Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients

Abstract

follow-up of 55 months, after excluding two who died perioperatively. RESULTSThere were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero-intestinal stricture in four and entero-urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and nighttime continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B 12 . The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age-matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. CONCLUSIONSThe modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy. KEYWORDSsigmoid neobladder, radical cystectomy, complication, functional outcome, quality of life Study Type -Therapy (outcomes study) Level of Evidence 2c OBJECTIVESTo retrospectively review our clinical experience with sigmoid neobladder reconstruction. PATIENTS AND METHODSThe study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health-related quality of life (HRQL, using the Short-Form 36 instrument) were evaluated in 80 patients with a mean

Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction

“…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). 5,6 Furthermore, daytime and night‐time continence rates in SNB were approximately 85 and 60%, respectively, which appeared to be markedly superior to those in previously reported outcomes in SNB (Table 1). 5–7,9,10 Considering the low compliance of SNB due to the physiological features of the sigmoid colon characterized by a high pressure with powerful contraction of the thick wall, we used a longer sigmoid segment (35–40 cm) than used in other studies, resulting in an increase in the pouch volume and its compliance.…”

“… 5,6 Furthermore, daytime and night‐time continence rates in SNB were approximately 85 and 60%, respectively, which appeared to be markedly superior to those in previously reported outcomes in SNB (Table 1). 5–7,9,10 Considering the low compliance of SNB due to the physiological features of the sigmoid colon characterized by a high pressure with powerful contraction of the thick wall, we used a longer sigmoid segment (35–40 cm) than used in other studies, resulting in an increase in the pouch volume and its compliance. In addition, a small post‐void residual urine, which has been shown to influence continence with a neobladder, 10 may also have contributed to the favorable continence status in our SNB series.…”

“…It also has little effect on metabolic and nutritional status and preserves the renal function. [3][4][5][6][7] Collectively, these findings suggest that the reconstruction of orthotopic SNB could facilitate at least equivalent or even better clinical outcomes than that of INB, particularly in women, considering their favorable postoperative voiding status. Benefit of sigmoid neobladder…”

“…2 At our institution, however, sigmoid neobladder (SNB) has been preferred for patients undergoing radical cystectomy irrespective of their characteristics. [3][4][5][6][7] As previously described , 3,4 we modified several steps of the original method to create SNB in order to minimize postoperative complications. 8 For example, rotation of the reservoir upside-down and 180°horizontally provides a tension-free enterourethral anastomosis and successfully prevents urethral ischemia ( Fig.…”

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

“…In addition, 85% of patients had complete daytime incontinence [6]. In another study, Miyake et al reported that the mean maximum flow rate, voided volume, and postvoid residual volume of 82 orthotopic sigmoid NBs were 18.6 mL/s, 345.3 mL, and 24.5 mL, respectively [7]. 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].…”