Long-term Functional Outcomes of Ileal Neobladder Reconstruction Following Radical Cystectomy

ABSTRACT

PURPOSE: The aim of this study is to compare clinical and urodynamic parameters among patients undergoing orthotopic neobladder substitution with ileal segment. MATERIALS AND METHODS: Between 1991 and 2015 orthotopic bladder replacement with an ileal segment was performed 158 patients. All data were recorded retrospectively from medical records. For neobladder function, at 1-year follow-up we checked abdominal computed tomography, voiding cystourethrography, and voiding diary. Twenty-eight patients underwent urodynamic evaluation. Urodynamic data were divided into 4 groups based on follow-up duration. Preoperative (17 patients), 6 months (24 patients), 1–5 years (20 patients) and above 5 years (15 patients) after surgery evaluations were performed by urodynamic study. RESULTS: All patients were men. Mean age is 61.7 years (range, 40–72 years). Mean follow-up period is 86.7 months (range, 7–182 months). Maximum bladder capacity, maximum detrusor pressure (Pdet), and maximum urethral closure pressure improve over the time. Maximum flow rate (Qmax) is constant during the follow-up. There was vesico-ureteric reflux during voiding in 5 renal units. At day time, 23 of 28 substitution patients were completely continent. Thirteen of 28 substitutions have night time continence. Of neobladder-related complications, the most common was acute pyelonephritis. CONCLUSIONS: Long-term functional outcomes with the ileal neobladder have acceptable. The urodynamic parameters without Qmax tended to improve with the lapse of time. However, the number of patients in each group was relatively small in comparison to the numbers of orthotopic diversion. Our results support the good functional outcomes of radical cystectomy with Studer ileal neobladder.