Neobladder after cystectomy: an Indian experience

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Radical cystectomy for infiltrating bladder cancer necessitates urinary diversion.
• Continent urinary diversion aims to restore natural micturition and improve quality of life.
• Ileocolonic segments are frequently used for neobladder construction.

Purpose of the Study:

• To evaluate the efficacy and safety of an ileocolonic continent urinary reservoir constructed and anastomosed to the urethra in male patients post-cystectomy.
• To assess continence, reservoir capacity, and emptying efficiency.
• To report early post-operative complications and long-term outcomes.

Main Methods:

• Continent urinary reservoir creation using an ileocolonic segment in 30 male patients undergoing radical cystectomy.
• Anastomosis to the urethra with a retained prostatic cuff.
• Ureteric anastomosis via the "pull through" method from within the reservoir.
• Post-operative assessment of continence, residual urine, urodynamics, and complications.

Main Results:

• Complete urinary continence achieved in 29 out of 30 patients (96.7%).
• Adequate reservoir capacity (>400 ml) and satisfactory emptying (<50 ml residual urine) were observed.
• Urodynamic studies showed acceptable intra-abdominal pressures.
• Early complications included urinary leaks (3), intestinal obstruction (3), and faecal fistula (1).
• Upper tract deterioration occurred in 5 cases.

Conclusions:

• Ileocolonic continent urinary reservoir construction is a highly effective method for achieving urinary continence after radical cystectomy.
• The technique offers good reservoir function and satisfactory emptying.
• While early complications can occur, long-term survival and continence rates are promising.