Detubularized sigmoid neobladder versus detubularized W-shaped ileal neobladder as a bladder substitute after radical cystectomy for carcinoma of the urinary bladder: a study of 60 patients.

OBJECTIVES

To compare the urodynamic parameters, continence rates, and complications between two different continent urinary reservoirs-the sigmoid neobladder (SN) and W-shaped ileal neobladder (IN).

MATERIAL AND METHODS

Sixty patients with bladder cancer underwent radical cystectomy and were divided into two groups. The first group comprised 33 patients who underwent detubularized sigmoid neobladder surgery. The second group included 27 patients who underwent detubuarized W-shaped ileal neobladder surgery.

RESULTS

Early post-operative complications occurred in 42% of patients in the sigmoid neobladder (SN) group and in 33% of patients in the ileal neobladder (IN) group. Most of these complications were minor, mainly due to wound infection or urinary leak, and were managed conservatively. No early post-operative mortality occurred in patients of either group. Day-time continence was achieved in 78.8% and 74% of patients in the SN group and the IN groups, respectively. Night-time continence was achieved in 45.5% of patients in the former group and 59.3% of patients in the latter. The mean neobladder capacity was 472.5cc in patients who underwent detubularized SN surgery and 463.8cc in patients who underwent detubularized IN surgery. The mean post-voiding residual volume was slightly lower in SN group (90.1cc) than in those of IN group (93.7cc). The pelvicalyceal systems were preserved in 94% of patients in the SN group and in 96.3% of patients in the IN group. No significant metabolic disturbances occurred in patients of either group.

CONCLUSIONS

Both methods are good alternatives as a bladder substitute. Surgeon preference, ease of construction and length of mesentery are among the factors that must be considered when choosing between them.