Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results

To present our experience with a sigmoid orthotopic neobladder.

We retrospectively evaluated the functional and oncological outcomes of 160 patients who underwent orthotopic neobladder reconstruction using a detubularized 20-25-cm sigmoid segment at our institution.

Each patient was evaluated every 3 months the first year, every 6 months for the next 4 years and annually thereafter. Urodynamic studies of all consenting patients were carried out after 6 months, and 2, 5 and 10 years. We carried out the log-rank test, and used Cox regression models and Kaplan-Meier survival analysis. The anova test was used to compare urodynamic findings over time.

Mean follow up was 6.8 years (range 0.65-21.7 years). Overall survival was 58.1% at 5 years, and 47.1% at 10 years. Early complications occurred in 36 patients (22.6%); late complications in 40 (25%). Stage V chronic kidney disease developed in two patients (1.3%). Complete (daytime and night-time) continence, defined as no need for pads or condom devices, was achieved by 45% of patients at 5 years, daytime continence was achieved by just 36% of patients; both were unchanged at 10 years. A significant difference emerged in maximal neobladder capacity and post-void residual values between 6 months and 2 years, and between 2 and 5 years (P < 0.01 and P = 0.03, respectively).

Sigmoid neobladder continence and capacity significantly improve over the first 5 years, and they remain stable over the long term. Upper urinary tract function is not affected by endoluminal pressure, and the rate of metabolic imbalance is negligible.

International journal of urology : official journal of the Japanese Urological Association. 2016 Sep 07 [Epub ahead of print]

Giulio Nicita, Alberto Martini, Maria T Filocamo, Calogero Saieva, Aldo Tosto, Niceta Stomaci, Barbara Bigazzi, Donata Villari

Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. ., Department of Urology, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Azienda Sanitaria Locale Cn1, Savigliano, Italy., Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy.

Go Beyond the Abstract with a commentary written by the authors

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