[Clinical study of bladder replacement--multilateral evaluation of the neobladder in patients with colon bladder...

Following radical cystoprostatectomy, 32 male patients with bladder cancers underwent total bladder replacement using the detubularized right colonic or ileocolonic segment. Early postoperative complications related to the urinary reservoir occurred in 10 patients, in one of these patients, an additional other urinary diversion was required. In follow-up study with excretory urography, no upper urinary tract obstruction was detected, other than in one patient with unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphic studies detected no reflux into the upper urinary tract in any patients. Renal function, serum electrolytes and arterial blood pH were all within normal limits during the follow-up period (6-68 months). All patients were able to void well, except one who was performing intermittent self-catheterization. Of the 23 patients, day and night continence was preserved in 73.9% (17/23). Urodynamic evaluation showed the neobladder to be a low-pressure reservoir with a capacity of 300 ml or greater. Mean maximum flow rate was 15.3 ml/sec. Maximum urethral closure pressure was almost normal (mean, 62.8 cmH2O) in 12 patients. The incidences of pyuria and bacteriuria were 17.4% and 8.7%, respectively. We evaluated the postoperative life in 21 patients by scoring its condition. The scores concerning working condition and sexual life postoperatively reduced to 59.9%, and 39.2%, respectively. 14.3% of patients suffered insomnia. Other postoperative scores were not significantly different from those obtained preoperatively. These findings demonstrated that Colon Bladder Replacement is in appropriate patients an acceptable form of urinary diversion following radical cystoprostatectomy.