Clinical Efficacy Of Orthotopic Ileal Neobladder And Orthotopic Sigmoid Neobladder

Objective: To evaluate the clinical efficacy of orthotopic ileal neobladder and orthotopic sigmoid neobladder. Methods: We retrospectively reviewed the clinical data of 19 patients who had undergone orthotopic ileal neobladder and 13 patients who had undergone orthotopic sigmoid neobladder from 1999 to 2009. thirty two patients ( 28 mails and 4 femails ) .The mean age was 59 years old ( range 20～77 years old ).We analyzed the operative indications, contraindication, perioperative condition, urinary continence, urodynamics, and pouch-related complications. Results: Mean operative time was 440 minutes ( range 365～565 minutes ), mean intraoperative blood loss was 1115.6 ml ( range 400～3500ml ),and transfusion was needed in 29 case. The mean follow-up was 17.9 months( range 3～36 month).Of all the 32 patients, 3 ( 9.4% ) were lost to follow-up. One patient died of cancer metastasis and two cases died of non-cancer during follow-up. 20 patients underwent urodynamic test.The mean maximal bladder capacity was (378±57)ml ,mean maximal flow rate was (14.9±1.3)ml/s,mean residual urine was(26±8)ml at 6 months.The day time and the night time urinary continent rates at 6 months postoperatively were 93.1% (27 patients) and 82.8% (24 patients) ,respectively. All the patients voided without difficulty. Complications including bowel obstruction in 1 case , bowel obstruction and peptic ulcer in 1 case , urine leakage at ureter anastomosis in 5 cases , urinary incontinence in 4 cases , wound dehiscence in 1 case , urethral stricture in 2 cases , metabolic acidosis in 5 cases, dilatation of ureter in 4 cases, urine backflow in 2 cases.were cured correctly by conservative or surgical methods.The overall short-term and long-term complication rates were 48.3% and 55.2%. During the follow-up,no patient was detected to develop recurrent urethral carcinoma. Conclusion:Orthotopic ileal neobladder and sigmoid neobladder have wide indications, shorter recovery time and similar to physiological voiding,and both can achieve satisfactory clinical results.It is recommended to be widely used in selective candidates.