Practice Patterns for Improving Outcomes in Women with Ileal Neobladder: An Evidence-Based Analysis

Abstract

Introduction: The aim of this review is to provide practice pattern on how to obtain best possible oncological and functional outcomes in women with orthotopic neobladder substitutes. Evidence Synthesis: The treating surgeon has to balance oncological and functional risks as well as patient´s preferences and the final decision must be based on consent between the surgeon and the patient. Long- term survival can be achieved in the majority of neobladder patients even with extravesical, node-negative disease. Therefore, surgeons should not be reluctant to proceed with an ileal neobladder in patients with locally advanded tumour stage excluding T4b stage, any positive soft tissue surgical margin and bulky lymph node disease. During preoperative work-up, women with a positive bladder neck biopsy may be still candidates for an orthotopic neobladder unless a carefully obtained full-thickness biopsy of the urethra reveals evidence of malignancy. The key issue in the follow-up of women with neobladder is to achieve a neobladder capacity of 400-500mL, residual free voiding of sterile urine and the elimination of any outlet or upper tract obstruction. Medical conditions (i.e. arterial hypertension, diabetes mellitus) can also cause renal deterioration in the long-term and therefore demand early and thorough treatment. Conclusions: The clinical background of the treating urologist is of paramount importance for appropriate patient selection, accurate surgical performance and adequate monitoring of women with ileal neobladders. A high level of patient compliance and willingness to undergo follow-up examinations at regular intervals is mandatory for improved outcomes.