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Keywords:

  • ileal neobladder;
  • quality of life;
  • serosa-lined uretero-ileal anastomosis;
  • urethral pressure profilometry;
  • urodynamics

Objectives

Functional and urodynamic (UDS) outcomes of W-configured ileal orthotopic neobladder (ONB) with extramural serosa-lined tunnel uretero-ileal anastomosis are presented

Methods

Consecutive 17 patients undergoing ONB during December 2009 to March 2011 were enrolled. Of these 15 men (bladder cancer 14, tuberculosis 1) with mean age 52.7 ± 11.3 years completed the follow-up. Pouch-related quality of life (PQOL) was assessed using a published questionnaire. Uroflowmetry, cystometry/cystography and urethral-pressure profilometry were done at two follow-up visits at least 3 months apart. Mean follow up 10 ± 5 months. Mean length of harvested ileum 48 ± 6 cm.

Results

Overall PQOL were similar at both evaluations (55 ± 11 and 54 ± 15, respectively). During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 ± 4 mL/sec, 246 ± 99 mL and 68 ± 74.9 mL and 10.4 ± 4.6 mL/sec, 234 ± 138 mL and 86 ± 146 mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 ± 244 mL, 50.5 ± 49.1 mL/cmH2O, 42 ±20 cmH2O and 22 ± 12 mm, and 468 ± 250 mL, 46.4 ± 47.5 mL/cmH2O, 52 ± 27cmH2O and 23 ± 12 mm, respectively. Patients with smaller pouch (r = 0.828; P = 0.0001), longer urethral length (r = −0.392; P = 0.023) and lesser incontinence (r = 0.429; P = 0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P = 0.058), MUCP (P = 0.05) and bothersome incontinence (P = NS) was observed. None of the patients had any obstruction or reflux of the upper tracts.

Conclusion

The index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence.