title: Long-term functional outcomes in patients with a W-shaped ileal orthotopic neobladder with no antireflux mechanism.
abstract: OBJECTIVE
  To evaluate the long-term renal function, continence, and voiding function in 64 patients, surviving for 5 or more years after W-shaped ileal neobladder with a short afferent limb and refluxing ureterointestinal anastomoses.
  
  
  METHODS
  Kidney morphology and function were evaluated using nuclear renography, creatinine, and glomerular filtration rate. Continence and voiding function were evaluated with a diary on frequency, voided volumes, number of pads, and with the incontinence severity index (ISI) questionnaire, the American Urological Association-Symptom Index (AUA-SI), and the American Urological Association-Symptom Problem Index.
  
  
  RESULTS
  The renal scan showed a dilatation of the upper urinary tract in 4.8% of renoureteral units. Of the patients, 12.5% voided with intermittent or permanent catheterization. The remaining 87.5% voided spontaneously; 75% did not use pads, 12.5% used protection for safety, 7.1% 1 pad, and 5.4% more than 1 pad, during the day; during night, 55.3% did not use pads, 23.2% used protection for safety, and 12.6% and 8.9% 1 or more than 1 pad. The ISI questionnaire showed that 35.7% were fully continent, whereas 41%, 12.5%, and 10.8% had slight, moderate, and severe incontinence. The AUA-SI showed that 50% had mild, 39.3% moderate, and 10.7% severe lower urinary tract symptoms. Urinary incontinence, daytime frequency, and nocturia correlated positively with the age of patients at follow-up and negatively with voided volume.
  
  
  CONCLUSIONS
  Long-term detrimental effect on renal function of orthotopic neobladder with no antireflux anastomoses is limited. Long-term continence and voiding function results are satisfactory. The ISI questionnaire might be useful to evaluate and grade incontinence in patients with orthotopic neobladder, whereas the AUA-SI has many limitations.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: andreamine@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Chiara
authors.initials: C
authors.lastname: Mariani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pagni
authors.forename: Michele
authors.initials: M
authors.lastname: Santarsieri
authors.forename: Girolamo
authors.initials: G
authors.lastname: Morelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Giannese
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Riccardo
authors.initials: R
authors.lastname: Minervini
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000637:transplantation; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016476:Urinary Reservoirs, Continent / Q000502:physiology*; D014554:Urination