Ileal neobladder. Principles of function and continence

Area of Science:

• Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Radical cystoprostatectomy necessitates urinary diversion.
• Ileal neobladder reconstruction is an established method for bladder substitution.
• Maintaining continence and potency are key goals in bladder reconstruction.

Purpose of the Study:

• To evaluate the efficacy and safety of a specific ileal neobladder technique.
• To assess the rates of urinary continence and preservation of potency.
• To determine the long-term outcomes of this urinary diversion method.

Main Methods:

• A standardized surgical technique involving a 4-fold folded, detubularized ileal segment was employed.
• Radical cystoprostatectomy or bladder augmentation was performed in 81 patients.
• Postoperative follow-up included urodynamic investigation and assessment of micturition behavior over a mean of 12.2 months.

Main Results:

• No perioperative mortality was observed.
• Over 90% of patients achieved total daytime and nighttime continence.
• Only 5 patients experienced incontinence requiring intervention (3 stress, 2 nighttime).
• Preservation of the neurovascular bundle and external urethral sphincter was possible, potentially maintaining potency.

Conclusions:

• The described ileal neobladder technique is a safe and reliable method for urinary diversion.
• Complete detubularization and folding of the ileal segment are crucial for achieving high rates of continence.
• This approach effectively prevents upper urinary tract deterioration and preserves functional outcomes like continence and potentially potency.