LONG-TERM FUNCTIONAL AND URODYNAMIC RESULTS OF 50 PATIENTS RECEIVING A MODIFIED SIGMOID NEOBLADDER CREATED WITH A SHORT DISTAL SEGMENT

ABSTRACT 

Purpose

We assessed the long-term functional and urodynamic outcomes of a modified sigmoid neobladder.

Materials and Methods

A total of 50 patients received a sigmoid neobladder with a short distal segment after radical cystoprostatectomy. Patients were followed at 3-month intervals the first year and every 6 months thereafter. Continence and voiding patterns were assessed using questionnaires and interview. The International Continence Society classification was used after 1996. Urodynamic assessment was performed 3 times during followup.

Results

Mean sigmoid segment length ± SD was 18 cm (± 2.8). Mean followup was 38 months (± 24.8). Ureter stricture and reflux were present in 8% and 17% of the reimplanted units, respectively. Mean creatinine serum levels did not change after surgery and remained stable during followup. At 2 years 89% of the patients were continent in the daytime and 90% had good or satisfactory daytime continence according to the International Continence Society classification. At 3 years 77% of the patients voided every 3 or 4 hours during the day. Nighttime continence was poor. Only 10% of the patients complied with an alarm program. Mean maximal capacity of the reservoir was 300 ml and remained stable during followup. Mean intrareservoir pressure at maximal capacity decreased from 61 to 51 cm H₂O from the first to the third urodynamic evaluation. No patient required clean intermittent catheterization.

Conclusions

This modified sigmoid neobladder offers good daytime continence with low post-void residual and adequate daytime micturition frequency. Nighttime continence is poor. The presence of high intrareservoir pressures did not impair renal function.

Key Words:  colon, sigmoid , bladder neoplasms, urodynamics, urinary diversion