Studer's Pouch: Clinical Experience and Evaluation

Lee, Keum Seob; Chung, Moon Kee

Abstract

Studer's pouch was evaluated clinically and urodynamically. The pouch was constructed for bladder substitution in 18 and for bladder augmentation in 2 from July 1990 to November l995. Three patients of substitution were not included in this review because of operation related death in 1 case and short period(<6 months) of follow-up in 2 cases. Mean age is 53.2(range: 22-69) years. Mean follow-up period is 22.2(range: 2-64) months. Mean cystometric capacity was 445 ml, mean intraluminal pressure at 200 ml and 400 ml filled was 12.8(range: 5-30) and 23.7(range: 5-45) cmH2O, respectively. Maximal urethral closure pressure was 54.3(range: 18-112) cmH2O in bladder substitution cases. Maximal flow rate was 19.1(range: 12.9-26.0) ml/sec. Mean residual urine was 37.8(range: 0-80) ml. Reflux into ileal limb occurred in all patient at mean volume of 227(range : 30-400) ml. Reflux into kidney occurred in 20 of 24 renal units at mean volume of 291(range : 50-450) ml, but it drained completely and rapidly in all cases. No pelvocalyceal ectatic changes were seen. Urine was sterilized in 9 patients. Recurrent bacteriuria occurred in 6 patients. All of them had been controlled by parenteral antibiotic therapy. All of 15 substitution patients were completely continent during daytime. Two had mild daytime stress incontinence in early postoperative period, but which is improved as time passing. Three of them have nighttime incontinence. One of three has intermittent incontinence and is using a diaper for prevention from bed wetting. Two have total nighttime incontinence using a kismo every night. Though longer follow-up should be needed to confirm the safety of upper tract, we think that Studer's pouch seems not only to guarantee the continence but to be rather simple and easy to perform.