Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results

Abstract

RESULTSWhile no patients died during surgery six died (mortality rate was 5%) in the first 30 days afterward (two of them from causes unrelated to the urinary diversion surgery). The early reoperation rate was 14%; there were early complications not requiring surgery in 40 (34%) and later reoperation rate was required in 20.6%. The mean (range) maximum neobladder capacity was 550 (310-720) mL, the maximum intravesical pressure at maximum capacity 26.4 (11-48) cmH 2 O, and the minimum and maximum flow rates 25.2 (16-64) and 17.5 (11-30) mL/s, respectively. Day-and night-time continence rates were 92% and 90% after 4 years. While there was no electrolyte imbalance, there was mild to moderate metabolic acidosis in 58% of patients. There was no urethral tumour recurrence in any patient. CONCLUSIONDetubularization of ileum to form a neobladder gives a more favourable lowpressure and high-capacity reservoir. Therefore, a shorter ileal segment can be used for orthotopic urinary diversion, to avoid various metabolic dysfunctions when using detubularized bowel, but the surgery is not as free of complications as the original technique.

Urodynamic characteristics of the modified orthotopic ileal neobladder

“…In our study PVR was 16.7 mL (0-140), compared to 40 (0-150) mL and 30 mL presented in two other studies 4,5 . The median maximal flow rate in our group was 22.1 mL/s (9.7-39.5) and in Sevin´s 4 study 17.5 mL/s (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) 4 .…”

“…The median maximal flow rate in our group was 22.1 mL/s (9.7-39.5) and in Sevin´s 4 study 17.5 mL/s (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) 4 . The difference is significant and expected.…”

“…They can be heterotopic (continent cutaneous urinary diversion) and orthotopic (pouch, neobladder) 2, 3 . The modified technique consists of using a segment of the ileum around 30 cm in length, shorter than standard technique [3][4][5][6][7] .…”

Modified S-Ileal Neobladder for Continent Urinary Diversion: Functional and Urodynamic Results after 20 Years of Follow-Up

“…Although nighttime continence rates and voiding intervals in our study are better than [16,18,19,20,21] or similar to [22,23] other techniques reported in the literature, nocturnal incontinence remains a noticeable problem in bladder substitution patients. After urinary bladder removal during radical cystectomy, loss of filling sensation and destruction of feedback mechanisms are naturally expected.…”

Voiding Symptoms and Urodynamic Findings in Patients with Modified Ileal Neobladde

“…Sevin G [26] 2004 Ileal neobladder: periodical neobladder contractions Kulkarni J [9] 2003 Ileocecal neobladder: uninhibited bladder contraction or increase in reservoir pressure persistence of involuntary contractions Sigmoid: postvoid residual urine in neobladder Reddy PK [4] 1991 Sigmoid neobladder (Reddy): low neobladder capacity, lack of filling sensation, spontaneous neobladder wall contractions 8. Urethral pressure profile measurements were performed to assess the resting closure pressure of the sphincter (P clos.…”