Urodynamic characteristics of the modified orthotopic ileal neobladder

Abstract

Background/Aim. Radical cystectomy is the method of choice in management of muscle invasive, organ-confined tumors of the bladder (?2-?4, N0-Nx). The most frequent continent orthotopic urinary diversion after radical cystectomy is the ileal neobladder. A modified technique consists of using a shorter segment of the terminal ileum than the standard technique, around 30 cm. The aim of this study was to determine the urodynamic characteristics of the orthotopic ileal neobladder created by a modified technique. Methods. In this prospective clinical study we analyzed the urodynamic parameters of 24 patients who had underwent radical cystectomy with orthotopic urinary diversion by ileal neobladder created using a modified technique. In all the patients we performed invasive and noninvasive urodynamic investigations 12 months after the operation. The urethral pressure profile parameters analyzed were maximal urethral pressure, maximal urethral closure pressure and the functional urethral profile length. Results. The average age of the patients was 63 (49-73) years, 90% were males and 10% were females. The median length of the shorter segment of the terminal ileum was 28 (range 22-35) cm. Prior to enterocystometry and uroflowmetry postvoid residual (PVR) urine was measured by a urethral catheter. The median PVR was 16.7 (0-140) mL. The median enterocystometric capacity was 396 (range 372-532) mL. The median end filling pouch pressure was 27.6 (range 20-70) cmH20. The median maximal flow of urine was 22.1 (range 9.7- 39.5) mL/s and the average flow of urine was 9.61 (range 3.6-17.6) mL/s. Flow time in the analyzed group was 47.5 (range 22-119) s. The median maximal urethral pressure was 54 (range 12-101) cmH2O, maximal urethral closure pressure 36.6 (range 6-91) cmH2O. Functional urethral profile length was 14.9 (range 4-37) mm. Conclusion. An ileal orthotopic pouch created by a modified technique using a shorter segment of the terminal ileum after 12 months presents with urodynamic characteristics similar to the native bladder.Uvod/Cilj. Radikalna cistektomija predstavlja metodu izbora u lecenju misicnoinvazivnog organ-ogranicenog tumora mokracne besike (T2-T4, N0-Nx). Radikalna cistektomija zahteva da se obezbedi derivacija urina. Ilealna neobesika je najcesca kontinentna ortotopna derivacija urina. Modifikovana tehnika podrazumeva upotrebu kraceg segmenta terminalnog ileuma u duzini od oko 30 cm. Cilj rada bio je da se utvrde urodinamske karakteristike ortotopne ilealne neobesike kreirane modifikovanom tehnikom. Metode. U prospektivnoj klinickoj studiji mereni su urodinamski parametri 24 bolesnika kod kojih je ucinjena radikalna cistektomija sa ortotopnom derivacijom urina formiranjem ilealne neobesike modifikovanom tehnikom. Kod svih bolesnika sprovedeni su invazivni i neinvazivni urodinamski pregledi 12 meseci nakon operativnog lecenja. Profilometrijom uretralnih pritisaka odredjivan je maksimalni uretralni pritisak, maksimalni pritisak zatvaranja uretre i funkcionalna duzina uretre. Rezultati. Zivotno doba bolesnika bilo je 63 (49-73) godine. Muskaraca je bilo 90%, a zena 10%. Duzina segmenta terminalnog ileuma bila je 28 (22-35) cm. Pre enterocistometrije, kao i nakon uroprotoka, kod svih bolesnika meren je rezidualni volumen urina (PVR) uretralnim kateterom. Vrednosti PVR bile su 16,7 (0-140) mL, a maksimalni enterocistometrijski kapacitet 396 (372-532) mL. Pritisak unutar neobesike pri maksimalnom enterocistometrijskom kapacitetu iznosio je 27,6 (20-70) cmH20. Maksimalni protok urina iznosio je 22,1 (9,7-39,5) mL/s. Vrednost prosecnog protoka urina pri mokrenju iznosila je 9,61 (3,6-17,6) mL/s, a vreme mokrenja bilo je 47,5 (22-119) s. Vrednosti maksimalnog pritiska uretre bile su 54 (12-101) cmH2O, dok je maksimalni pritisak zatvaranja uretre iznosio 36,6 (6-91) cmH2O. Funkcionalna duzina uretre u posmatranoj grupi bila je 14,9 (4-37) mm. Zakljucak. Ilealna ortotopna neobesika, kreirana modifikovanom tehnikom koriscenjem kraceg segmenta terminalnog ileuma, nakon godinu dana poseduje urodinamske karakteristike slicne nativnoj besici.