Orthotopic ileal neobladder reconstruction using a modified Goodwin method: functional outcome in 37 patients

Since 1996, we have been using a modified Goodwin technique for orthotopic ileal neobladder replacement. We report on the surgical technique and the voiding function of ileal neobladder in 37 patients. A small bowel segment, 50 cm in length, was resected 20 cm proximal to the ileocecal valve. The small bowel loops were then arranged in a U shape. Vodiing function was evaluated in terms of voiding pattern, continence and urodynamic study. The mean follow-up period was 18 months (range 3 to 64). The mean maximum neobladder pressure in the storage phase was 15 cm water at 6 months, 12 at 12 months, and 7 at 24 months. The mean maximal urethral closed pressure was 52 cm water at 6 months, 51.7 at 12 months, and 66 at 24 months. The mean maximal urinary flow rate was 16.2 ml per second at 6 months, 17.6 at 12 months, and 20.8 at 24 months. The mean maximal neobladder capacity was 300 ml at 6 months, 302 ml at 12 months, 382 ml at 24 months. Among the 37 patients, 30 remained completely dry day and night. Three patients were incontinent only during the nighttime, and required only one pad. Four patients were wet day and night, and required 2 pads daily. Our results indicate that the modified Goodwin method appears to be an excellent technique for ileal neobladder replacement following cystectomy and seems successful in producing balanced voiding dynamics.