DOI: http://dx.doi.org/10.18203/2349-2902.isj20205872

Long-term outcomes of sigmoid neobladder after radical cystectomy in Indian population: a single centre experience

Sabyasachi Panda, Gyan Prakash Singh, Srikant Kumar Pathi

Abstract


Background: Radical cystectomy with orthotopic neobladder is the standard of care for MIBC. Long-term data on sigmoid neobladder is limited. Sigmoid neobladder offers the advantage of low long-term metabolic and nutritional complications, due to sparing of ileum and ileo-caecal valve. We present our experience and long-term results of orthotopic sigmoid neobladder reconstruction after radical cystectomy.

Methods: The study included 57 male patients who underwent radical cystectomy and orthotopic sigmoid neobladder for muscle-invasive carcinoma of bladder from January 2002 to December 2019. Data was collected with regards to complication rate, voiding patterns, continence status, recurrence-free and overall survival.

Results: Mean age was 52.7 years (range 35 to 74). Median duration of follow-up was 62 months. There were 3 (5.3%) perioperative deaths. 15 patients (26.3%) developed early and 5 patients (8.7%) developed delayed complications. Node positive disease (N+) was found in 11 (19.3%) patients and 17 (29.8%) required adjuvant chemotherapy. 94.7% patients were continent and 42 (82.4%) patients had spontaneous voiding pattern. Daytime and nocturnal incontinence rate were 5.3% and 24.6%, respectively. Clean intermittent catheterization (CIC) was required in 8 (14.1%) cases. The recurrence-free survival (RFS) and overall survival (OS) were 57% and 50% at 5 years and 62.5% and 35.8% at 10 years, respectively.

Conclusions: Sigmoid neobladder remains a viable form of orthotopic urinary diversion and provides satisfactory long-term continence and voiding results with acceptable rate of complications. Good long-term results in sigmoid neobladder in Indian population may be due to long sigmoid colons in Indian patients with low incidence of diverticulosis.

 


Keywords


Overall survival, Radical cystectomy, Sigmoid neobladder

Full Text:

PDF

References


Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004;54:8-29.

Reddy PK, Lange PH, Fraley EE. Total bladder replacement using detubularized sigmoid colon: technique and results. J Urol. 1991;145:51-5.

Thuroff J, Mattiasson A, Andersen JT, Hedlund H, Hinman F Jr, Hohenfellner M, et al. The standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs. International Continence Society Committee on Standardization of Terminology. Subcommittee on Intestinal Urinary Reservoirs. Br J Urol. 1996;78:516.

Fujisawa M, Isotani S, Gotoh A, Hara I, Okada H, Arakawa S, et al. Voiding dysfunction of sigmoid neobladder in women: a comparative study with men. Eur Urol. 2001;40:191-5.

Koraitim MM, Atta Ma, Foda MK. Desire to void and force of micturition in patients with intestinal neobladders. J Urol. 1996;155:1214-6.

Chen KK, Chang LS, Chen MT. Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy. J Urol. 1991;146:311-5.

Pantuck A, Ken-Ryu H, Perroti M, Weiss R, Cummings KB. Ureteroenteric anastomosis in continent urinary diversion. Long-term results and complications of direct vs non-refluxing techniques. Urology. 2000;163:450-5.

Fujisawa M, Takenaka A, Kamidono S. A new technique for creation of a sigmoid neobladder for urinary reconstruction: clinical outcome in 42 men. Urology, 2003;62:254.

Da Pozzo LF, Colombo R, Pompa P, Montorsi F, Di Girolamo F, Rigatti P. Detubularized sigmoid colon for bladder replacement after radical cystectomy. J Urol. 1994;152:1409.

Chen KK, Chang LS, Chen MT. Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy. J Urol. 1991;146:311.

Jakobsen H, Steven K, Stigsby B, Klarskov P, Hald T. Pathogenesis of nocturnal urinary incontinence after ileocecal bladder replacement. Br J Urol. 1987;59:148.

Hugonnet CL, Danuser H, Springer JP, Studer UE. Decreased sensitivity in the membranous urethra after orthotopic ileal bladder substitute. J Urol. 1999;161:418.

Steven K, Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol. 2000;164:288.

Hautmann RE, De Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of follow-up. J Urol. 1999;161:422.