique.
Day continence was achieved in 20 patients. Twelve patients suffer from stress incontinence. Eight patients have
a post-micturition residue of 250-300 ml calling for a combination of medicamentous treatment and autocatheteri-
zation. The capacity of the neovesicle is the cause of nycturia: 21 patients must micturate once or twice during the
night. Urodynamic studies did not reveal significant differences between patients with chronic post-miction residues
and without residues. Also the mean functional length of the urethra was in both groups similar (27 mm in patients
with a residue and 26.2 mm in patients without a residue).
Conclusions. The elaborated surgical technique of cystectomy and creation of a neovesica makes a good quality
of the patients’ life possible.
carcinoma of the urinary bladder, orthotopic neovesicle, cystectomy, incontinence.