The ileal conduit has long been considered the gold standard for urinary diversion.
The neobladder (NB) as an orthotopic bladder substitute approaches the ideal urinary diversion by providing a low-pressure, easily emptied continent reservoir. Continent urinary diversions may be of great psychological benefit to select patients.
However, they may be associated with different complications. Typical early postoperative complications include urine leak, pyelonephritis, and bowel complications. Late complications include ureteroenteric and neovesical-urethral anastomotic stricture, urinary fistula, urolithiasis, voiding dysfunction, and incontinence. However, improvements in surgical technique and modern perioperative care have substantially diminished the perioperative complication rate.
The main goal of our study was to analyse the functional outcomes and complications after 4 years of follow up in a single center series of patients who underwent cystectomy and Studer ileal neobladder substitution (SINS).
Between 2015-2018, 9 male patients underwent SINS at Centro Hospitalar Lisboa Central. We collected all the data regarding follow-up time, pathologic stage, the mean hospitalization time, perioperative death, early and late complications and the continent or incontinent status after the surgery.
The ages at surgery ranged from 53-80. The mean follow-up period was 12 months. Before the operation, all patients received 2-3 courses of systemic chemotherapy. There was no perioperative death. The mean hospitalization time was 11 days.
Day time continence defined as 0-1 pads/day was achieved in 100% (p<0.001), while night time continence depending on definition and management of patients was around 78% (p<0.005).
Early complications included: 1 anastomic leak, 1 pyelonephritis,1 urinoma. Late complications were: 4pyelonephritis, 1 urosepsis and 1 urinary retention.
The early and late complication rates in our series were consistent with those of previously reported series, in which the perioperative complication rate ranged from 9 to 18% and the late complication rate ranged from 6 to 24%. Furthermore, there was no remarkable difference in types of complications between our cases and previously reported series.
We tried not to perform this type of urinary diversion in patients with poor incentive to learn a new voiding pattern such as timed voiding and voiding via abdominal straining after operation.