Long-term functional outcomes of ileal and sigmoid orthotopic neobladder procedures.

Objectives: To retrospectively compare the long-term functional outcomes of ileal and sigmoid orthotopic bladder replacements after radical cystectomy.

Methods: From 1990 to 2004, 123 male patients underwent orthotopic neobladder reconstruction after cystectomy; 75 underwent ileal neobladder (IN) and 48 sigmoid neobladder (SN) procedures. The observation period was 12.3 to 151.6 months (median 61.1). The voiding function of each patient was evaluated at three different observation periods: time 1, less than 5 years; time 2, 5 to 10 years; and time 3, more than 10 years after surgery.

Results: Almost every SN patient could void without assistance throughout the observation period. In contrast, the rate of spontaneous voiders was significantly low for the IN patients. Daytime continence was significantly worse in the SN than in the IN patients at time 2 (P <0.01), and the difference in nighttime continence between the two groups was even larger during the first 10 years after surgery (P <0.01). The postvoid residual urinary volume at time 2 was significantly larger in the IN than in the SN patients (P <0.01). No significant change in neobladder capacity was observed for either procedure throughout the observation period. The mean serum creatinine level was stable for both groups throughout the follow-up period.

Conclusions: The IN and SN procedures result in different outcomes. The rate of spontaneous voiders was better in the SN group than in the IN group. The IN tends to provide better continence than the SN. In choosing a neobladder procedure, a proper understanding of the prospects of voiding functions is required.