THE ILEAL NEOBLADDER IN WOMEN - 9 YEARS OF EXPERIENCE WITH 18 PATIENTS

Purpose: We present our surgical and functional experience with orthot opic bladder replacement in women. Materials and Methods: Since 1986, 18 women have undergone lower urinary tract reconstruction with an ile al neobladder. A nerve sparing cystectomy is done, and reservoirs are connected to the proximal urethra or urethrovesical junction. A total of 13 patients was available for complete followup as of March 1995. R esults: There were no perioperative deaths and few early complications . The only 2 failures were a neobladder vaginal fistula and these case s, which were converted to a conduit, are excluded from this study. La te complications requiring rehospitalization or reoperation in 2 patie nts included urethroileal stenosis that had to be dilated without furt her sequelae and bilateral ureteroileal stenosis that was treated endo scopically. At 3 months postoperatively excellent continence was achie ved in 8 patients, while 2 had grade 1 stress incontinence and 3 were hypercontinent. As of March 1995 only 4 patients voided to completion while 9 required intermittent catheterization (continuously in 5 and t wice daily for residual urine in 4). We were unable to demonstrate a f unctional difference of the various resection lines located at the pro ximal urethra or urethrovesical junction. Conclusions: Urethral suppor t and nerve sparing cystectomy plus the ileal neobladder as a reservoi r guarantee excellent continence in all patients. Despite our efforts, we have been unable to demonstrate any advantage of the nerve and ure thral support sparing cystectomy technique as far as micturition is co ncerned. The development of hypercontinence in 70% of the patients wit h time demonstrates that our current understanding of the functional a nd anatomical basics of the voiding process is too limited to allow bl adder replacement with a perfect functional result in all female patie nts. Our long-term experience, which is different from initial reports , justifies creation of an ileal neobladder in select female patients as long as they accept a 70% risk of clean intermittent catheterizatio n in the long term. Overall patient satisfaction, including sexual lif e, is exceptional. However, disappointment is considerable when clean intermittent catheterization is required after periods of successful v oiding per urethram.