The 'pitcher pot' ileal neobladder: early experiences.
OBJECTIVE
To analyse initial results of newly designed ileal neobladder-a modification of Studer neobladder


METHODS
Twenty-four patients with urinary bladder cancer underwent radical cystoprostatectomy from February 2005 to March 2006. Twenty-one of them had urinary diversion using ileal neobladder in spherical configuration with ileal neourethra (giving the shape of an inverted Indian earthenware container called a 'pitcher pot') to circumvent the problem of short mesentery and construct a low-pressure spherical ileal neobladder.


RESULTS
Early post-operative complications occurred in 42% of patients. Late complications occurred in 23% of patients. Most of these complications were minor, mainly as a result of wound infection, urine leak or urinary tract infections and were managed conservatively. No early post-operative mortality was observed. Daytime continence was achieved in 100% of patients who completed the 1 year follow-up. Night-time continence was variable as it depended on timed voiding--75% of patients achieved nocturnal continence by 1 year. The functional neobladder capacity was 426 ml. The mean post-operative residual volume was 36 ml. Three patients required cystoscopic mucus evacuation and catheterization. None of them required clean intermittent catheterization. No significant metabolic disturbance occurred in any patient.


CONCLUSIONS
Length of mesentery remains one of the factors in deciding the segment of intestine to be taken for neobladder. Ileal neourethra gives about 2-3 cm extra length to perform tensionless anastomosis, which is a key factor in the smooth recovery after such major surgery and also maintains optimum urodynamic features of neobladder.
Rawal
Sudhir
S
Department of Urooncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi 110085, India. dr_rawal@yahoo.com
Kumar
Prem
P
Kaul
Rakesh
R
Raghunath
S K
SK
Julka
Saurabh
S
D000328:Adult; D000368:Aged; D015653:Cystectomy; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D016055:Urinary Retention / Q000209:etiology; D014563:Urodynamics