The Ileal W-Shaped Neobladder Following Radical Cystectomy for Carcinoma of the Urinary Bladder: Experience and Results of 50 Cases

Purpose: The optimal urinary bladder substitute for patients undergoing radical cystectomy is still controversial. The ideal reservoir should provide a large storage capacity at low pressure achieving effective continence with less frequency and minimal renal reflux. In this study we present our experience with W-shaped ileal neobladder following radical cystectomy. Material and Methods: Between April 1995 and September 1999, a total of 50 male patients underwent lower urinary tract reconstruction following radical cystoprostatectomy by means of ileal W-shaped neobladder. All patients had invasive bladder cancer proved by preoperative cystoscopy. Results: Their mean age was 45.5 years. The median neobladder pouch capacity was 420 ml; daytime continence rate was 89.4%, while nighttime continence was noticed in 53.3% of cases. The ureterointestinal anastomoses were performed employing Le Duc technique in all patients. Renal units remained normal in 25 out of 30 evaluated patients. Dilatation of the pelvicalyceal system and the ureter, either unilateral or bilateral occurred in 5/30 of patients (16.6%). These were due to stricture at the urethro or uretero-pouch anastomosis that needed transurethral urethrotomy or revision of the anastomosis; however, renal functions were maintained in all patients. There were three postoperative mortalities (6%) and the early postoperative complications included urinary leakage (6%), prolonged ileus (10%) and deep venous thrombosis (4%). Late complications related to the neobladder were acceptable including metabolic acidosis (2%). Conclusions: The ileal W-shaped neobladder is a good choice for male patients after radical cystectomy, provided that there is no evidence of prostatic or urethral tumor invasion.