Experience with the orthotopic ileal neobladder in women: a mid-term follow-up.
OBJECTIVE
To report our experience with orthotopic bladder reconstruction in women, as currently the ileal orthotopic neobladder is the diversion of choice for women requiring a bladder substitute at our institution.


METHODS
From February 1995 to March 2001, 29 women with muscle-invasive bladder carcinoma underwent a nerve-sparing radical cystectomy and had an orthotopic ileal neobladder reconstructed. The outcome was evaluated at 2 and 6 months and then yearly, by a clinical history, physical examination, voiding diary, stress test and estimate of functional neobladder capacity.


RESULTS
All patients were followed for at least 14 months (mean 27.5); there were no major complications related to the surgery. The mean (range) neobladder capacity 2 months after surgery was 250 (190-320) mL; at 6 months it increased, remaining stable for the remaining follow-up, at 450 (350-700) mL. Four patients (14%) had nocturnal incontinence and one stress urinary incontinence, associated with using three pads per day. Three patients (10%) required catheterization for a postvoid urinary residual of >100 mL. Of the 29 patients, seven died with metastatic disease and three from causes unrelated to the reservoir or bladder cancer. Currently, 19 patients (65%) are alive and disease-free, with a mean follow-up of 35 months.


CONCLUSIONS
Orthotopic neobladder reconstruction in women, using 40 cm of ileum, is safe and gives high continence and low urinary retention rates. Therefore, it should be advised as the first option in women with good renal function and a tumour-free bladder neck.
Nesrallah
Luciano João
LJ
Federal University of São Paulo (UNIFESP-EPM), São Paulo, Brazil. nesrallahuro@uol.com.br
Almeida
Fernando Gonçalves
FG
Dall'oglio
Marcos F
MF
Nesrallah
Adriano João
AJ
Srougi
Miguel
M
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology