Persistent and occasional nocturnal enuresis in orthotopic urinary diversion: is there a urodynamic difference?

Abstract

OBJECTIVETo establish urodynamic criteria differentiating between men with a radical cystoprostatectomy and ileal neobladder who are persistently enuretic and those who are occasionally enuretic. PATIENTS AND METHODSFifty enuretic men at least 1 year after a radical cystoprostatectomy and ileal neobladder (hemi-Kock or 'W' neobladders) were divided into two groups according to the persistence of their complaint; 17 men were persistently enuretic (nightly) and 33 were occasionally enuretic ( < 3 episodes/week). Both groups were compared with 50 fully continent men with similar reservoirs. Uroflowmetry, enterocystometry and urethral pressure profilometry were carried out according to International Continence Society standards and terminology. RESULTSBoth enuretic groups had significantly higher residual urine volumes, pressure at midcapacity and at maximum enterocystometric capacity, amplitude of uninhibited contractions, and lower compliance than continent men. Men with occasional enuresis also had a significantly higher frequency and duration of uninhibited contractions than continent men. Men with persistent enuresis had significantly lower average and maximum urinary flow rates than continent men, and significantly lower functional urethral length and maximum urethral pressure. Uroflowmetric and urethral pressure differences were dissimilar between men with occasional enuresis and controls. CONCLUSIONEnuretic men had significantly higher residual urine volumes and enterocystometric pressure variables than continent men. Men with persistent enuresis had significantly lower flow rates and less urethral resistance. Pharmacological inhibition of reservoir contraction and/or management of residual urine by clean intermittent catheterization before sleep might cure occasional enuresis.

Bladder, Bowel, and Sexual Dysfunction in Parkinson's Disease

“…Six months later, the transit and defecation reflex are recovered [125]. In contrast, chronic replacement of esophagus [126] or bladder [127] by a colonic segment preserves colonic motility. Pathological studies in PD have shown a degenerative lesion in the spinal parasympathetic PGN [128], although the degree is much less than that in MSA.…”

Neobladder overactivity; an equivalent to spontaneous rectal contraction

“…Previously, neobladder overactivity has been described as ‘motor movement’, 2 ‘pressure variable’, 3 or ‘uninhibited contraction’ 3,4 . Since the neobladder is made from intestinal segments, it may well exhibit SPC.…”

“…Previously, neobladder overactivity has been described as 'motor movement', 2 'pressure variable', 3 or 'uninhibited contraction'. 3,4 Since the neobladder is made from intestinal segments, it may well exhibit SPC. For use with neobladder, Lobel and colleagues 2 have compared three gut segments (ileal, ileocolic, and colic).…”

“…1 In addition, nocturnal enuresis or even urgency incontinence may appear. 1 Neobladder overactivity has been described as a causative factor for nocturnal enuresis, [2][3][4] however the origin of neobladder overactivity is still unknown. Anorectal videomanometry is the method to reproduce anorectal storage and defecation, allowing us to measure multiple physiological parameters.…”

Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy

“…Cystoscopy can help identify mucosal prolapse, anastomotic stricture, or obstruction from residual prostatic tissue with incomplete emptying and overflow incontinence. Urodynamic assessment may be helpful in rare cases to identify high-pressure contractions, in particular in patients with nighttime incontinence [11].…”