The ileal neobladder: Complications and functional results in 363 patientsafter 11 years of followup

Purpose: Since 1986 orthotopic lower urinary tract reconstruction using the ileal neobladder has been our diversion of choice in patients of both sexe s undergoing cystectomy, We report on experience and functional results of the first 363 men 11 years after this procedure. Materials and Methods: Complications were assessed, tabulated, subdivided i nto early (3 months or less postoperatively) and late types, and further ca tegorized with respect to relationship to neobladder construction. Continen ce and voiding pattern were individually evaluated via a detailed patient q uestionnaire. Results: Perioperative death occurred in 11 patients (3%). Neobladder relat ed early and late complications occurred in 56 (15.4%) and 85 (23.4%) of th e 363 patients, respectively. Neobladder related early and late abdominal r eoperation rates were 0.3 and 4.4%, respectively. Perioperative neobladder unrelated early complications were observed in 122 patients (33.6%) and 44 (12.1%) required operative treatment. Late postoperative complications unre lated to the neobladder occurred in 45 patients (12.4%) and 19 required ope n surgical revision. Of 290 evaluable patients 96.1% void spontaneously, 3. 9% perform clean intermittent catheterization:in some form and 1.7% perform regular intermittent catheterization. Daytime and nighttime continence was reported as good by 95.9% and satisfactory by 95% of the patients. Unaccep table daytime continence requiring more than 1 pad per day occurred in only 4.1% of the patients and only 5% are wetting more than 1 pad a night. Conclusions: The ileal neobladder produces good functional results and can be constructed with acceptable complications. Our data suggest that althoug h it is not a complication-free procedure, we advocate its use when possibl e.