Management of Stress Urinary Incontinence in the Neobladder Patient

Abstract

Considering the intent for provision of near-normal urinary function with an orthotopic diversion, issues with voiding dysfunction and urinary incontinence manifest substantial impact on quality of life for neobladder patients. Following appropriate functional and anatomic evaluation, often employing cystoscopy and urodynamics, multiple treatment strategies are available for treatment of stress incontinence in this complex patient population. Conservative modalities including pelvic floor physical therapy, behavioral therapies, and general education regarding neobladder diversion are foremost. Pharmacologic therapies may be suitable in select circumstances. Minimally invasive treatments such as transurethral bulking agents can provide improvement for women with stress incontinence following orthotopic diversion; however the risk profile may preclude use in many patients. Midurethral tape technologies, including transobturator and single incision slings, represent a comparatively recent iteration of implements to be considered. The pitfalls of fascial pubovaginal sling include navigation of complex anatomy combined with a high rate of urinary retention. In men, artificial urinary sphincter continues to exemplify an effective continence procedure following neobladder diversion with only a modestly elevated complication profile in these high risk patients. Male sling technologies are additionally gaining appreciation as an option for treatment of sphincteric dysfunction following orthotopic neobladder and forgo several drawbacks associated with artificial sphincter placement. © 2013 Springer Science+Business Media New York.