The Ileocolic Neobladder: 5-Year Experience in 49 Male Bladder Cancer Patients / 대한비뇨기과학회지

Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for bladder cancer has been performed at our hospital. We report our 5 year experience of ileocolic neobladder with focus on complications, urodynamic data and continence status. Between May 1991 and April 1996, a total of 49 men underwent bladder replacement with an orthotopic ileocolic neobladder following radical cystectomy for management of invasive bladder cancer. Mean age of the patient .was 53.2 years (range 34-68) Mean follow up was 42 months (range 4-63). There was one perioperative death due to sepsis who had been suffered from diabetes mellitus. Early complications were developed in 8 patients (16.7%); neobladder leak in 1 (2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%), prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral anastomosis site stricture in 1 (2.1%) which was treated endoscopically, ureteral strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully treated with balloon dilation in 4 patients and with open revision in 1 patient, and neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae. Urethral recurrence was noted in 1 patient and has been managed with M-VAC chemotherapy. There was no. vesicoureteral reflux in any patient. Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2 cm H2O), large capacity (mean 553 ml) and an adequate maximal urethral closure pressure (mean 51.3 cmH2O). The peak flow rate in all patients was good (mean 11.3m/sec). All patients were dry during daytime but mild stress urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladder provides good functional results and would be one of the ideal urinary diversion for bladder substitution after radical cystoprostatectomy and will continue to be our procedure of choice in selected male bladder cancer patients.

Urodynamic Analysis of the Ileocolic Neobladder / 대한비뇨기과학회지

From May 1991 to December 1993, 30 male bladder cancer patients with 34 to 68 years old age (mean age 52.4 years) underwent bladder replacement with the ileocolic neobladder. A divided segment of ileum and colon was used to create a neobladder after radical cystectomy with a cecourethral anastomosis to provide volitional voiding with continence. Urodynamic studies were followed up 3, 6, l2 and 18 months postoperatively. The mean maximal reservoir capacity was 420+/-87.7, 553+/-65.3, 565+/-60.3, 563+/-53.5ml, mean maximal reservoir pressure was 33.2+/-7.5, 24.2+/-6.1, 24.0+/-5.9, 23.1+/-6.3cmH2O, mean maximal urethral closure pressure was 57.9+/-9.5, 61.3+/-7.6, 61.0+/-7.3, 61.5+/-6.9cmH2O, maximal flow rate was 23.2+/-7.2, 24.3+/-5.8, 24.0+/-6.1, 24.1+/-5.4ml/s and residual urine was 40.0+/-10.3, 35.0+/-7.8, 24.0+/-6.1, 24.1+/-5.4ml/s. The daytime continence rate was 100% and the nighttime continence rate was 93% at 6 months postoperatively. With its very good functional results and its ease of performance, ileocolic neobladder may be one of the ideal urinary diversion for bladder substitution after radical cystectomy.

Urinary diversion in conjunction with radical cystectomy in bladder cancer patient / 대한비뇨기과학회지

Several different methods of urinary diversion currently are available in conjunction with radical cystectomy. We reviewed our last 30 months of experience with diversion in 56 patients with bladder cancer undergoing surgery from May, 1990 through October. 1992 and focused on the decision- making process used to select the type of diversion. The results obtained were as follows. 1. Of the 56 patients. 27 patients had a diversion with an external appliance (26 via an ileal conduit and 1 via a cutaneous ureterostomy), 15 patients had a diversion with a continent urinary reservoir(Indiana pouch) and 14 patients had a diversion with an internal reservoir anastomosed to the urethra( 13 via an ileocolic neobladder and 1 via a Camey procedure). 2. The ileal conduit was evenly performed during the period. But the Indiana pouch was more performed between May 1990 and April 1991 and the ileocolic neobladder was mainly per formed since May 1991. 3. There were 50 men and 6 women. The majority of female patients (83%) underwent the Indiana pouch. The ileocolic neobladder was performed in patients who were relatively young and in good medical condition. 4. Urodynamic studies of the Indiana pouch and ileocolic neobladder performed at 6 months postoperatively showed low pressure, large capacity reservoir and high outlet (plicated ileum or urethra) resistance. All patients achieved satisfactory continence during the day. However.1 or 13 patients who underwent the ileocolic neobladder was incontinent at night. In conclusion. there are inherent advantages and disadvantages to each form of urinary diversion. Our general policy is the ileal conduit remains the most wise diversion in most patients but the alternative methods may be reasonable in certain circumstances and patients selection will be important to identify the most appropriate method of diversion for individual. Though the follow-up period is not long enough. Indiana pouch and ileocolic neobladder met the demands for ideal form of urinary diversion. With improvement in the technical aspects or the continent and internal functional reservoir, the number of patients having these reservoirs will increase.