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[Low pressure bladder replacement after total cysto-prostatectomy. Apropos of a series of 40 patients].

The results of 40 consecutive patients who underwent bladder replacement following cystoprostatectomy for invasive bladder cancer are reported. A 30 cm detubularized ileal segment was used to make the neobladder. Mean follow-up was 19 months (over 2 years in 17 patients). All patients achieved diurnal continence. Nocturnal continence was obtained in 70.5% of patients: 41% had no leakage and nocturia less than 2, while 29.5% had some occasional leakage. Urodynamic evaluation showed the average peak flow to be at 18.3 ml/s and an average neobladder capacity of 410 ml. Six patients had spontaneous contractions of the enteric bladder of greater than 40 cm H20, always associated with elevated urethral pressure. Post-void residue was smaller than 100 cc in all cases. This procedure is simple to do, and led to an excellent diurnal continence, although it cannot assure nocturnal continence in every single patient.