PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES

Abstract

INTRODUCTION AND OBJECTIVE: The ileal neobladder (INB) has now been performed on a regular basis for more than 30 years at our institution. This study aims to assess the long term functional outcomes including near normal voiding function, continence, incidence of UTI and metabolic requirements. METHODS: From our consecutive series of 893 male patients who underwent radical cystectomy (RC) and urinary diversion with the INB from 1986 to 2009 we only included those with minimum follow-up of 5 years. We excluded patients with previous irradiation therapy of abdomen or pelvis, with previous other forms of urinary diversion, and with postoperative tumor recurrence. Between 10/08 and 03/09 questionnaires were sent to the remaining 303 patients, with telephone-interviews in those, who did not respond. 44 patients were not available: Death with NED in n=43, living abroad n=6, and n=5 with Alzheimer's. The remaining 259 patients formed the study population. Continence was defined as use of not more than 1 pad/ daytime or nighttime. Patients were asked for the number of feverish UTI within the last 5 years, problems with mucus production, and requirement of (self)catheterization. RESULTS: The mean age at the time of surgery was 60.6±10y ranging from 23y to 81y. The mean time of follow-up in this series was 131±56mon ranging from 60mon to 267mon. The mean age at the time of the survey was 73±10y ranging from 43y to 92y. While the risk of urinary retention and bicarbonate therapy decreased over time, the changes in the rate of daytime and nighttime incontinence seemed to be attributed more to age than to the length of follow-up (Table 1). Transurethral catheters were required in 1 case after 12, in 2 cases after 16 and 17 years postoperatively. Three patients are on substitution of vitamin B12, one patient is on colestyramine therapy for short bowel syndrome. One patient developed end stage renal failure 5 years after surgery. CONCLUSIONS: INB patients who survived more than 5 years after RC and diversion enjoy acceptable urinary continence and retain their ability to void spontaneously in >90 % of patients. The percentage of recurrent UTI and the need of bicarbonate therapy are not negligible. Especially in young patients with favourable pathologic findings an ileal neobladder provides excellent results even after 20 years and more. (Table Presented).