Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center

J Urol. 2021 Jan;205(1):174-182. doi: 10.1097/JU.0000000000001345. Epub 2020 Aug 28.

Abstract

Purpose: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience.

Materials and methods: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included.

Results: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05).

Conclusions: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate.

Keywords: cystectomy; treatment outcome; urinary bladder neoplasms; urinary diversion.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cystectomy / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Ileum / surgery*
  • Incidence
  • Incontinence Pads / statistics & numerical data
  • Intermittent Urethral Catheterization / statistics & numerical data
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Prospective Studies
  • Severity of Illness Index
  • Treatment Outcome
  • Urinary Bladder / pathology
  • Urinary Bladder / surgery
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / surgery*
  • Urinary Diversion / adverse effects*
  • Urinary Diversion / methods
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / epidemiology*
  • Urinary Incontinence / etiology
  • Urinary Incontinence / therapy
  • Urinary Reservoirs, Continent / adverse effects*
  • Young Adult