[Modified intestinal in situ neobladder in functional reconstruction of lower urinary tract after radical cystectomy: report of 15 cases]

Abstract

Background & objective: Quality of life (QOL) in the patients who are performed radical cystectomy is affected by the methods of urinary diversion. The patients with continent or non-continent urinary diversion could not void by themselves and their QOL was poor. However, the intestinal neobladder in situ could provide the patients with good voiding and improve QOL. Unfortunately, some degree of poor empty and incontinence would occur in these patients. The aim of this paper was to report the authors' experience of modified intestinal in situ neobladder in reconstructing the lower urinary tract after radical cystectomy.

Methods: Reconstruction of the lower urinary tract using modified sigmoid neobladder (in 12 patients) and modified ileal neobladder (in 3 patients) was carried out in 15 patients (male 14, female 1; age 33-68 years, mean 53 years) who underwent radical cystectomy for invasive bladder cancer. The patients were followed up for 3-30 months. Nine of them were followed up for more than 16 months. Clinical outcome of these patients including the function of the neobladder, urinary function, sexual status, renal function, serum electrolytes, and QOL was evaluated.

Results: All patients voided well by themselves and did not need self-catheterization. Thirteen patients were continent in daytime and night-time. One patient was continent in daytime, but had mild incontinence at night. A female patient had moderate stress incontinence. The capacity of the neobladder was 240-640 ml and the residual volume was 0-250 ml. Renal function was normal in all patients. Serum electrolytes were normal in 14 patients. Metabolic acidosis and unilateral ureteral dilation was encountered in one patient respectively. Nine male patients restored sexual function and 13 patients came back to work. All patients felt satisfied with the function of the neobladder.

Conclusion: Satisfactory urinary continence and voiding function was achieved with modified intestinal neobladder, which was believed an ideal procedure for lower urinary tract reconstruction after radical cystectomy.