Assessment of morbidity and functional results in bladder replacement with Hautmann ileal neobladder after radical cystectomy: a clinical experience in 55 highly selected patients

Abstract

Objectives. To analyze the morbidity and functional results of the ileal neobladder in a series of 55 highly selected patients. The ileal neobladder is a commonly used technique for orthotopic bladder reconstruction after radical cystectomy in both sexes. Good results have been published from Ulm University, where the technique was popularized.

Methods. From February 1994 to June 2000, 55 patients (47 men and 8 women), 32 to 75 years old (mean age 58) with good performance status (American Society of Anesthesiologists score 1 and 2), underwent radical cystectomy for bladder cancer and Hautmann ileal neobladder reconstruction. Functional assessments were done at 3 months and every 6 months thereafter, with special attention to urinary continence and upper urinary tract status.

Results. The median follow-up was 28.8 months (range 8 to 96). One perioperative death occurred. Early complications occurred in 23.6% without repeated surgery and late complications occurred in 25.4%, with three repeated operations for occlusive syndromes. The daytime and nighttime continence rates at 3, 6, and 12 months were 59.6%, 80.8%, and 88.5% and 38.5%, 61.5%, and 78.8%, respectively. The overall continence rate in patients younger than 70 years old was 80.8%. Three patients required self-catheterization to empty their neobladder. Eleven patients died of metastatic evolution of their bladder cancer or intercurrent disease at 6 to 36 months.

Conclusions. In highly selected patients, the ileal neobladder provides good functional results regarding continence with an acceptable complication rate. In this series, the results were comparable to those reported in the referent institution.