Urinary continence after orthotopic urinary diversion

ABSTRACT

To assess, in a retrospective study, urinary continence after radical cystectomy and orthotopic urinary diversion using two types of neobladder [sigmoid and ileal neobladder] at the Urology Department of Al-Azhar University, Cairo, Egypt. Over an 8-year period, radical cystectomy followed by orthotopic urinary diversion in the form of W-ileal or sigmoid neobladder was performed in 223 patients with invasive bladder carcinoma. Only 150 patients who survived for one year after surgery were included in this study. The voiding pattern, diurnal and nocturnal frequency of micturition and the continence rates were evaluated subjectively and objectively. Urodynamic assessment was done for 70 continent patients and all patients with diurnal and nocturnal incontinence. The mean follow-up was 23 +/- 3 [range 12-43] months. A sigmoid neobladder was created in 92 [61.3%] and a W-ileal neobladder in 58 [38.7%] patients. Diurnal continence was experienced by 87 patients [94.6%] and 54 patients [93.1%] with sigmoid and W-ileal pouches, respectively. The overall rate of nocturnal enuresis was 34.7% [52 patients]; 20.7% [31 patients] after sigmoid pouch and 14% [21 patients] after W-ileal pouch. Both sigmoid and W-ileal pouch provide good diurnal and satisfactory nocturnal continence rates. As for urinary continence, no significant difference between the two types of neobladder was detected clinically or by urodynamic studies