Orthotopic bladder substitution in women with an ileocolonic pouch: functional and oncological outcome

In select female patients, bladder reconstruction following cystectomy will provide a better quality of life and self-image. We reviewed our results with ileocolonic orthotopic neobladders in female patients undergoing cystectomy for bladder cancer. Impact of pathologic stage on disease outcome, urinary continence results and surgical technique are described. Because of the relative paucity in the number of female neobladders performed, reporting of our results appear warranted.

Radical cystectomy with ileocolonic neobladder was performed in 22 consecutive women with bladder cancer over a five year period. Our technique spares the urethral support mechanism and innervation of the rhabdosphincter. Patients were selected based on renal function, ability to perform self-catheterization, organ confined disease and evidence of a disease free urethra, trigone and bladder neck. A retrospective review of the functional and cancer outcome was conducted.

Postoperatively total diurnal urinary continence was achieved by 86% of the patients. Seventy-three percent of the patients had diurnal and nocturnal continence. Hypercontinence developed in 13.6% of patients. Only three patients developed advanced metastatic disease. None of the patients had evidence of local pelvic recurrence. The pathologic stage in the three patients that progressed were pT3a, pT3b, and pT2.

Orthotopic neobladder substitution in female patients with bladder cancer is an alternative to a non-continent diversion. We report oncologic outcomes similar to the traditional anterior pelvic exenteration and non-continent urinary diversion. Surgical outcomes and complications are comparable with a significant improvement in the quality of life.