[Long-term urodynamic and clinical follow-up in 70 patients with ileal bladder replacement combined with an antireflux mechanism or an afferent tubular segment].
OBJECTIVE
A low-pressure ileal bladder replacement does not have any coordinated contraction during micturition, which is why we have evaluated various antireflux mechanisms in the context of a randomized prospective study.


METHODS
70 patients undergoing low-pressure ileal bladder replacement were randomized into 2 groups. An antireflux mechanism was performed in 35 patients and an afferent tubular segment was performed in the other 35 patients.


RESULTS
After a median follow-up of 57 and 45 months respectively, the functional capacity of the reservoir, incidence of urinary tract infections, urinary continence, voiding havits, and serum urea and creatinine were similar in the two groups. 11/67 (16.5%) evaluable ureteropelvic units with an antireflux mechanism and 2/69 (3%) units with an afferent tubular segment developed major dilatation due to stenosis of the antireflux mechanism or the ureteroileal anastomosis (Fisher's exact test, p < 0.009). No radiological reflux could be demonstrated during micturition in either group. A simultaneous increase of intravesical, intraabdominal and intrapelvic pressure was observed during a Valsalva manoeuvre.


CONCLUSIONS
Protection of the upper urinary tract by an ileal afferent tubular segment has yet to be confirmed in a larger series of patients with a longer follow-up. Our results show that prevention of reflux is less important in the case of orthotopic low-pressure ileal bladder replacement. Consequently, creation of an antireflux mechanism, associated with a high complication rate, is probably not justified.
Hugonnet
C L
CL
Clinique d'Urologie, Université de Berne, Suisse.
Danuser
H
H
Thalmann
G N
GN
Studer
U E
UE
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015653:Cystectomy; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
Résultats urodynamiques et cliniques à long terme chez 70 patients ayant une vessie iléale de substitution combinée à un mécanisme anti-reflux ou un segment tubulaire afférent.