Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results.
To present our experience with a sigmoid orthotopic neobladder.



We retrospectively evaluated the functional and oncological outcomes of 160 patients who underwent orthotopic neobladder reconstruction using a detubularized 20-25-cm sigmoid segment at our institution. Each patient was evaluated every 3 months the first year, every 6 months for the next 4 years and annually thereafter. Urodynamic studies of all consenting patients were carried out after 6 months, and 2, 5 and 10 years. We carried out the log-rank test, and used Cox regression models and Kaplan-Meier survival analysis. The anova test was used to compare urodynamic findings over time.



Mean follow up was 6.8 years (range 0.65-21.7 years). Overall survival was 58.1% at 5 years, and 47.1% at 10 years. Early complications occurred in 36 patients (22.6%); late complications in 40 (25%). Stage V chronic kidney disease developed in two patients (1.3%). Complete (daytime and night-time) continence, defined as no need for pads or condom devices, was achieved by 45% of patients at 5 years, daytime continence was achieved by just 36% of patients; both were unchanged at 10 years. A significant difference emerged in maximal neobladder capacity and post-void residual values between 6 months and 2 years, and between 2 and 5 years (P < 0.01 and P = 0.03, respectively).



Sigmoid neobladder continence and capacity significantly improve over the first 5 years, and they remain stable over the long term. Upper urinary tract function is not affected by endoluminal pressure, and the rate of metabolic imbalance is negligible.
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Giulio
G
Nicita
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Alberto
A
Martini
Department of Urology, Azienda Sanitaria Locale Cn1, Savigliano, Italy.
Maria T
MT
Filocamo
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy.
Calogero
C
Saieva
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Aldo
A
Tosto
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Niceta
N
Stomaci
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Barbara
B
Bigazzi
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Donata
D
Villari
D012809:Colon, Sigmoid / Q000601:surgery*; D015653:Cystectomy; D005500:Follow-Up Studies; D006801:Humans; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics
bladder cancer; functional results; orthotopic bladder substitute; reconstructive surgical procedures; sigmoid neobladder