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Orthotopic ileal neobladder: our experience
P Cortellini1, M Larosa, S Ferretti
1Division of Urology, Azienda Ospedaliera di Parma.
Acta Bio-Medica De L'Ateneo Parmense : Organo Della Societa Di Medicina E Scienze Naturali Di Parma
|January 1, 1995
Summary
Orthotopic ileal neobladder reconstruction after radical prostatectomy offers good functional outcomes. This technique provides adequate capacity and continence, with minimal complications, preserving urethral sphincter function.
Area of Science:
- Urology
- Surgical Oncology
- Reconstructive Surgery
Background:
- Radical prostatectomy for locally advanced cancer necessitates urinary diversion.
- Orthotopic ileal neobladder reconstruction is a complex procedure with varying techniques.
Purpose of the Study:
- To evaluate the clinical and urodynamic outcomes of orthotopic ileal neobladder reconstruction using the Rouxel-Coadou technique.
- To assess the feasibility and efficacy of using staplers for neobladder creation.
Main Methods:
- Retrospective analysis of 30 patients undergoing radical prostatocystectomy with orthotopic ileal neobladder.
- Various neobladder techniques were employed, with a focus on stapler-assisted Rouxel-Coadou.
- Clinical and urodynamic assessments were conducted at regular intervals (3, 6, 12, 18 months, annually).
Main Results:
- High rates of daytime continence (achieved by 3 months) and nighttime continence (70% by 24 months).
- Preserved urethral sphincter function (MUCP 72.4 cm H2O) with absent post-void residual volume at 18 months.
- Mean neobladder capacity of 475 ml with low basal cystometric pressure (10-15 cm H2O).
- Reported complications included calculosis (2), neobladder-urethral anastomosis stenosis (2), and hydronephrosis (2) due to ureteral-ileal anastomosis stenosis.
Conclusions:
- Debutularized and bended ileum facilitates the creation of low-pressure, continent orthotopic reservoirs.
- Stapler-assisted Rouxel-Coadou technique offers simplicity and speed, beneficial for surgical staff.
- Orthotopic ileal neobladder reconstruction is a viable option for urinary diversion post-prostatectomy, achieving favorable functional results.