RESUMEN
Objectives: A prospective clinical trial to assess the functional lower urinary tract voiding outcomes after orthotopic ileal W-neobladder urinary diversion following cystectomy
Material and Methods: Between February 1999 and September 2002, a total of 19 male patients with median age of 49.5 [38-67] years, having bladder cancer, underwent radical cystoprostatectomy and lower urinary tract reconstruction by means of detubularized ileal W-neobladder [Hautmann technique] as an orthotopic diversion. We made a modification at the pouch urethra anastomosis region to create a neobladder neck with funneling to improve continence. The functional voiding outcome was determined by a detailed patient interview, urodynamic studies and radiological investigations
Results: Daytime continence was 53% in the immediate postoperative period and increased to 94% after 12 months. Nighttime dryness was 32% and improved to 74%. The median neobladder pouch capacity was 510 ml 6 months after surgery and the mean voiding volume to reservoir capacity ratio was 53%. This ratio increased to 99% after one year with rapid decrease in residual volume. Continence satisfaction was 32% in the immediate post operative period -increased to 74% after one year. The upper urinary tract function kept stable or improved in 17/19 [89.4%]. Dilatation of the pelvicalyceal and the ureter either unilateral or bilateral occurred in two patients. Six cases [31%] had early postoperative complications and did not required surgical intervention. Early post operative complications related to neobladder included [15.8%] urinary leakage and [21%] prolonged ileus. Late complications related to the neobladder was found in 8 cases [42%] included metabolic acidosis [40%], urinary retention [18%] and ureteric stricture in [10.5%]
Conclusion: Ileal W-neobladder produces good functional results and can be constructed with acceptable easily treatable complications