Background: Radical cystectomy with orthotopic neobladder reconstruction in women is now an accepted urinary diversion in selected patients. Up to 20% of patients may experience stress urinary incontinence (SUI) following this procedure. Few reports have addressed the management of SUI. We present our experience with the surgical treatment of SUI following radical cystectomy and orthotopic neobladder reconstruction in women.
Methods: Between 1998 and 2004, 6 female patients, ages 36-73, developed persistent SUI after radical cystectomy and orthotopic neobladder reconstruction. Three patients had high-grade, muscle invasive transitional cell carcinoma and 3 patients had cervical carcinoma (all patients treated with preoperative external beam radiotherapy). Surgical treatment included transvaginal sling with bone anchors and cadaver dermis, pubovaginal sling with autologous fascia, and pubovaginal sling with synthetic mesh.
Results: A total of 8 procedures were performed in the 6 patients (2 required two procedures). Three patients underwent transvaginal sling with bone anchors and cadaveric dermis, 3 patients underwent autologous pubovaginal sling, and 2 patients underwent pubovaginal sling with synthetic mesh. Three patients (50%) required an ileal conduit including all patients receiving preoperative external beam radiotherapy. Three patients are dry with intermittent catheterization of which 2 underwent pubovaginal sling with synthetic mesh and the other a autologous fascial pubovaginal sling (follow-up 4-18 months). There were no significant postoperative complications. See table.
Conclusions: Postoperative SUI can exist following radical cystectomy and orthotopic neobadder reconstruction. Optimal treatment has yet to be defined. In this small series, we have demonstrated that pubovaginal fascial or synthetic mesh slings can be curative in a select group of patients, although long term IC is required. Patients who receive preoperative radiation however fared poorly, ultimately requiring ileal loop diversion.

Patient	Age	Diagnosis	Surgery/Diversion	Radiation therapy	Type of sling	Results
1	36	cervical cancer	Anterior exenteration/ileal neobladder	Yes	transvaginal sling with bone anchors/cadaver dermis	ileal conduit
2	39	cervical cancer	Total pelvic exenteration/ileal neobladder	Yes	transvaginal sling with bone anchors/cadaver dermis	local pelvic recurrence; ileal conduit
3	51	cervical cancer	Anterior exenteration/ileal neobladder	Yes	1.) transvaginal sling with bone anchors/cadaver dermis; repair of neobladder vaginal fistula; Martius flap 2.) pubovaginal sling with autologous fascia	ileal conduit
4	73	TCCa of bladder	Anterior exenteration/ileal neobladder	No	pubovaginal sling with autologous fascia	dry with IC
5	52	TCCa of bladder	Anterior exenteration/ileal neobladder	No	1.) pubovaginal sling with autologous fascia 2.) pubovaginal sling with synthetic mesh	dry with IC
6	49	TCCa of bladder	Anterior exenteration/ileal neobladder	No	pubovaginal sling with synthetic mesh	dry with IC

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