Urodynamic Analysis of Orthotopic “Studer” Ileal Neobladder Following Radical Cystectomy

Abstract: Objectives We evaluated the surgical outcome,quality of life and urodynamic results of patients with "Studer"orthotopic ileal neobladder.Materials and methods Between Dec. 2002 and Nov. 2007, we performed "Studer" ileal neobladder with an open end-to-side ureteroileal anastomosis in 96 patients following radical cystectomy as urinary diversion. Twenty patients whose follow-up data were available .All of these patients had a follow-up of more than 1 year and were enrolled into the study. Following standard radical cystectomy and pelvic lymphadenectomy, "Studer" orthotopic ileal neobladder with an open end-to-side ureteroileal anastomosis was performed. Urodynamic evaluation consisted of filling cystometry, uroflowmetry, and postvoiding residual (PVR) urine volume determination,etc. Intravesical, abdominal, and detrusor pressures; maximum pouch capacity; and pouch compliance were measured in each patient at the same time.Results The mean duration to postoperative urodynamic study was 31.5 months. Mean maximum pouch capacity (MPC), compliance, maximal pouch pressure (MPP) and PVR were 566.75ml,46.25ml/cmH_2O, 36.90cmH_2O,46.95ml, respectively. Eighteen patients (90%) had complete daytime continence. Total continence (nighttime and daytime) rate was fifteen patients (75%). Two patients (10%) were incompletely incontinent. Pearson correlation test revealed a positive correlation between MPC and compliance (P<0.01). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethra-neobladder anastomosis stricture was found to be significantly related with increased PVR(P<0.01).Continence status was not correlated with any other urodynamic parameters in the study. Between the control group and the orthotopic group, independent samples t test showed that the average detrusor pressure and PVR were no significant difference (P> 0.05), the remaining parameters were statistically difference.Conclusion In this study, we found that "Studer" orthotopic ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. We conclude that "Studer" ileal neobladder construction results in a near normal- functioning orthotopic reservoir that is a good alternative surgical choice…
Key words: Bladder cancer; Orthotopic neobladder; Urodynamics

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