1. Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience
- Author
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Goto Gangkak, Ram Gopal Yadav, Rajeev Mathur, Vinay Tomar, and Sher Singh Yadav
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Bladder capacity ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Urine flow rate ,Ileum ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Urinary Reservoirs, Continent ,Urinary diversion ,Metabolic acidosis ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Urodynamics ,Treatment Outcome ,Urinary Bladder Neoplasms ,Ileal segment ,030220 oncology & carcinogenesis ,business - Abstract
Objective To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. Materials and Methods In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early ( 3 months). Results There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H 2 O and 34.6 cm H 2 O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Q max ) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B 12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%). Conclusion Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.
- Published
- 2016
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