Well Gloria..if he knows how to do a lift he's the first one i know who can do it. This is one of the complications with women and neobladders that they don't bother to mention prior to surgery and its really more related to the urethra in the female.
Introduction: There is a great debate about the cause of the higher incidence of hypercontinence in women undergoing orthotopic diversion after cystectomy in relation to men.
Methods: A total of 39 females with orthotopic diversion were studied: 21 from the Theodore Bilharz Research Institute (TBRI), and 18 from the University of South Florida at Tampa (USF). Nerve preservation was attempted in all cases. Cystectomy was done with a cut across the bladder neck in the TBRI cases, while the urethral cut in the USF cases was done across the proximal urethra.
Results: Hypercontinence was found in 38% (8 of 21) of TBRI patients and in 16% (3 of 18) of USF patients. Urodynamic evaluation was done in 10 of the TBRI cases, and it was comparable to other series regarding pouch capacity (mean = 500 ml), pouch pressure (mean = 17 cm H2O at capacity), maximum urethral pressure (mean = 67 cm H2O), and maximum urethral closure pressure (mean = 49.2 cm H2O).
Conclusion: The relaxation of the striated sphincter and the contraction of the longitudinal smooth muscle opens the way for micturition. The loss of this normal coordinated reflex leads to the presence of a urethra with a fixed tone that does not open with trials of evacuation. As men and women have an intact striated sphincter, the higher incidence of hypercontinence in females compared to males is due to the presence of the extra tone of the urethral smooth muscles. This study proves that the more urethral length left, the higher the incidence of hypercontinence because more smooth muscle tone is faced during micturition. Nerve preservation has no impact because the coordinated detrusor urethral smooth muscle action is lost.
Keywords: Women, Orthotopic diversion, Hypercontinence
Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt, This email address is being protected from spambots. You need JavaScript enabled to view it. email address is being protected from spam bots, you need Javascript enabled to view it
To Cite this Article: Ismail MAA, Wishahi MM, Elsherbeeny M, Sewallam TA, Lockhart J. Hypercontinence in Women after Orthotopic Neobladder Diversion. UIJ. In Press. doi:10.3834/uij.1944-5784.2008.12.05
I've contacted several uro's and they have no solution...then i contacted one of the Gyno's at the Cleveland Clinic (#2 in Urology) about it and the answer was that the slings do not work...they barely work in women with a prolapsed real bladder. They have had some success with injecting botulism into the neobladder...some!! The Uro's are not recognising this problem with females???
Now having said that...maybe you haven't given it enough time...8 months is still a training period and even the guys have to go through that. Are you doing the kegals?
Where did you have the surgery done?
Pat
Doc says that I would need to get another surgery to get the bladder lifted as it's sitting too low which is the cause of the problem. I just wanted to see if any one out there is going through the same thing or has any information on what I should expect. It's just hard to go through another surgery again after just having gone through one major one. I just want to know if this surgery is worth having.
