Long-Term Functional and Urodynamic Results of 50 Patients Receiving a Modified Sigmoid Neobladder Created With a Short Distal Segment

Abstract

This modified sigmoid neobladder offers good daytime continence with low post-void residual and adequate daytime micturition frequency. Nighttime continence is poor. The presence of high intrareservoir pressures did not impair renal function.

Outcome of Sigmoid Compared to Ileal Orthotopic Bladder Substitution in Terms of Micturition and Defecation Parameters in an 8-Year Long-Term Follow-Up

“…The reduced level of consciousness during nighttime makes it impossible to increase the muscle tonus. In contrast to other studies, we could not find a higher pressure in the sigmoid pressure compared to the ileal neobladder [17] . Contrary to other studies, pressure values were less in the sigmoid bladder group and capacity was higher.…”

Modified S-Ileal Neobladder for Continent Urinary Diversion: Functional and Urodynamic Results after 20 Years of Follow-Up

“…Although nighttime continence rates and voiding intervals in our study are better than [16,18,19,20,21] or similar to [22,23] other techniques reported in the literature, nocturnal incontinence remains a noticeable problem in bladder substitution patients. After urinary bladder removal during radical cystectomy, loss of filling sensation and destruction of feedback mechanisms are naturally expected.…”

Voiding Symptoms and Urodynamic Findings in Patients with Modified Ileal Neobladde

“…The most frequent complication reducing quality of life of patients is incontinence, mostly occurring at night. The incidence of daily incontinence is 0-65%, while the nocturnal incontinence is between 3%, 5% and 97% [4,[7][8][9][10][11][12][13]. The reasons of this significant fluctuation can be explained by different follow-up periods, different explanation of the term 'continence', and by the dissimilar type of orthotopic urine reservoir.…”

“…Furthermore, there was an insignificant increase observed after a followup of 0.5-2 years; however after this period there was no increase detected. In the case of sigmoid neobladder, Laguna [11] detected a stabilized capacity of neobladder (about 300 ml) after a follow-up of 3 months to 5 years. In addition, Burkhard [28], who performed a urodynamic examination 9 months and 5 years separately after the surgery, could not detect increase in bladder capacity either.…”

“…The analytical protocol consisted of the following steps: Ileal neobladder: neurovascular bundle resection (decreased maximum urethral pressure and shortened functional urethral length) Burkhard FC [28] 2006 Ileal neobladder (Studer): missing urethrosphincteric guarding reflex: decrease of external urethral sphincter tonus Jensen JB [13] 2006 Ileal neobladder (Hautmann): low capacity, high neobladder pressure Laguna MP [11] 2005 Sigmoid neobladder (modified): decreased maximal urethral pressure, high neobladder pressure, low compliance Schrier B [25] 2005 Ileal neobladder: periodical neobladder contractions and decrease of urethral sphincter tonus Sigmoid neobladder: low capacity of the neobladder Skolarikos A [10] 2004 Ileal neobladder (modified): high pressure peristaltic waves override urethral resistance, decreased urethral sensitivity, decreased urethral pressure, relaxation of the pelvic floor. Sevin G [26] 2004 Ileal neobladder: periodical neobladder contractions Kulkarni J [9] 2003 Ileocecal neobladder: uninhibited bladder contraction or increase in reservoir pressure persistence of involuntary contractions Sigmoid: postvoid residual urine in neobladder Reddy PK [4] 1991 Sigmoid neobladder (Reddy): low neobladder capacity, lack of filling sensation, spontaneous neobladder wall contractions 8.…”