Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience

Objective To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. Materials and Methods In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversio...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2016-08, Vol.94, p.167-172
Main Authors: Yadav, Sher Singh, Gangkak, Goto, Mathur, Rajeev, Yadav, Ram Gopal, Tomar, Vinay
Format: Article
Language:English
Subjects:
Adult
Aged
Humans
Ileum - metabolism
Ileum - transplantation
Male
Middle Aged
Prospective Studies
Time Factors
Treatment Outcome
Urinary Bladder Neoplasms - surgery
Urinary Reservoirs, Continent - physiology
Urodynamics
Urology
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Summary:Objective To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. Materials and Methods In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early (3 months). Results There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H2 O and 34.6 cm H2 O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Qmax ) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%). Conclusion Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2016.04.013