Stanford pouch ileal neobladder: clinical, radiologic, and urodynamic follow-up

The Stanford pouch is an orthotopic neobladder which consists of a reservoir made from 30 cm of detubularized ileum and an antireflux segment based on a series of intestinal pleats. The clinical, radiologic, and urodynamic follow-up of 40 patients who have undergone the operation and have been followed for at least six months is presented. Renal function, based on serum creatinine levels, has remained stable. Voiding cystourethrograms obtained in 34 patients revealed that 38 percent of patients had no reflux. Of the 62 percent of patients with reflux, 49 percent had grades I-II/V reflux and 51 percent had grades III-IV/V reflux. Imaging of the upper urinary tracts in 32 patients revealed mild hydronephrosis in 3/64 (4.7%) of renal units. Daytime continence was attained in 95 percent of patients, and nighttime continence in 59 percent of patients. Urodynamic studies in 30 patients revealed an average capacity of 695 cc, phasic contractions whose mean pressure was less than 40 cm water, and a low basal neobladder pressure of 21.9 cm water at capacity. Twenty-four-hour voiding diaries in 24 patients revealed an average voided volume of 267 cc, a mean maximum voided volume of 445 cc, and a mean frequency of urination of one hundred eighty-two minutes. Based on these results, the Stanford pouch is a viable form of continent diversion to the urethra.