Urinary Continence after Orthotopic Detubularized Ileocaecal Pouch Versus Ileal Neobladder: Does it Differ?

Abdalla El Azab, Sameh Kotb, Amro Mostafa, Ahmed Mahmoud Shouman, Mohamed Salama


Objective: To compare both techniques of detubularized ileocaecal and ileal neobladder post radical cystectomy with regards to functional results in the form of continence (day and night) with the use of urodynamics (for assessment of voiding volume and pouch capacity). Methods: This is a prospective randomized clinical trial that was done at the National Cancer Institute, Cairo University from August 2016 and January 2018. Sixty-two patients presented with muscle invasive urinary bladder cancer and no history of urinary incontinence or urethral stricture were included in this study. All patients underwent preoperative cystoscopic examination. Radical cystectomy was done, and patients were divided into two groups according to the type of diversion. Group A included 31 patients with orthotopoic detubularized ileal neobladder and group B included 31 patients with orthotopic detubularized ileocaecal neobladder. Urodynamic studies were done to 27 patients in group A and 27 patients in group B at just 6 and 12 months postoperatively. Results: The mean age in group A was 59.2 ± 8.0 while in group B was 57.8 ± 6.6. In each group, we compared day and night continence in a period of 3 and 6 months. Postoperatively in group A, day continence after 3 months was 81.5% which improved to 96.3% after 6 months postoperatively with significant P-value (0.025). Night continence after 3 months was fair in 66.7%, unsatisfactory in 33.3% and 0% for good state which improved to 70% for fair state, 18% unsatisfactory and 11% for good state after 6 months with significant p-value (0.035) while in group B, day continence after 3 months and 6 months postoperatively was 100% and night continence after 3 months was good in 0.0 %, fair in 78.6 % and unsatisfactory in 21.4 % which improved to 10.7 % for good state, 85.7 % for fair state and 3.6 % for unsatisfactory after 6 months with significant P-value (0.005). Conclusion: There are no significant differences between detubularized ileocaecal and ileal neobladder in relation to continence. However, there is significant change in each type of diversion separately with time.


Bladder cancer; radical cystectomy; ileocaecal; ileal; neobladder; urodynamic

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DOI: http://dx.doi.org/10.30564/amor.v4i5.186


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