Long‐term functional outcomes in patients with various types of orthotopic intestinal neobladder

Abstract

Objectives:To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB). Methods: Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively. Results: Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups. Conclusions: Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based.

Functional Assessment of the Hautmann Ileal Neobladder with Chimney Modification Using Uroflowmetry and a Questionnaire

“…The mean maximum NB capacity, PVR, and maximum flow rate were 413.2 mL, 43.7 mL, and 20.8 mL/s, respectively, as listed in Table 2. According to previous studies, the mean maximum NB capacity, PVR, and maximum flow rate were 240.4–628.9 mL, 22.7–91.0 mL, and 11.2–18.6 mL/s, respectively, which are similar to the results of this study [6–8, 10]. We attempted to evaluate the uroflowmetry patterns using the previously presented classifications.…”

“…Daytime and nighttime continence rates were 88% and 71%, respectively, which were comparable to those reported in other studies (87–93% and 57–86%, resp.) [6–8, 10]. Lower nighttime continence rates presumably result from the absence of the sphincter-detrusor reflux, decreased rhabdosphincter tone, and increased diuresis at night; this theory supports our results indicating that none of the patients used pads only during the day [20].…”

“…Zhong et al reported that the mean maximum flow rate, voided volume, and postvoid residual volume of 56 “U-shaped” ileal NBs were 16.2 mL/s, 317.9 mL, and 22.7 mL, respectively [10]. Most studies report daytime and nocturnal continence rates of 87–96% and 57–86%, respectively [6–8, 10]. …”

Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction

“…Of the several problems associated with neobladder, voiding dysfunction probably has the most adverse impact on a patient's postoperative satisfaction. In general, despite an unfavorable continence status, particularly night‐time continence, SNB is likely to acquire an adequate voiding status by emptying the reservoir 7,9,10 . Furthermore, in our series the favorable voiding status of SNB was confirmed; that is, more than 90% of the patients could void spontaneously, and their post‐void residual urine was less than 25 mL (Table 1).…”

Early and late urodynamic assessment of the orthotopic N-shaped neobladder

“…Neobladder substitution has currently become the standard for urinary diversion due to good long-term functional results (13–15). Various segments of bowel have been used extensively for bladder augmentation or replacement, including detubularized ileum, detubularized sigmoid colon and the right colon with or without a patch of ileum.…”