Clinical, urodynamic and endoscopic characteristics of the Stanford pouch ileal neobladder constructed with absorbable staples

Purpose: The clinical, urodynamic and endoscopic aspects of the Stanford po uch ileal neobladder formed with absorbable staples were investigated. Methods: A Stanford pouch ileal neobladder was formed using absorbable stap les after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mea n age of the patients was 62 (range 41-70) years. Patients were followed wi th arterial blood gas, serum biochemistry, pouch cystography, urodynamic te sts and endoscopy. Results: Five (16.7%) patients had early postoperative complications and th ree were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preo perative and 6 months postoperative serum creatinine levels were 1.07 +/- 0 .3 mg/dL and 1.2 +/- 0.4 mg/dL, respectively, but the difference was not st atistically significant (P = 0.1). Six months postoperatively the mean seru m chloride level was 109 +/- 4.5 (range 100-113) mmol/L and the mean arteri al blood pH was 7.37 +/- 0.2 (range 7.3-7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the pati ents except one were continent throughout the day after 1 year. However, no cturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was in creased gradually up to 12 months postoperatively and the mean pouch capaci ty 12 months postoperatively was 460 +/- 95.8 mL. Micturition occurred spon taneously in most patients while some needed abdominal straining. None of t he patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4-15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively o nly a white scar could be observed at the suture line. Conclusion: The Stanford pouch ileal neobladder constructed using absorbabl e staples was able to provide a good capacity-low pressure reservoir with a low rate of complications.