Simon J et al. (2006) Neobladder emptying failure in males: incidence, etiology and therapeutic options. J Urol 176: 1468–1472

Invasive bladder cancer is usually treated with radical cystectomy followed by urinary diversion. Most male patients undergo continent reconstruction using an ileal neobladder, which is presumed to improve their quality of life. Incontinence (i.e. neobladder storage failure) after orthotopic diversion has been described previously; however, data on neobladder emptying failure are sparse.

Simon and colleagues retrospectively analyzed data from 655 consecutive men aged 23–82 years who underwent radical cystectomy and orthotopic ileal neobladder reconstruction at a single center. Patients were followed up at 3-month intervals for the first 2 years, at 6-month intervals for the next 2 years, and annually thereafter until the end of the study or death (median follow-up 36.5 months). Neobladder emptying failure was caused by either mechanical obstruction (n = 52) or dysfunctional voiding (n = 23). Failure that required therapy occurred a median of 17 months after cystectomy.

Obstruction comprised benign strictures of the neovesicourethral junction in 23 patients, and of the anterior urethra in 11 patients. Tumor recurrence extending to the pelvic floor near the bladder neck caused obstruction in 13 patients. Obstruction by mucosal valves occurred in three patients; in the remaining two, obstruction was caused by nonurologic malignancy and a foreign body, respectively. Complete bladder emptying was restored by endourologic procedures in 38 of 52 patients; the remainder required catheterization. All 23 patients with dysfunctional voiding required catheterization.

Simon and colleagues conclude that it is mandatory to identify the underlying cause of emptying failure in each patient, so that treatment can be optimized.