Long-term urodynamic and functional analysis of orthotopic "W" ileal neobladder following radical cystectomy.
OBJECTIVE
In this study, we evaluated the long-term functional outcomes and urodynamic results of the "W" orthotopic ileal neobladder.


METHODS
Twenty patients whose long-term follow-up data were available and willing to participate in this project were enrolled into the study. The operations were performed between 1997 and 2005. Following standard radical cystoprostatectomy and pelvic lymphadenectomy, "W"-shaped orthotopic ileal neobladder with extramural serous-lined tunnel ureteral implantation was performed. Urodynamic evaluation consisted of standard three-channel filling cystometry with 0.09% sodium chloride solution, and uroflowmetry with postvoiding residual (PVR) urine measurement.


RESULTS
All patients were men. The mean duration to postoperative urodynamic study was 38.5 months. Mean cytometric capacity (MCC), compliance, maximal pouch pressure (MPP) and PVR were 584.7 ml, 42.4 ml/cmH2O, 34.8 cmH2O, and 83.5 ml, respectively. Seventeen patients (85%) had complete daytime continence. Total continence (nighttime and daytime) rate was 40%. Three patients (15%) were totally incontinent. Pearson correlation test revealed a positive correlation between MCC and compliance (P<0.05). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethrapouch anastomosis stricture was found to be significantly related with increased PVR. Continence status was not correlated with any urodynamic parameter.


CONCLUSIONS
In this study, we found that "W" ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. Urodynamic evaluation of the "W" neobladder revealed similar results to that of a normal bladder. We conclude that "W" ileal neobladder construction results in a near-normal-functioning orthotopic reservoir that can be safely offered to patients.
Marim
Gungor
G
Department of Urology, Ataturk Research and Training Hospital, Yesilyurt, Izmir 35360, Turkey.
Bal
Kaan
K
Balci
Ugur
U
Girgin
Cengiz
C
Dinçel
Cetin
C
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics