title: Orthotopic detaenial sigmoid neobladder after radical cystectomy: technical considerations, complications and functional outcomes.
abstract: OBJECTIVE
  In recent years the orthotopic neobladder has gained increasing popularity in patients who undergo radical cystectomy. However, there are only a few reports of orthotopic neobladders reconstructed from the sigmoid without detubularization. We investigated the complications and functional outcomes of the orthotopic sigmoid neobladder reconstructed using our detaenial technique.
  
  
  METHODS
  We performed a retrospective study of the detaenial sigmoid neobladder in 210 consecutive patients who underwent radical cystectomy at our institution from January 2003 to March 2010. ANOVA was used to investigate urodynamic finding differentials with time. Univariable and multivariable analyses were done to determine factors influencing continence.
  
  
  RESULTS
  Median followup was 48 months. Early complications (90 days or less) were observed in 65 patients (31%). Late complications (greater than 90 days) were observed in 45 patients (21.5%). Five-year daytime and nighttime complete continence rates were 74.6% and 57.1%, respectively. Younger age was the only independent factor associated with complete continence during the day (OR 2.342, 95% CI 1.803-3.041, p <0.001) and night (OR 1.193, 95% CI 1.087-1.310, p <0.001). Mean maximal capacity and post-void residual urine were 328.8 and 22.2 ml, respectively. The mean maximal flow rate was 18.5 ml per second. The mean end filling pressure, pressure at maximal capacity and maximal intravesical pressure were 35.8, 55 and 60.6 cm H2O, respectively. These parameters remained stable with time (each p >0.05).
  
  
  CONCLUSIONS
  This study confirms that detaenial sigmoid neobladder is a safe, feasible alternative for urinary diversion.
authors.affiliation: Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.forename: Chun-Xiao
authors.initials: CX
authors.lastname: Liu
authors.forename: Shao-Bo
authors.initials: SB
authors.lastname: Zheng
authors.forename: Hu-Lin
authors.initials: HL
authors.lastname: Li
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Xu
authors.forename: A-Bai
authors.initials: AB
authors.lastname: Xu
authors.forename: Bin-Shen
authors.initials: BS
authors.lastname: Chen
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014521:Urethra / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D014563:Urodynamics
keywords: DSN; IC; IN; ON; PVR; RC; SN; colon; detaenial sigmoid neobladder; ileal neobladder; intermittent catheterization; orthotopic neobladder; post-void residual urine; radical cystectomy; reconstructive surgical procedures; sigmoid; sigmoid neobladder; taenia; urinary diversion; urodynamics