title: A new technique for creation of a sigmoid neobladder for urinary reconstruction: clinical outcome in 42 men.
abstract: OBJECTIVE
  To present the results of a new technique for construction of a sigmoid neobladder after radical cystectomy.
  
  
  METHODS
  Forty-two men, 43 to 74 years of age (mean age 62 +/- 8), underwent radical cystectomy for invasive bladder cancer and had a sigmoid neobladder created using a modification of the standard ureterointestinal anastomosis with rotation of the reservoir. The mean follow-up of this retrospective study was 35 +/- 20 months (range 6 to 90). The blood chemistry was analyzed routinely during follow-up, and complications, continence, and voiding pattern were assessed at regular intervals.
  
  
  RESULTS
  There were 21 early complications in 14 patients: persistent urinary leakage in 2; wound infection in 9; prolonged ileus in 4; leakage from the colonic anastomosis in 2; and pulmonary embolus in 2. One patient each had venous thrombus of the lower extremities and methicillin-resistant Staphylococcus aureus colitis. One patient died in the perioperative period of massive pulmonary embolus, yielding a mortality rate of 2.4%. Eleven late complications occurred in 9 patients. Stenosis of the ureterointestinal anastomosis developed in 2 of 82 anastomoses, stenosis of urethral anastomosis in 4, and neobladder-ureteral reflux in 1. A reservoir stone was found in 1 patient, and adenoma and adenocarcinoma of the reservoir occurred in 1 patient each. One patient developed symptomatic hyperchloremic metabolic acidosis, and routine electrolyte evaluation revealed a slight metabolic acidosis in 6 patients. Hypovitaminosis B(12) did not occur in any patients. Of the 42 patients, 40 could void volitionally without catheterization. Patient satisfaction on continence, by day and night, was 77.3% and 72.7%, respectively. The mean neobladder capacity and the mean residual urine volume was 375 +/- 116 mL (range 234 to 624) and 68 +/- 86 mL (range 4 to 365), respectively.
  
  
  CONCLUSIONS
  The modified sigmoid neobladder provides satisfactory results after radical cystectomy.
authors.affiliation: Department of Urology, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Sadao
authors.initials: S
authors.lastname: Kamidono
mesh_terms: D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D019738:Surgically-Created Structures / Q000009:adverse effects / Q000502:physiology*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent / Q000502:physiology; D014563:Urodynamics / Q000502:physiology