Clinical Efficacy Of Orthotopic Neobladder And Morphological Changes In Mucosa Of

Obejctive:To evalulate clinical efficacy among patients who hadgone orthotopicneobladder substitution with sigmoid or ileal segments and investigate themorphological changes in mucosa of new-bladder.Methods: Continent urinary reservoirs were constructed in65patients from2006.1to2011.6. Forty patients with an ileal neobladder(IN) and25patients were received asigmoid neobladder(SN).We analyzed urinary continence,urodynamics,pouch-relatedcomplications and morphological changes in mucosa of new-bladder.Results:Complete follow-up was performed in65cases18months averagelypostoperatively．There was no perioperative fatality cases.The patients was examinedafter6months. The average reservoir capacity of IN (480±58)ml was higher than ofSN(351±51)ml(P＜0.01), the bladder filling pressure and urination bladder pressurewere lower than of SN(P<0.01). Daytime continence was87.5%in IN group and92.0%in SN group，nighttime continence was65.0%in IN group and48.0%in SN group(P＞0.05).Complications including urine leakage in4cases, mucus jammed the urethra in2cases,urinary incontinence in1case, bowel obstruction in1case,void dysfunctions in2cases,wound infectious in2cases; anastomosis stricture in4cases,hydronephrosis in2cases,chronic urinary retention in3cases,ED in6cases,pelvic metastases in1case.In those with ileal pouch, the microvillous height was (0.58±0.21)mm,(0.36±0.15)mmand (2.45±0.12)mm in short-term group,long-term group and control group. Ascompared with the control group,mucous atrophy in these patients was more severe. Inpatients with colonic pouch, the glandular depth was (0.16±0.03)mm, which weresignificantly lower than those (0.41±0.03) mm in the control group.Conclusions: A neobladder constructed from detubularized ileum achieves adequatereservoir capacity， accepted urodynamics with a satisfactory daytime continencerate．Ileum are ideal bladder substitutions.Mucosa has some morphological“adaptive”changes after the operation.