Followup Results Of 101 Cases With Orthotopic Neobladder Using Complete Detenial Sigmoid Colon

Blackground In recently,orthotopic bladder substitution has become popular following radical cystectomy for invasive bladder cancer and bladder dysfunction.So far,nearly every part of gastrointestinal tract from stomach to rectum can be used for bladder substitution.And many of these new technicals are very benefit to improve the paitients' quality of life and anticipated life span.Though the reconstructive methods,the selections of gun,the shape and size of the neobladders,the technecals of the ureter reimplantation are varied,the objectives are to create a reservoir with low-pressure,adequate capacity,high compliance,high continence rate and no residual urine.The technique should also protect renal function,avoide electrolyte disturbance,keep self-image and a better quality of life.Professor Liu Chunxiao from the Urology Department,ZHUJIANG Hospital of South Medical University invented a new technique of orthotopic neobladder using complete detenial sigmoid colon in 2000.So far,there are nearly 400 patients who underwent this operation all over the nation by professor Liu.Objective To assess,in a retrospective study,the long-term results of 101 cases with orthotopic neobladder using complete detenial sigmoid colon operated in ZHUJIANG Hospital between Febrary 2000 and August 2007.. Methods1,we collected 101 cases who underwent cystectomy and receive a orthotopic neobladder using complete detenial sigmoid colon in the Urologic Department of ZHUJIANG Hospital of Medical College of South University from Febrary 2000 to August 2007.2,All perioperative datas include renal function,electrolyte and sexual function before operation,therapeutic effect and early complications.3,The follow approaches include telephone investigation,mailing questonaire and direct examination.4,The follow up includes questionare,examination(blood assay,urine assay, renalfunction,electrolyte,B ultrasound,IVP,chest film,CT,cystographyand cystoscopy),urodynamics examination and late complation.5,All results were expressed by(?)±s.Statistical analysis was performed with the SPSS 11.5 for Windows package Statistics includedχ²-test in the comparisions of continences between our team and documents,and t-test in the comparision between preoperative and postoperative renal function and electrolyte,α=0.05.Results1,A total of 101 patients were evaluated including 85 men and 16 women with a mean age of 61 years.ranged form 10 months to 84 years old at the operative time.Out of 101cases,94 were bladder carcinomas,3 were bladder adenocarcinoma,1 was bladder undifferentiated carcinoma,2 was bladder rhabdomyosarcoma,and 1 was severe cystitis glandularis.2,In all,101 patients underwent radical cystectomy and the construction of continent in othotopic bladder using complete detenial sigmoid colon in the study period;Early complications occurred in 35patients(34.65%) although open surgical intervention was required in 11(31.43%).5 patients(4.9%) were dead in perioperative.The other 96 patients' mean(range) follow-up was 30(6-90) months.Late complications occurred in 27patients(28.12%).These late complications were primarily caused by vesico-urethral strictures(10.42%)and obstruction of upper urinary tract(7.89%).The Cr,BUN,K⁺,Na⁺ and Ca²⁺ before operation are not statistically significants different(t=1.305,p=0.195;t=0.258,P=0.797;t=1.358, p=0.180;t=-1.643,p=0.106;t=1.095,p=0.278) from those six months after operation.But the CO2CP and CL are significants different(t=4.829,P=0.000; t=-6.047,p=0.000 ) between the two groups3,Most patients have daytime continence(91.67%),and night-time continence was 66.67%.4,The mean maximum pouch capacity(mL) and pouch pressure at capacity (cmH2O) of 53 patients were 216.70(100±400) ml and 31.60(20±48) H)2Ocm respectively;while the mean maximum uroflowmetry was 10.15(2.30-24.80) ml/s. The mean postvoid residual was 10.50±9.75(0-35) ml.5,In 44 patients with normol sexual function who were not older than 70, followed more than 9 months,the erection of 13(29.55%) patients can be recoveried.6,24 patients of 95 cases with bladder cancer had recurrence of disease,of whom 14 died.CONCLUSION The complete detenial sigmoid neobladder can be performed easily with an acceptable early and late complication rate and satisfactory continence..This operation maybe generally applied in clinical practice.