PD41-02 SHORT SEGMENT ILEAL ORTHOTOPIC NEOBLADDER FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: DOES SIZE MATTER?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-02 SHORT SEGMENT ILEAL ORTHOTOPIC NEOBLADDER FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: DOES SIZE MATTER? Anthony Devasia*, Arun George, Ramani Kumar, and Chandra Singh Anthony Devasia*Anthony Devasia* More articles by this author , Arun GeorgeArun George More articles by this author , Ramani KumarRamani Kumar More articles by this author , and Chandra SinghChandra Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder is a diversion that is increasingly used following cystectomy for bladder cancer. The standard length of ileum used is 60 cm. We evaluated the functional outcomes of a short segment (35+5cm) ileal neobladder. METHODS: Following at least one side nerve sparing radical cystectomy for bladder cancer, orthotopic ileal neobladder was constructed using 35 cm of ileum for the pouch with an additional 5cm chimney. Preoperatively all patients were taught pelvic floor excercises and advised to perform them several times a day while awaiting surgery. Postoperatively frequent voiding was advised with alarm regulated voids at night keeping the voided volume to <400ml.Data was retrieved from our electronic database. Pouch capacity, voiding, continence, erectile function, upper tracts and biochemistry were assessed RESULTS: Of a total of 39 males who underwent the procedure from 2003 to 2019, an N pouch was constructed in 34. The mean age was 50.7 (SD 10.5)years and the mean follow up was 54 months. At 1 month, continence was 59% and at 3 months, 82.4% were fully continent with occasional nocturnal leak. By 6 months, all were continent not requiring pads with a rare leak of a few drops in a few, only at night. All men voided spontaneously without the need for clean catheterisation with a mean Q max of 22 ml/sec (SD 12), voided volume of 273ml (SD 109) and a residue of 30 ml(SD 23). There was no metabolic abnormality and renal function remained stable in all with no upper tract dilatation. Spontaneous erections were seen in 44% and 17% required PDE5 inhibitors. Six received chemotherapy (neoadjuvant 5, adjuvant 1). Two, in their late sixties who were fully continent for several years developed mild worsening of continence that improved after restarting pelvic floor exercises. Five years post operatively, one developed a calculus on the suture at the urethral anastomosis causing a ball valve effect, resulting in poor flow. The flow was restored after removal of the calculus. Thirty three (84.6%)were tumor free at the last review and 6 expired with late recurrence and metastases CONCLUSIONS: Orthotopic neobladder with a short segment of ileum (35+5) had good outcomes in terms of voiding to completion, continence and capacity, with biochemical and upper tract preservation in a carefully selected group. Source of Funding: nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e821 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Devasia* More articles by this author Arun George More articles by this author Ramani Kumar More articles by this author Chandra Singh More articles by this author Expand All Advertisement PDF downloadLoading ...