Bladder substitution by ileal neobladder for women with interstitial cystitis.
OBJECTIVE
To report our experience with cystectomy and ileal neobladder for women with interstitial cystitis (IC).


METHODS
Thirty-five female patients treated during 2000-2005 with the mean age of 45.9 +/- 4.4 years were included in this study. All of them had experience suprapubic pain with irritative voiding symptoms and were diagnosed as having IC based on NIDDK criteria for at least 2 years. Conservative treatments had failed to relieve their symptoms; and therefore all of them agreed to undergo a bladder removal. For cystectomy, the urethra was cut 0.5 cm below the bladder neck, proximal to the pubourethral ligament, leaving the endopelvic fascia intact. An ileal segment of 65 cm was used to create the neobladder with the Studer's technique.


RESULTS
All patients presented good treatment outcome with regard to both diurnal and nocturnal urinary control without any pain. Quality of life using the SF-36 questionnaire showed significant improvement of both physical health and mental health. Spontaneous voiding with minimal residual urine was found in 33 cases (94.3%), and the remaining 2 cases (5.7%) had spontaneous voiding with residual urine and were placed on clean intermittent catheterization (CIC). Twelve out of 30 cases with sexually active ability had a mild degree of dyspareunia but without disturbance to sexual life.


CONCLUSIONS
Bladder substitution by ileal neobladder for women who suffer from IC can be a satisfactory option after failure of conservative treatment. Resection of the urethra distal to the bladder neck can preserve continence and allow spontaneous voiding in almost all patients.
Kochakarn
Wachira
W
Division of Urology, Department of Surgery, School of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. ravkc@mahidol.ac.th
Lertsithichai
Panuwat
P
Pummangura
Wipaporn
W
D000328:Adult; D000704:Analysis of Variance; D015653:Cystectomy / Q000379:methods*; D018856:Cystitis, Interstitial / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum; D007431:Intraoperative Complications; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011788:Quality of Life; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D016476:Urinary Reservoirs, Continent / Q000502:physiology; D014554:Urination / Q000502:physiology