Long-Term Outcome of Orthotopic Neobladder Reconstruction after Radical Cystectomy – Sohag Experience

Abstract

Objective: To assess the long-term outcome of neobladder reconstruction after radical cystectomy. Patients and Methods: In this retrospective study we evaluated the records of 90 patients (70 males and 20 females) subjected to radical cystectomy and orthotopic neobladder reconstruction at Sohag University Hospital, Sohag, Egypt, between January 1999 and January 2006. The age of the patients ranged from 35 to 70 years with a median age of 42 years. All patients had invasive bladder carcinoma: squamous cell carcinoma in 55, transitional cell carcinoma in 33 and adenocarcinoma in 2 patients. Thirty-five patients had a W-neobladder with serous-lined extramural ureteral reimplantation, 35 patients had Studer pouch and 20 patients had colonic (sigmoid) neobladder reconstruction. After surgery all patients were followed up for a period of 6 to 84 months (median 45 months) in order to evaluate the functional and oncological outcome. Results: Thirty (33.3%) patients developed early complications (defined as within 30 days from surgery). Chest infection and wound infection occurred in 3 (3.3%) and 5 (5.6%) patients, respectively, and was treated with antibiotics. Eight patients developed paralytic ileus which was managed with naso-gastric tube drainage. Re-operation was required in 8 patients: 3 required re-suturing of the abdominal incision, bleeding occurred in 2, while 2 developed intestinal obstruction and one ureterointestinal leakage. Pouch leakage was observed in 6 patients. Late complications occurred in 18 (20%) patients. Re-operation was necessary in 15 cases: 4 with stone formation in the neobladder, 3 with incisional hernia, 5 with a stricture at the ureterovesical junction, one with vesicourethral stricture and 2 with vesicovaginal fistula. Complete continence during day and night was achieved in 63 patients (70%). The daytime continence rate was 86.6% (87 patients), while 24 patients (26.7%) had nocturnal incontinence and 3 patients (3.3%) were fully incontinent. Four patients (4.4%) used clean intermittent self-catheterization. Twenty-seven (30%) patients developed recurrence of cancer within 4 to 30 months from surgery, among them 3 with urethral recurrence, 20 with local pelvic recurrence and 4 with distant metastases. All 27 patients with tumor recurrence died from disease progression during the follow-up period; 4 patients died from causes not related to the operation. Conclusion: Orthotopic neobladder reconstruction provides acceptable continence rates and has an acceptable early and late complication rate. We therefore recommend that all suitable patients undergoing cystectomy should have an option of orthotopic neobladder reconstruction. Keywords : orthotopic diversion, neobladder, cystectomy African Journal of Urology Vol. 13 (3) 2007: pp. 198-202