Detublarized sigmoid colon for total urinary bladder replacement : clinical outcome in 51 patients

الملخص EN

Objectives : the technique and results of a detublarized sigmoid neobladder for total urinary bladder substitution after radical cystectomy is described.

Methods : Fifty one patients (44 men and 7 women) having a mean age of 46 (range, 32-61 years).

Radical cyst prostatectomy was performed for the male patients and anterior pelvic exoneration for the female patients.

This was followed by total replacement of the bladder with a detubularized sigmoid colon.

They were selected to have invasive bladder cancer away from the bladder neck.

The mean follow-up period was 38.8 months (range 8-96).

Blood chemistry was analyzed periodically every month during the follow-up period.

Early and late complications, continence and voiding pattern were recorded.

Urodynamic studies were performed every 6 months.

Results : Early postoperative complications included, urinary leakage in 7 patients (14 %) ; wound infection in 11 patients (22 %), deep venous thrombosis of the lower extremities in one patient (2 %).

Late complications included stenosis of the ureter intestinal anastomosis in one patient (2 %), stenosis of urethral anastomosis in one patient (2 %).

A reservoir stone occurred in one patient (2 %).

Neither metabolic acidosis nor vitamin B12 deficiency was reported.

The upper urinary tract function was either improved or stable in 96 % of cases.

However, deterioration occurred in only 4% of cases.

All patients could void voluntary without catheterization.

Patient satisfaction for continence, by daytime and nighttime (nocturnal continence), was 86 % and 72 %, respectively.

The mean neo-bladder capacity and mean residual urine volume was 463.8 ml (range, 275-603) and 93.7 ml (range 50-189), respectively.

Pressure flow analysis showed that the mean basal pressure was 5.1 cm H2O (range, 1-18) and the mean pressure at maximal capacity was 37.4 cm H2O (range, 1-73).

The mean maximal flow rate was 17.8 ml / sec (range 3.1-24.5), the mean average flow rate was 11.4 ml / sec.

(range 1.9-14.6).

The mean first sensation volume was 310.1 ml (range, 171-471).

Conclusions: The detublarized sigmoid neobladder provides versatile and satisfactory results after radical Cystectomy.

It provides one stage total bladder substitution and is feasible with a very low morbidity.

Furthermore, the technique can be employed successfully for a cystec-tomized female patients.