Jillo..cannot compare male neobladder to success rates in female neobladders.......there is no comparison. Men have a longer urethra so better outcomes but even if they don't want to admit it they generally have to cath at some point. A bit easier for a guy to cath...got a better eye for the target as we do not. One of the problems with females is we have lost all support down there...no uterus...nada...it prolapses thus it doesn't empty properly and there is no valve to keep it from backing up into the kidneys and causing UTI's. The surgeons won't recommend it because very simply they don't know how to do it....and besides they're usually men and its a manly thing to pee with your penis. True rates are not published out there on females and neo's....at best its a 33% success rate and i'll bet Dr. Koch has all of them. I've had an Indiana for 7 l/2 yrs now with a naval stoma...no bulges anywhere so its not obvious at all....i have it trained to go every 4 to 6 hrs during the day and i sleep all night......i'll put those stats up with anyone with a neo!
The surgeons who do know how to do the Indiana will come right out and tell you that its the best conversion for a female and they know how to do all 3 conversions. Shame on Mayo.....they're wrong.
Most investigators have reported on a single type of diversion. Over the years, Santucci et al. [8•] have suggested that a variety of configurations might be appropriate and therefore have constructed five different continent urinary reservoirs when required. They reported long-term continence rates and compared urodynamic results in a series in which the senior surgeons performed a variety of different continent urinary reconstructions [8•]. Stomal urinary reservoirs had the best continence rates (Indiana pouch 100%, Mainz pouch 91%). Neobladder continence rates were as follows: Hautmann 80%; Mainz 75%; sigmoid 50%; and gastric 33%. Compared with the other pouches, gastric and sigmoid reconstructions had the smallest capacity, were the least compliant and were the most contractile. Stomal urinary reservoirs using ileocecal valve and right colon, with or without an overlying patch of ileum, provided similar excellent results. Continence approached 100% in compliant patients without the need for revision. Patients with neobladders were less continent, although those with ileal or ileocecal configurations still had very good continence rates. Neobladders of sigmoid or stomach can be used when necessary, but with greater incontinence rates. This poorer continence can be explained by the decreased capacity, decreased compliance and a tendency toward high pressure spikes despite detubularization"
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