Orthotopic bladder substitution after radical cystectomy: 5 years of experience with a novel personal modification of the ileal S pouch

Purpose: We report a 5-year experience with 52 patients who underwent radic al cystoprostatectomy for bladder cancer and orthotopic bladder substitutio n using a novel personal modification of the S pouch. Materials and Methods: From September 1995 to December 1999, 52 men 36 to 7 2 years old (mean age 63) underwent bladder substitution with an S pouch. T hey were followed until September 2000. The pouch was constructed with a 36 cm. segment of ileum with the whole length used for the reservoir. The ure ters were directly anastomosed with one above the other in the mid segment of the pouch without any antireflux procedure. Complications were documente d and classified as early or up Do 3 months postoperatively and late, and f urther subdivided by the relationship to neobladder construction. Continenc e and voiding pattern were evaluated by personal interview and neobladder f unction was urodynamically assessed. Mean followup in our patients was 30 m onths. Results: The most, common of the 5 early and 9 late neobladder related comp lications were persistent urine leakage and reflux, respectively. There was no reflux greater than grade III in the 4 patients with reflux (5 refluxin g ureters) and no functional disorders. We observed 12 early and 5 late com plications unrelated to the neobladder. Open reoperation was required in 5 cases. Good or satisfactory daytime and nighttime continence was reported b y 95% and 88% of our patients, respectively. By year 1 postoperatively 91% of our patients voided at an interval of 3 to 5 hours during the day. Mean maximum neobladder capacity was 672 mi. and mean post-void residual was 30 mi. by year 3 postoperatively. Two patients required self-catheterization o nce daily and mild hyperchloremia without acidosis developed in 2. Conclusions: The advantages of our modified S pouch are technical simplicit y, substantially shorter operative time and decreased bowel length required . It is associated with an acceptable complication rate and functional para meters with subsequent patient satisfaction and good quality of life.