Functional lower urinary tract voiding outcomes after cystectomy and orthotopic neobladder

Purpose: We reviewed our experience with orthotopic continent urinary recon struction after radical cystectomy to determine the functional voiding patt erns and compare different methods of reservoir construction. Materials and Methods: The study included 100 consecutive patients who unde rwent cystectomy and orthotopic neobladder. Reservoir construction consiste d of a W-shaped ileal reservoir in 40 patients, ileal reservoir with affere nt limb in 26, a Padua ileal reservoir in 18, right colon in 14 and sigmoid colon in 2. The functional voiding outcome was determined by a detailed pa tient interview and chart review. Results: There were no perioperative deaths. All patients regained good day time urinary control and none required protective pads, although 18% used p rotective padding at night because of nocturnal leakage. Eight patients (8% ) performed self-intermittent catheterization because of poor reservoir emp tying. There were no substantial differences in outcomes among the various methods of reservoir construction. Conclusions: Excellent functional voiding outcomes are obtained with radica l cystectomy and orthotopic bladder reconstruction. Comparable results can be achieved with use of either large bowel or ileum and with various method s of bowel folding as long as principles of preservation of the periurethra l sphincter muscle, and construction of an adequate capacity and low pressu re reservoir are maintained.