Detubularisation in cystoplasty: clinical review.

Cystoplasty using a detubularised bowel segment is preferable to using a tubularised length of intestine. This has been shown experimentally to result in a reduction in the contractility of the neobladder, although contractions are not completely abolished. Incontinence, especially nocturnal, may still be a problem. Assessment of renal function has shown a marked incidence of upper tract dysfunction despite detubularisation. All patients remain at risk of upper tract obstruction following cystoplasty. Because bowel contraction waves are brought on by distension, it may be possible either to postpone or to prevent the onset of contractions by avoiding an excessive build-up of bladder volume. Clean intermittent self-catheterisation is an efficient means of emptying the bladder, although sphincter rebalancing may also be required.