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Total bladder replacement using detubularized sigmoid colon: technique and results.

P K Reddy1, P H Lange, E E Fraley

  • 1Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis.

The Journal of Urology
|January 1, 1991
PubMed
Summary
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This study shows that using a detubularized sigmoid colon for bladder replacement after cystoprostatectomy offers a favorable neobladder construction. Long-term results demonstrate good reservoir function and acceptable complication rates for patients.

Area of Science:

  • Urology
  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Cystoprostatectomy necessitates bladder reconstruction.
  • Various neobladder techniques exist with differing outcomes.
  • Optimizing neobladder function and patient continence is crucial.

Purpose of the Study:

  • To report the surgical technique and long-term outcomes of total bladder replacement using a detubularized sigmoid colon segment.
  • To evaluate the efficacy and safety of this neobladder configuration.
  • To compare this technique with other neobladder types.

Main Methods:

  • Total bladder replacement performed using a detubularized segment of sigmoid colon in 27 patients post-cystoprostatectomy.
  • Surgical technique detailed.

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  • Long-term functional results and complications assessed.

    • Main Results:

    • The detubularized sigmoid neobladder was easier to construct compared to other types.
    • Surgical complications were acceptable.
    • Initial reservoir function improved over time, with average capacity of 600 cc after 1 year.
    • Low filling and capacity pressures (avg. 12 and 16 cm H2O) and satisfactory emptying (residual urine 4-80 cc) were observed.
    • Daytime continence was achieved in all patients; 67% achieved nighttime continence.
    • Two patients with persistent nighttime incontinence were successfully treated with an artificial urinary sphincter.

    Conclusions:

    • The detubularized sigmoid colon is an excellent and reliable neobladder configuration following cystoprostatectomy.
    • This technique offers favorable functional outcomes and acceptable safety profile.
    • Further improvements in reservoir function and continence are noted with time.