Ileocecal with teniamyotomies and ileal detubularized neobladders: Considerations about a videourodynamic study after a long-term follow-up

Objective. To evaluate the functionality of ileal detubularized reservoir and ileocecal neobladder with multiple teniamyotomies after a long term follow-up. Material and Methods. Eight patients with ileal detubularized reservoir (IR) and 10 with ileocecal neobladder with multiple teniamyotomies (ICUS) with an average follow-up of 95 months, were submitted to a videourodynamic digital fluorongiographic examination. The patients had the longest disease-free follow-up of our series. Results. Urodynamic data collected were almost good and comparable between IR and ICUS. Anyway the exams showed that the smooth intestinal muscles remain active both in non-detubularized and detubularized bladders even after years. Continence is mostly assured by the striated sphincter, which can withstand transient high pressure peaks but is less effective when facing prolonged pressure increases. While in some cases a valid micturition was achieved simply relaxing the perineal floor, in other cases micturition was obtained by an abdominal straining against the resistance of a contracted urethral sphincter/pelvic floor even after a long follow-up. Conclusions. Detubularization and teniamyotomies can equally help the striated sphincter function by increasing the neobladder compliance. Moreover we observed that a non-spherical neobladder was compatible with good clinical results as well, proving that neobladder shape was less important in achieving good functional performance. Furthermore, in some cases the optimal relaxation of the perineal floor made abdominal straining superfluous especially when neobladders had physiological capacity. Thus a perineal floor musculature training and its co-ordination with abdominal muscles may improve the quality of micturition.