The "I-Pouch": Results of a new ileal neobladder technique

The aim of this study was to investigate perioperative, oncological and functional outcomes of the "I-Pouch" neobladder.

From 2002 to 2011, 97 patients (72 men, 25 women, median age 65, range 42-84 years) underwent radical cystectomy with I-Pouch neobladder reconstruction. Complications were graded according to the Clavien-Dindo classification. Oncological and functional outcomes were assessed. The median oncological and functional follow-up was 41 months (range 3-107 months) and 18 months (3-111 months), respectively.

In the total cohort, the 5 year cancer-specific survival was 67.9%. The major 30 and 90 day complication rates were 14.4% and 17.5%, respectively. Open reimplantation for ureterointestinal stricture was necessary in two (2.1%). Of the 95 functionally evaluable patients postoperatively, 93 urinated spontaneously (97.9%) and two patients (2.1%) required clean intermittent catheterization to empty their neobladder. The median postvoid residual urine volume (PVR) was 0 ml (range 0-200 ml). One patient had postoperative reflux (1%), as evidenced by voiding cystography. The median number of urinary tract infections per year was 0 (range 0-2) and showed no association with increased PVR (p = 0.18).

The perioperative, oncological and functional outcomes of the I-Pouch are comparable to those of other types of ileal neobladder. An advantage of the I-Pouch is that the implantation of the ureters lies on the neobladder floor, which facilitates later instrumentation of the upper tract.