Continence and Urodinamic Parameters: Comparison and Long Term Orthotopic Sigmoid and Ileal Neobladders

Objective: The of this study was to compare continence rates and urodinamics parameters among patients who had under gone orthotopic substitution with sigmoid or Ileal segments. Methods: After radical cystectomy for patients with invasive cancer blader continent urinary reservoir was constructive in 110 patients. 40 patients received a sigmoid neoblader (SN) and 70 received an Ileal neoblader. Mean age was years for SN and year for IN. Post operative urodinamic evaluation was done after 18 and 36 months follow up period ranged from 3 to 10 years. Results: Clinically, frequency of micturation by day was less in the IN group (4-6 times/d), while in the SN group was (6-8 times/d). Day time continence was achieved in 95% of IN patients and in 90% of SN patients. W hile 85% IN patients and 65% of SN patients where continent by night respectively. Urodinamically the average reservoir capacity of the SN is (320 ml) was lower than the IN (536 ml) with filling pressure of 13 cm H2O and 15 cm H2O for the IN and SN group respectively. The majority of patients void by the Valsalva maneuver yet achieved good peek flow rates (SN group 17 ml/sec and IN group 15.5 ml/sec mean flow) with patients in both groups empty their reservoirs adequately with post void residual (PVR) less than 10% of the void volume. Conclusion: Completely detubularized sigmoid blader is functionally and urodinamically comparable to detubularized Ileal neoblader and it can be an adequate alternative for continent urinary diversion in case an Ileal segment cannot be used (eg. short mesentry). The higher incidents of night time urinary incontinence in the SN group could be explained by periods of high pressure due to neoblader contractions in combination with a relaxed sphincter during sleep plus the smaller functional capacity of the sigmoid neo blader.