title: Videourodynamic evaluation of intracorporeally reconstructed orthotopic U-shaped ileal neobladders.
abstract: OBJECTIVE
  To study the functional outcomes of 30 patients who had previously undergone laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder reconstruction using videourodynamic (VUDM) assessment 180 days postoperatively.
  
  
  METHODS
  Between November 2010 and December 2013, 30 male patients had undergone laparoscopic radical cystectomy with bilateral standard pelvic lymphadenectomy and pure laparoscopic orthotopic ileal U-shaped neobladder diversion. The demographic data were as follows: median age, 67 years (range, 62-79); body mass index, 22.3 kg/m(2) (range, 16-26.1 kg/m(2)); and mean American Society of Anesthesiologists score 2.2 (range, 1-3). Functional outcomes were assessed performing a standard VUDM study combined with perineal floor electromyography 180 days postoperatively.
  
  
  RESULTS
  VUDM evaluations showed good functional outcomes of the reservoirs. Mean maximal neobladder capacity was 287 mL (range, 210-335 mL). Residual peristaltic activity was observed in all the individuals evaluated; however, only 9 of 30 individuals (30%) displayed severe peristaltic activity. Six of these 9 individuals (66.6%) experienced urinary leakage during these contractions. Mean postvoid residual volume was 44 mL (range, 0-105 mL), and peak flow rate was 13.9 mL/s (range, 9.7-29.2 mL/s). The Valsalva maneuver was positive in 5 of 30 subjects (17%). Bladder morphology assessed during contrast cystography showed the desired U-shape in all cases. Ureteral reflux was observed in 7 of 30 individuals (23.3%).
  
  
  CONCLUSIONS
  Based on VUDM, our study shows that U-shaped ileal neobladders achieved by a totally laparoscopic approach obtained good functional outcomes. These findings support the evidence that a minimally invasive approach does not impose technical limitations that negatively impact the surgical results.
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy; Uroresearch Association, non-profit research, Latina, Italy.
authors: Giovanni
authors: G
authors: Palleschi
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy; Uroresearch Association, non-profit research, Latina, Italy. Electronic address: antopast@hotmail.com.
authors: Antonio Luigi
authors: AL
authors: Pastore
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy.
authors: Andrea
authors: A
authors: Ripoli
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy.
authors: Luigi
authors: L
authors: Silvestri
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Histopathology Unit ICOT, Latina, Italy.
authors: Vincenzo
authors: V
authors: Petrozza
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy; Uroresearch Association, non-profit research, Latina, Italy.
authors: Antonio
authors: A
authors: Carbone
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000556:secondary / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects; D004576:Electromyography; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects / Q000502:physiology*; D014554:Urination; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000209:etiology