title: Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience.
abstract: OBJECTIVE
  To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder.
  
  
  METHODS
  In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early (<3 months) or late (>3 months).
  
  
  RESULTS
  There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H2O and 34.6 cm H2O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Qmax) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%).
  
  
  CONCLUSIONS
  Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.
authors.affiliation: Department of Urology and Renal Transplantation, Sawai Man Singh Medical College & Hospitals, Jaipur, Rajasthan, India. Electronic address: dryadavSMS@yahoo.com.
authors.forename: Sher Singh
authors.initials: SS
authors.lastname: Yadav
authors.affiliation: Department of Urology and Renal Transplantation, Sawai Man Singh Medical College & Hospitals, Jaipur, Rajasthan, India.
authors.forename: Goto
authors.initials: G
authors.lastname: Gangkak
authors.affiliation: Department of Urology and Renal Transplantation, Sawai Man Singh Medical College & Hospitals, Jaipur, Rajasthan, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Department of Urology and Renal Transplantation, Sawai Man Singh Medical College & Hospitals, Jaipur, Rajasthan, India.
authors.forename: Ram Gopal
authors.initials: RG
authors.lastname: Yadav
authors.affiliation: Department of Urology and Renal Transplantation, Sawai Man Singh Medical College & Hospitals, Jaipur, Rajasthan, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Tomar
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007082:Ileum / Q000378:metabolism* / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent / Q000502:physiology*; D014563:Urodynamics