Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 19

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
Conclusion: Male premies void with a high degree of
dyscoordination, small volumes and Qmax values indicating
incomplete bladder emptying. Dyscoordinated voiding seems
to be part of the natural development of voiding function. This
study supports the observations made in mature newborns and
during infancy showing maturational voiding coordination.
30 Orthotopic bladder substitutes at 12 months: Which
is the best?
I Paananen1, P Ohtonen1,1 Perttila2, O Jonsson3, C Edlund3, P Wiklund4, B
Ljungberg5, KM Jensen6, E Jonsson7, W Mánsson8
'Oulu University Hospital, Dept. ofUrology, Oulu, Finland, 2University
Hospital, Dept. ofUrology, Helsinki, Finland, 2Sahlgrenska University Hospital,
Dept. ofUrology, Gothenburg, Sweden, 4Karolinska University Hospital,
Dept. ofUrology, Stockholm, Sweden, sUmeá University Hospital, Dept. of
Urology, Umeá, Sweden,6'Aarhus University Hospital, Dept. ofUrology,
Aarhus, Denmark, 7University Hospital, Dept. ofUrology, Reykjavik, Iceland,
8University Hospital, Dept. ofUrology, Lund, Sweden
ilkka.paananen@ppshp.fi
Introduction and objectives: Many techniques for orthotopic
bladder substitution have been described. The definition of
continence after the procedure varies, as do the continence rates
reported. Few studies have focused on objective functional
parameters.
Material and methods: The Collaboration Group for
Reconstructive Urology within the Scandinavian Association
of Urology performed a prospective comparative study in
men undergoing radical cystectomy and orthotopic bladder
substitution. Consecutive patients underwent enterocystometry,
uroflowmetry, pad weight test, and filled in a micturition protocol
6 and 12 months postoperatively. 78 men; 66 with an ileal bladder
(30 with a Studer Pouch (S), 24 with a Hautmann Pouch (H), and
12 with a T-Pouch (T)), and 12 with a detubularized right colonic
bladder were studied. No attempt at nerve sparing was done at
cystectomy. Patients who received adjuvant chemotherapy or
developed recurrence were excluded.
Results: Enterocystometry did not differ between the groups
with regard to volume and basal pressure at FS, ND and SD,
except for volume at SD, which was higher in colonic than in
ileal pouches (p=0.001). There was no difference in compliance.
The amplitude of contractions was higher in colonic pouches
than in ileal pouches at SD (p=0.042), but not at FS and ND.
Free uroflowmetry showed lower voided volume, lower Qmax
and higher residual urine in colonic than in ileal pouches
(p=0.01, p<0.001 and 0.059, respectively).In the flow given after
enterocystometry there were no differences. Pad or urinal was
used during the day by all patients with a colonic pouch and by
32% of those with ileal pouch (p<0.001). Within the ileal group
the figures were 19%, 41%, 56% of S, H and T, respectively.
Corresponding figures for use at night were 100 %, 68%, 65%,
and 89%. Pad weight test showed a median/mean daytime
leakage of 16/82 ml in the colonic group and 0/4 in the ileal
group (p<0.001). The figures were 0/0.05 ml, 0/11 ml, and 0/1.5
ml for the S, H and T, respectively. Corresponding figures for
nocturnal leakage were 13/60 ml for the colonic group and 4/64
ml for the ileal group (NS). The figures were 7/36 ml, 0/51 ml,
and 120/166 ml for the S, H and T, respectively. There was no
correlation between the amplitude of contractions and urine
leakage in the colonic group, nor in the ileal group. CIC was
performed by no patient with colonic bladder and by 18% of
those with an ileal bladder (NS). The figures were 7%, 36% and
22%, respectively, for those with S, H and T.
Conclusions: Right colonic pouches are inferior to those
constructed from ileum, both at enterocystometry, uroflowmetry
and clinically. The three types of ileal pouches are rather similar
in these respects, although the T-pouch was associated with
considerably greater nocturnal leakage. The variation within
each group was large, and has not yet been explained. This
warrants further studies.
31 Continent cutaneous urinary diversion with a right
colonic reservoir: Long-term follow-up
HV Holm, T Talseth, A Schultz
Oslo University Hospital, Rikshospitalet, Department ofUrology, Nonoay
henriette. veiby.hol m@rikshospi talet.no
Aim of investigation: Continent urinary diversion is an
alternative to conduit in patients who need supravesical
diversion because of severe benign dysfunction or malformation
of the lower urinary tract. The aim of this study is to assess the
result of a 19-year experience with the continent right colonic
urinary reservoir, performed and followed up according to a
prospective protocol.
Material and methods: Since 1989 all patients who received a
continent right colonic detubularized urinary reservoir were
included in the study. Parameters evaluated include functional
outcomes and complications. 91 patients are included in the
study, 68 females and 26 males, mean age at surgery 33.7
years (14 - 69). The mean follow-up was 115 months (13 - 227
months).
Results: There was no mortality related to the procedure. 75
patients (82%) experienced one or more complications, ranging
from vitamin B]2 deficiency (12%) and urinary tract infections
(16%) to surgery. In 56 patients (62%) surgery was undertaken
because of leakage (18%), catheterization difficulties (14%),
perforation of the reservoir (13%), and ureteral stenosis (11%).
Conclusion: A continent right colonic urinary reservoir is a
good alternative for urinary diversion. The rate of complications
requiring surgery was relatively high, but the majority was
minor interventions.
32 Modified Indiana pouch with umbilical stoma
R Hofmann, P Olbert, A Hegele, A Schrader
Dept. of Urology and Pediatric Urology, Philipps University Marburg,
Germany
Rainer.Hofinann@med.iini-marbnrg.de
Aim: Urinary diversion following cystectomy can be performed
either by standard ileal conduit, ileal- oder ileocecal neobladder
or a pouch with an efferent limb to the skin.
The principle of the Indiana pouch with a tapered terminal
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