Complications and functional results of standard orthotopic diversion: studer`s pouch

Objective: The purpose of this study was to evaluate early and late complications, reservoir functional outcome, continence status and upper tract functional throughout the follow up after Studer ileal neobladder

Patients and methods: Thirty two patients were included in this study and followed at a regular interval of three months for one year postoperatively. Early and late complications, urinary continence and upper tract configuration and function were evaluated. Patients were assessed by interviews and history taking, voiding diary, continence questionnaire, abdominopelvic ultrasound, IVU and urodynamic study

Results: No postoperative mortality. Early and late postoperative complications rates were 28.1% and 12.5% respectively. Out of 32 patients, febrile urinary tract infection occurred in 4 patients, prolonged urinary leakeage in 2 patients, unilateral hydronephrosis in 3 patients, urethroileal stricture in 3 patients, and metabolic acidosis in one patient. The mean functional pouch capacity increased over time from 298 +/- 65ml at 3month postoperatively to 423 +/- 93 at 9 month of follow up and became fixed thereafter. The mean post voiding residual urine estimated by ultrasound was 46 +/- 18 at 6 month of follow up. All patients underwent urodynamic evaluation at 6 and 12 month postoperative. The maximal pouch capacity was 395 +/- 75 ml with the pouch pressure at maximal capacity was 30 +/- 6 cm water at 6 month postoperative with similar value at 12 month and thereafter. Continence status improved over time, meanwhile the night time continence rate was lower than daytime, unsatisfactory night continence who need more than one pad per night was recorded in 12.5% then reduced to 3.1% at 6 month and 12 month postoperative respectively .IVU at 6 month show no upper tract ectasia or dilatation in all patients through out next follow up period

Conclusion: Studer ileal neobladder is easy and satisfactory surgical technique of orthotropic urinary diversion. It provides an acceptable rate of postoperative complications with good functional reservoir outcome and continence status while preserving upper tract function

ureteric orifice configuration and position

This study aimed at collecting more data about the configurations and positions the ureteric orifices among our patients and their clinical significance. The commonest normal shapes of ureteric openings among our patients were, the slit-shape [60% among females and 35.29% among males] then the cone-shape [17% among. females and 14.71% among males]. The horse-shoe shape [21% in females and 36.76% in males] was more common then the stadium shape [29 among females and 9.55% among males]. The golf-hole shape was the least shape met with among males 2.94% and not met with among the females studied. The normal trigonal position of the ureteric orifice. The "A" postion [20 m from the internal urethral meatus among females and 25 m among males in our measurements] was 72.79% in males and 86% in females. The "B" position [2 mm among females and 33 mm among males] was 24.26% in males and 14% in females. The "C" position [40%mm from the internal urethral meatus among males] was 2.94% in males