Spherical Ileocecal Neobladder and Proximal Urethral Sparing: Extended Qualified Evaluation

Author(s): Omaya A H. Nassar, Mohamed Fahim

Background: long-term review of the functional sufficiency and safety of an innovative modified ileocecal neobladder (IC) after proximal urethral sparing cystectomy (PUS) post neoadjuvant down staging chemotherapy. Materials and methods: (2000-2016), 126 participants (55 females) with bladder and uterine cervix cancers underwent cystectomy / anterior pelvic resection. 51% had cisplatin-based neoadjuvant chemotherapy. Entirely open IC was implanted to PUS in 61 patients (24-females). Another 65 (31-females) underwent classical non PUS cystectomy. Continence progress and morbidity were evaluated over 68 month (m). Results: PUS improved day time continence and stress drips significantly vs. non PUS both for males and females besides increased bladder neck and voluntary urethral median pressures (27.6 & 102 cm H2O vs. 20.4& 71 for non PUS p .0141). Capacities and voiding volumes significantly increased 6 to 12 m post surgery; but residual volume & compliance didn’t. Females had lower bladder neck and urethral pressures than males even PUS and day& night continence were delayed significantly. Male total 24 hour control was (36, 59, 73& 70%) after 6, 12 & 24- m until 5-years respectively. Ladies continence was (0, 12.5, 33 & 30%) for the similar times. Stress incontinence at 2-m was 84% (grade II & III), dropped to 49% (grade I) after 5-years. Early complications (17.5%) were mostly Clavien-grade I-III with 2-mortality and 5 reoperations. Late complications (13.5%) were grade II & III including 4 reoperations without rediversion. Conclusions: IC with PUS is nearly uncomplicated technique with adequate compliance and offers consistent rising continence rates for both sexes with prolonged intact renal function.