Long-term urodynamic evaluation of a continent urinary reservoir

Objective: To characterize urodynamic changes among patients who underwent a continent urinary reservoir (Florida Pouch). Methods: Patients who had a continent urinary diversion performed between January 1988 and December 1991 were asked to undergo sequential urodynamic evaluation to compare early (≤24 mo) versus late (>24 mo) changes in reservoir function. The difference in reservoir function was evaluated by defining change in maximum enterocystometric capacity of ≥100 mL, changes in pressure of 5 cm H 2O, changes in segmental contractions were ≥3. High pressure contractions were those ≥30 mm H 2O. Results: Seventeen patients underwent sequential urodynamic evaluation. The mean timing of the early study was 12.2 months (range 3–24 mo). The mean timing of the late study was 47.1 months (range 30–58 mo). The mean capacity of the reservoir initially was 698 mL (range 474–1000 mL). On long-term study the mean was 793 mL (range 400–1000 mL). The capacity remained unchanged or increased in 88% of patients. The pressure within the reservoir remained unchanged in seven patients, decreased in eight, and increased in two. Segmental contractions originally occurred in 15 patients with 11 low pressure and 4 high pressure type contractions. On long-term evaluation, 13 patients demonstrated contractions with 10 low pressure and 3 high pressure in character. Of note, 75% of those with initial high pressure contractions had no (1) or low pressure (2) contractions on subsequent evaluation. Conclusion: In long-term urodynamic evaluation of the continent urinary reservoir the reservoir capacity remained unchanged or increased in 88% of patients, while reservoir pressure remained unchanged or decreased in 88%. This long-term evaluation, therefore, demonstrates the continent urinary reservoir to be a low pressure system of adequate capacity thereby minimizing the risk of reflux.