Ileal orthotopic neobladder in women: the first experiences from Turkey and our modifications

The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy.

Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinely in the bladder neck and there were no tumour and CIS in any patient.

The mean age was 65.4 years (53-70) and the mean postoperative follow-up time was 31.8 months (6-48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in I patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence. one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%).

The results of ileal orthotopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject.