Comparative study of ileocecal vs. ileal neobladders in radical cystectomy patients

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May 18 2006

The use of orthotopic urinary diversion has gained increasing popularity in the past 20 years.

Intestinal options for neobladders include ileocecal and ileal segments. The choice of intestinal segment has both functional and metabolic implications.

In the April issue of the BJU International, Dr. Khafagy and associates from the National Cancer Institute, Cairo, Egypt report a comparative study using either ileocecal or ileal neobladders.

Between 1999 and 2001, 60 patients with bladder cancer who underwent radical cystectomy were randomized to reconstruction with either an ileal (group A) or ileocecal (group B) neobladder. Group A consisted of 29 patients; 27 men and 2 women, median age 50 years and group B consisted of 31 patients; 28 men and 3 women, median age 51 years. Imaging and laboratory tests were used to assess for recurrent cancer, renal cortical thickness and metabolic function. Urodynamics was performed in 13 patients. Histology revealed primarily squamous cell carcinoma, but about one-third and transitional cell carcinoma and a few had adenocarcinoma.

Two deaths in each group were not related to technical aspects of the diversion. Complete continence was achieved by 4 months and voiding by 3.5 months with no difference between the groups. Diurnal continence was achieved in 93% of group A and 90% of group B patients. Day and night incontinence was reported in 11% of group A and 14% of group B patients.

Serum pH and sodium levels among group A patients were significantly low compared to group B. Serum creatinine was similar in both groups, but renal cortical thickness was greater among group B than in group A patients, although not significantly so. Renal deterioration was noted in 15% and 7% of group A and B patients, respectively. Men who had an ileal neobladder had significantly greater post-void residual urine (72 vs. 20 cc) but better pouch compliance.

Survival in both groups was similar (78-83%). Urodynamic data provided limited interpretation due to small patient numbers and no explanation for the indications. These data suggest both ileal and ileocecal neobladders have excellent outcomes, although renal preservation and metabolic complications were perhaps better in the ileocecal group.

By Christopher P. Evans, MD