Urodynamic evaluation and long-term results of the orthotopic gastric neobladder in men

Purpose: Orthotopic neobladders are most commonly formed from colon and/or small bowel segments. However, after excellent results were reported in chi ldren, we constructed gastric neobladders in select men who had undergone c ystectomy. Although gastric neobladders in adults have been reported to hav e decreased capacity, to our knowledge neither long-term followup nor urody namic parameters have been reported in these patients. Materials and Methods: Gastric neobladder was performed in 8 patients follo wing cystectomy for malignancy in 7 and undiversion in 1. Average followup was 43 months and all patients underwent urodynamic evaluations an average of 9.1 months after surgery. Patients also completed an incontinence questi onnaire. The gastric neobladder group was compared to a similar group of pa tients who underwent neobladder construction from either small bowel (Kock/ Hautmann/Studer) or ileocecal segments (Mainz). Results: The gastric neobladder group had significantly reduced mean bladde r capacity compared to the ileal or ileocecal neobladder group (309 versus 551 cc, respectively, t = 0.001), while compliance was similarly decreased (27 versus 59 cc/cm. H2O, respectively, t = 0.04). Incontinence rates were greater in the gastric neobladder group (63%) compared to the ileal or ileo cecal neobladder group (8% to 23%, t = 0.02). Complication rates were compa rable. Revision or removal was required in 3 (38%) patients for severe inco ntinence, intractable dysuria and ureterogastric anastomotic stricture, res pectively. Conclusions: Adult gastric neobladders as currently constructed are associa ted with poor urodynamic parameters and high incontinence rates. Routine us e of gastric neobladders in adults is not recommended. They may be appropri ate, especially as composites, in select cases such as renal failure or ina dequate bowel length. The reasons for success in some patients and not in o thers are unknown.