Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients

Abstract

Objectives: To retrospectively review our clinical experience with sigmoid neobladder reconstruction.

Patients and methods: The study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health-related quality of life (HRQL, using the Short-Form 36 instrument) were evaluated in 80 patients with a mean follow-up of 55 months, after excluding two who died perioperatively.

Results: There were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero-intestinal stricture in four and entero-urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and night-time continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B(12). The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age-matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients.

Conclusions: The modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy.