Clinical, urodynamic and endoscopic characteristics of the stanford pouch ileal neobladder constructed with absorbable staples.
OBJECTIVE
The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated.


METHODS
A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41-70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy.


RESULTS
Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07+/-0.3 mg/dL and 1.2+/-0.4 mg/dL, respectively, but the difference was not statistically significant (P=0.1). Six months postoperatively the mean serum chloride level was 109+/-4.5 (range 100-113) mmol/L and the mean arterial blood pH was 7.37+/-0.2 (range 7.3-7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460+/-95.8mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4-15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line.


CONCLUSIONS
The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity low pressure reservoir with a low rate of complications.
Uygur
M C
MC
Urology Clinic of Ministry of Health, Ankara Hospital, Turkey. uygurdc@superonline.com
Tan
M O
MO
Altug
U
U
Yilmaz
C
C
Erol
D
D
D020341:Absorbable Implants; D000136:Acid-Base Equilibrium; D000328:Adult; D000368:Aged; D004724:Endoscopy; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000209:etiology; D019738:Surgically-Created Structures / Q000009:adverse effects; D013537:Sutures; D001743:Urinary Bladder / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014563:Urodynamics; D014570:Urologic Diseases / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000209:etiology