Short-Term Functional and Urodynamic Outcome of W-ileal Orthotopic Neobladder with Serosa-Lined Tunneled Uretero-Ileal Anastomosis

作者：Barapatre Yogesh R; Agarwal Mayank M^*; Mavuduru Ravimohan; Sharma Suresh K; Kumar Santosh; Singh Shrawan K; Mandal Arup K

来源：Lower Urinary Tract Symptoms, 2014, 6(1): 26-34.

DOI：10.1111/luts.12014

• ileal neobladder
• quality of life
• serosa-lined uretero-ileal anastomosis
• urethral pressure profilometry
• urodynamics

ObjectivesFunctional and urodynamic (UDS) outcomes of W-configured ileal orthotopic neobladder (ONB) with extramural serosa-lined tunnel uretero-ileal anastomosis are presented
MethodsConsecutive 17 patients undergoing ONB during December 2009 to March 2011 were enrolled. Of these 15 men (bladder cancer 14, tuberculosis 1) with mean age 52.711.3years completed the follow-up. Pouch-related quality of life (PQOL) was assessed using a published questionnaire. Uroflowmetry, cystometry/cystography and urethral-pressure profilometry were done at two follow-up visits at least 3months apart. Mean follow up 105months. Mean length of harvested ileum 48 +/- 6cm.
ResultsOverall PQOL were similar at both evaluations (55 +/- 11 and 54 +/- 15, respectively). During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 +/- 4mL/sec, 246 +/- 99mL and 68 +/- 74.9mL and 10.4 +/- 4.6mL/sec, 234 +/- 138mL and 86 +/- 146mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 +/- 244mL, 50.5 +/- 49.1mL/cmH(2)O, 42 +/- 20cmH(2)O and 22 +/- 12mm, and 468 +/- 250mL, 46.4 +/- 47.5mL/cmH(2)O, 52 +/- 27cmH(2)O and 23 +/- 12mm, respectively. Patients with smaller pouch (r=0.828; P=0.0001), longer urethral length (r=-0.392; P=0.023) and lesser incontinence (r=0.429; P=0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P=0.058), MUCP (P=0.05) and bothersome incontinence (P=NS) was observed. None of the patients had any obstruction or reflux of the upper tracts.
ConclusionThe index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence.

• 出版日期2014-1
• 单位河北医科大学