An urodynamic study on neobladder function

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Eight cases with neobladder after radical cystectomy for bladder cancer were analyzed regarding their urodynamic status. In 1999, we planned to analyze factors which correlated with the occurrence of upper urinary tract damage such as hydronephrasis and vesicoureteral reflux in the follow-up terms. Urodynamics included pressure-flow study and electromyography of the external urethral sphincter, while urography and voiding cystourethrography were also performed as radiological assessments. After a median follow-up of 2 years and 5 months, there are no patients who are unable to void, therefore, we could not identify the factors which relate to the efficacy of micturition. However, one case with large amount of residual urine had both daily and nocturnal incontinence, thus has been suspected of intrapelvic nerve damage which dominates the urinary sphincter other than direct sphincter injury and the fibrosis. As results of pressure-flow analysis, we found it important for voiding efficacy a shape of neobladder, position of urethroileal anastomosis and its flexibility. In 1 case, iatrogenic sphincter dyssynergia was suggested since he showed no urethral relaxation during voiding. There have been no cases with upper urinary tract damage so far. With these findings, however, we empathize the importance of careful long-term follow-up since upper urinary tract deteriration is generally multifactorial and slow to progress.