The Ileocolic Neobladder: 5-Year Experience in 49 Male Bladder Cancer Patients

Kwon, Byeong San; Hart, Chang Hee; Yoon, Moon Soo

Abstract

Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for bladder cancer has been performed at our hospital. We report our 5 year experience of ileocolic neobladder with focus on complications, urodynamic data and continence status. Between May 1991 and April 1996, a total of 49 men underwent bladder replacement with an orthotopic ileocolic neobladder following radical cystectomy for management of invasive bladder cancer. Mean age of the patient .was 53.2 years (range 34-68) Mean follow up was 42 months (range 4-63). There was one perioperative death due to sepsis who had been suffered from diabetes mellitus. Early complications were developed in 8 patients (16.7%); neobladder leak in 1 (2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%), prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral anastomosis site stricture in 1 (2.1%) which was treated endoscopically, ureteral strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully treated with balloon dilation in 4 patients and with open revision in 1 patient, and neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae. Urethral recurrence was noted in 1 patient and has been managed with M-VAC chemotherapy. There was no. vesicoureteral reflux in any patient. Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2 cm H2O), large capacity (mean 553 ml) and an adequate maximal urethral closure pressure (mean 51.3 cmH2O). The peak flow rate in all patients was good (mean 11.3m/sec). All patients were dry during daytime but mild stress urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladder provides good functional results and would be one of the ideal urinary diversion for bladder substitution after radical cystoprostatectomy and will continue to be our procedure of choice in selected male bladder cancer patients.