Colonic bladder replacement: Our experience

Abstract

Our preliminary results of ileal bladder replacements convinced us that these reservoirs are not ideal for all patients and prompted us to perform colonic neobladders. The aim of this work is to evaluate the mid-term results of sigmoid and right colonic bladder substitutions, discussing the indications for use of the colon for the orthotopic urinary diversion. From April 1992 to June 1995 we performed sigmoid neobladder in 38 patients and right colic reservoirs in 27. Thirty patients with left colonic bladder replacement and 12 with reservoir constructed according to an original technique (modified Goldwasser) were evaluated. The mean follow-up was 21.5 months in the first group and 30.5 in the second. Compared to data in literature, there were no differences with regard to continence, urodynamic findings and early and late complications. There are advantages and disadvantages with every bowel segment when constructing orthotopic reservoirs. Weighing up the results of sigmoid neobladders, we consider the ideal candidates for this type of derivation to be elderly patients, those intellectually less compliant and those who have difficulty in reaching the unit for follow-up controls. Both ileal or right colonic reservoirs can be constructed in other types of patients, but we think the latter should be perfbrmed in the case of urinary tract dilatation, chronic renal failure, large ureteral demolition, short and thick mesentery and obesity. Finally we do not believe that the urologist should tackle bladder replacement with a dogmatic attitude, but should choose the most suitable reservoir for the patient according to individual characteristics and anatomical conditions noted on the operating table.