医学与外科泌尿学
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Reconsideration of Ileocoecal Pouch as a Neobladder Post Cystectomy with Proximal Urethra Sparing: Extended Evaluation of Continence and Morbidity in 97 Patients

Omaya A H. Nassar

Purpose: To reconsider safety and functional sufficiency of ileocoecal pouch (IC) as a neobladder post urethral sparing cystectomy (USC) in a prolonged series. Secondary aim is male to female voiding control.

Materials and methods: From 2000-2016, 97 participants (36 females) with bladder and uterine cervix cancer underwent cystectomy/anterior pelvic resection. Entirely open IC was used with modifications to add urethral length. Continence progress and morbidity were evaluated over 68 month (m). Pad-free candidate in-between voiding times beside candidates’ satisfaction were a real continence.

Results: Male total 24-hour control was (36, 59, 73 70%) after 6, 12 and 24 month and 5-years respectively. Ladies continence was (0, 12.5, 33 and 30%) for the similar time. Stress incontinence was 84% (grade II and III) at 2-min decreased to 49% (grade I) after 5-years. Capacities and voiding volumes significantly elevated 6 minutes-12 minutes; but residual volume and compliance didn’t. Females had lower bladder neck and urethral pressures than males even USC and dayand night continence were delayed significantly. Female sex and comorbidity were the main factors to delay continence while age and USC were non-significant.

Early complications (20%) were mostly Clavien-grade I and II with 2-mortality and 3-reoperation. Leak was less for USC. Late complications (17.5%) were grade II and III including 4-reoperation without rediversion.

Conclusions: IC is still a safe straightforward technique with adequate compliance and offers consistent rising continence rates with average morbidity and renal preservation. Females may not benefit control for this diversion as males and USC has no significant impact.