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

Abstract

Introduction: Various techniques have been described for orthotopic bladder substitution. Bladder substitution with sigma is rather classed as a useful alternative standby. We report the long-term results of sigmoid neobladder in comparison to ileal neobladder with respect to urodynamic and defecation parameters. Patients and Methods: We matched 10 patients with sigmoid neobladder (mean age 62.6 ± 10.9) and 10 patients with ileal neobladder (mean age 66.4 ± 10.2). Mean follow-up for sigmoid neobladder was 8.1 ± 2.1 years and 7.2 ± 1.9 years for the ileal neobladder. Each patient was evaluated by medical history, the SF-36 questionnaire, physical examination and urodynamics. Results: Bladder capacity differed significantly between both groups (sigmoid neobladder 619 ml, ileal neobladder 422 ml). Pressure showed a slight statistical difference (sigmoid neobladder 15 ± 3 cm H₂O, ileal neobladder 18 ± 4 cm H₂O). The defecation frequency varied significantly between the two groups (sigmoid neobladder 1.1/day, ileal neobladder 3.1/day, p < 0.0001). The SF-36 questionnaire showed no significant difference. Conclusion: Orthotopic bladder substitution with sigmoid segments has shown equivalent results compared to orthotopic ileal bladder substitution. The sigmoid neobladder is a useful alternative to the ileal neobladder.

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

“…Both non-invasive and invasive UDS data are of outmost importance in the functional evaluation of patients with ONB, representing the only method to objectively assess the function of these neo-reservoirs. UDS in patients with ONB is not a new effort, since multiple studies have been conducted to investigate long-term changes in urodynamic parameters or to compare differences in urodynamic parameters between orthotopic neobladders with various intestinal segments [10][11][12][14][15][16][17][18][19][21][22][23][25][26][27]29,30,33,34,39,[42][43][44][47][48][49][52][53][54][55][56][57]64,65]. Unfortunately, the timing from the surgery to the UDS in the neobladder is usually not adequately defined.…”

“…Moreover, in all papers, both the UDS and continence outcomes are presented globally, with the patients being studied as a unique population without being subdivided by sex. Thirty-five studies include both males and females [7][8][9][10][11][12][15][16][17][20][21][22][30][31][32][33][34][35][36]38,40,41,43,48,50,51,53,55,57,58,[61][62][63][64][65], with only nineteen of them [8,[10][11][12]15,16,20,21,31,33,35,40,41,48,…”

“…The timing of continence evaluation and the adopted definitions of continence showed great variability among the included studies. The most common definition was 0-1 pads/days as adopted by 34 studies (55.6%) [8,[10][11][12]14,16,19,20,[22][23][24][25][27][28][29][30][31][33][34][35]37,39,40,44,45,47,49,52,55,56,59,[63][64][65]. In all studies, the information about voiding diaries (number of voidings per day and night) as well as the mean number of pads was lacking.…”

“…Twenty-two studies reported the use of validated questionnaires to evaluate QoL, lower urinary tract symptoms (LUTS), and continence. Only nine studies [10,[12][13][14]20,35,39,55,58,60,64] indicated which questionnaire was used (King's Quality of Life, EORTC QLQ-30, IONB-PRO, UDI-6, IIQ-7, FACT-BL score, FACT-BL, ICIQ).…”

Outcome of orthotopic sigmoid versus ileal neobladder reconstruction

“…Incidence of these complications could be decreased with the development of new procedures and refinement of the surgical techniques. [10]…”