Clinical Characteristics of Ileal Neobladder

Seo, Seong Il; Cho, Kyu Seon; Pyun, Seok Soo; Kim, Dae Young; Lee, Hae Won; Kim, Hyeon Hoe; Choi, Hwang; Kim, Si Whang; Lee, Sang Eun

Abstract

PURPOSE: To evaluate clinical characteristics of ileal neobladder as orthotopic bladder substitution, we examined the urodynamic characteristics, clinical symptoms and radiologic findings of 11 patients who had undergone ileal nobladder substitution following cystectomy or cystoprostatectomy. MATERIALS AND METHOD: From February 1993 to July 1996, 11 patients underwent lower urinary tract reconstruction with ileal neobladder. Cystectomy or cystoprostatectomy was done, and reservoirs were connected to the proximal urethra or urethrovesical junction. Urodynamic and radiologic studies were performed to evaluate neobladder function and upper tract. Clinical symptoms were evaluated via a detailed patient questionaire.
RESULTS
Mean cystometric capacity was 434m1(293-640m1). All patients voided by Valsalva maneuver and achieved good peak flow rates(mean value was 22.6m1/sec). Of the patients 10 emptied bladder to near completion with a mean post-void residual of 30m1, while 1 had post-void residuals of 110m1 The neobladder demonstrated good compliance for the storage of urine Phasic neobladder contractions were present during filling cystometrography. While the number of phasic contractions increased at higher neobladder volumes, the mean length and mean pressure of phasic contractions were not Increased a higher neobladder volumes. Daytime continence was obtained in all patients(100%), while nighttime continence was achieved in 8 patients (73%). Of these 8 nighttime continent patients, 4 patients(50%) had to void at least once a night to keep dry. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. There was no difference in any important urodynamic parameter between patients who had and had not received post-operative chemotherapy. Renal function, based on serum creatinine levels, had remained stable and no significant electrolyte or acid-base imbalance was found in all patients. Voiding cystourethrograms obtained in 9 patients revealed 3 patients(33%) had grades ll-lll/V reflux IVP in 9 patients revealed hydronephrosis in 1/18(5.5%) of renal units.
CONCLUSIONS
Neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. We conclude that neobladder may be the best choice of urinary diversion after cystectomy in the aspect of quality of life.