Spherical Ileocecal Neobladder and Proximal Urethral Sparing: Extended Qualified Evaluation

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Omaya A H. Nassar, Mohamed Fahim. Spherical Ileocecal Neobladder and Proximal Urethral Sparing: Extended Qualified Evaluation. Archives of Nephrology and Urology. 7 (2024): 09-16.

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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.


Continent Urinary Diversion, Orthotopic Neobladder, Ileocecal Pouch, Prostate Sparing Radical Cystectomy, Neobladder Urodynamic Study, Neobladder Morbidity, Female Neobladder

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