Orthotopic ileal neobladder: the influence of reservoir volume and configuration on urinary continence and emptying properties

• Published in: BJU international Vol. 93; no. 3; pp. 375 - 378
• Main Authors: Nesrallah, L.J., Srougi, M., Dall’oglio, M.F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-02-2004; Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Transitional Cell - surgery; Cystectomy - methods; Female; Humans; Male; Medical sciences; Middle Aged; orthotopic neobladder; outcome; Postoperative Complications - etiology; Postoperative Complications - pathology; Prostatectomy - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urinary Bladder Neoplasms - surgery; urinary incontinence; Urinary Incontinence - etiology; Urinary Incontinence - pathology; urinary reservoir; Urinary Reservoirs, Continent - pathology; Human; Nephrology; Urinary system disease; Configuration; orthotopic neobladder; Reservoir; Malignant tumor; Urinary tract disease; Transitional cell carcinoma; urinary reservoir; Ileum; Bladder cancer; Urology; Urinary incontinence; Plasty; Voiding dysfunction; Cystectomy; Treatment; Volume; Surgery; Complication; Bladder disease; Technique; outcome
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2003.04620.x

The authors from Sao Paulo describe their experience with orthotopic urinary reservoirs using segments of intestine after radical cystectomy. They felt that orthotopic ileal neobladders with a spherical configuration were not associated with better continence rates and were prone to progressive enlargement, leading to atomy and progressive failure of emptying.
OBJECTIVE
To evaluate the influence of the volume and configuration of the neobladder on urinary continence and reservoir emptying in orthotopic urinary reservoirs using intestinal segments for bladder replacement after radical cystectomy.
PATIENTS AND METHODS
Fifty‐nine patients who had had a radical cystectomy and urinary reconstruction with an orthotopic ileal neobladder were followed for ≥ 1 year; 27 (group 1) had the ileal neobladder created with a shorter intestinal segment (40 cm) in an elongated shape (‘J’), and 32 (group 2) had their reservoir made more spherical with a longer ileal loop (60–65 cm). The rates of urinary continence, enuresis, neobladder capacity and postvoid residual urine were evaluated first at 3–6 months and again 1 year after surgery in both groups.
RESULTS
At 3–6 months after surgery urinary incontinence and enuresis were more common in group 1, but at 1 year had the same frequency in both groups, at respectively 11% and 44% in group 1, and 13% and 47% in group 2 (P > 0.05). The neobladder capacity and postvoid residual urine were significantly higher in group 2, at > 600 mL and > 100 mL, respectively, in 14% and 14% of the patients in group 1 and 57% and 52% of those in group 2 (P < 0.05). Urinary retention requiring intermittent catheterization did not occur in group 1 but did in 19% of group 2.
CONCLUSION
The orthotopic spherical ileal neobladder with a large initial volume is apparently not associated with better continence rates and is prone to developing progressive enlargement, which can lead to neobladder atony and progressive emptying failure, increasing the chance of complete urinary retention.