title: Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience.
abstract: OBJECTIVE
  The aim of this study is to compare urodynamic and continence parameters among patients undergoing orthotropic neo-bladder substitution with sigmoid or ileal segments. Variations in the Urodynamic parameter between the continent and incontinent patients were also evaluated.
  
  
  METHODS
  From January 2008 to March 2012, 44 patients underwent ileal neobladder (IN) reconstruction and 36 patients underwent sigmoid neobladder (SN) reconstruction. Evaluation of Urodynamic and Continence parameters was performed at 12 months after surgery.
  
  
  RESULTS
  The average capacity of IN and SN was 510 ml and 532 ml respectively. The voiding pressure, mean peak flow rates and post void residual urine (PVRU) for IN and SN were 27.5 cm H2O versus 37 cm H2O, 15ml/s versus 17ml/s and 36 ml versus 25 ml respectively. Daytime continence for IN and SN was 93% (41/44) and 89% (32/36), and night-time continence was 91% (40/44) and 78% (28/36) respectively. The compliance, maximum cystometric capacity and PVRU in the daytime continent (versus incontinent) were 61 (versus 41), 471 (versus 651) and 22 (versus 124) and in the night-time continent (versus incontinent) were 57 (versus 43), 437 (versus 654) and 18 (versus 105) respectively.
  
  
  CONCLUSIONS
  A neobladder constructed from detubularized ileum or sigmoid achieves urodynamically proven adequate capacity and compliance with 89-93% daytime and 78-91% night time continence. Continent men when compared with incontinent (both daytime and night time) were more likely to have comparatively higher compliance, lower maximum cystometric capacity and lower PVRU. Urodynamic study could predict which incontinent men would improve with pelvic floor exercises and clean intermittent catheterization (CIC).
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Swarnendu
authors.initials: S
authors.lastname: Mandal
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Patil
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Rahul Janak
authors.initials: RJ
authors.lastname: Sinha
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Dheeraj Kumar
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Department of Urology, King George's Medical University (erstwhile Chattrapati Shahuji Maharaj Medical University), Lucknow, Uttar Pradesh, India.
authors.forename: Satya Narayan
authors.initials: SN
authors.lastname: Sankhwar
keywords: Ileal neobladder; nonrandomized; prospective; sigmoid neobladder; urodynamic