Detenial Sigmoid Neobladder Report Of 56 Cases

PURPOSE:To evaluate our experience with patients treated uniformly with radical cystectomy and pelvic lymph node dissection for invasive bladder cancer and to describe the association of the primary bladder tumor stage and regional lymph node status with clinical outcomes.To investigate the clinical outcome of detenial sigmoid neobladder as a continent form of urinary diversion.PATIENTS AND METHODS:All patients undergoing radical cystectomy with bilateral pelvic iliac lymphadenectomy,with the intent to cure,for transitional-cell carcinoma of the bladder between April 2003 and October 2006,without adjuvant radiation or chemotherapy,were evaluated.The clinical course,pathologic characteristics,and long-term clinical outcomes were evaluated in this group of patients.The intestine was incised over a length of 15-25 em with the detenial sigmoid as the midpoint so as to create a low pressure reservoir for urine and side- to-side anastomosis was performed on the posterior borders of the rectosigrnoid wall 1 Submucosal tunnel technique was employed in antireflux urethral implantation. RESULTS:A total of 56 patients(51 men and 5 women)with a median age of 66 years (range,56 to 81 years)were uniformly treated.Median follow-up wasl2 months(range, 3 to 18 months).There were 0 perioperative deaths,with a total of 6 early complications. lymph node-negative tumors was 32 cases for T_2Ainvasive bladder cancer,15 for T_3a tumors,respectively.Patients with muscle invasive(T₂ and T_3a),lymph positive tumors had 4 and 5 cases respectively.Continence has been achieved in all the 56 patients with amicturition frequency of 3-5 times during daytime and 2-4 times at night.The mean volume of pouch was 500ml(400-650 ml).The basal intra-reservoir pressure was 8-23cm H₂O(mean 16.5cm H₂O,1cm H₂O=0.098 kPa),the highest peak pressure was 12-33cm H₂O(mean 21.3cm H₂O).Conclusions:As a simple operation the detenial sigmoid neobladder procedure provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and with lower incidence of complication,it is also a better alternative diversion procedure that would be easily accepted by surgeons and patients.