Analysis of Urinary Continence, Complications, and Urodynamic Characteristics Following Orthotopic Ileocaecal Neobladder Reconstruction: A Preliminary Study on Safety and Feasibility.

OBJECTIVE

This study aimed to evaluate the postoperative recovery of urinary continence, complications, metabolic changes and urodynamic parameters in patients with bladder cancer undergoing radical cystectomy combined with orthotopic ileocaecal neobladder reconstruction and to explore the safety and functional feasibility of this surgical approach.

METHODS

A retrospective analysis was performed on 45 bladder cancer patients who underwent radical cystectomy with orthotopic ileocaecal neobladder reconstruction at our hospital between January 2020 and January 2025. All patients received standardised postoperative follow-up, including urodynamic evaluations at 6 and 12 months, and rehabilitation training such as pelvic floor exercises, abdominal pressure-assisted voiding, and bladder sensation training. Clinical outcomes were assessed by comparing urinary continence, complications, biochemical parameters, and urodynamic indices at different postoperative time points.

RESULTS

At 3 months postoperatively, urinary incontinence (daytime and nighttime) was higher than at 6 months, indicating gradual improvement over time (p < 0.05). Early complications, mainly urine leakage and infections, were relatively common within 3 months but decreased thereafter, with few patients experiencing enterocutaneous fistula, urinary fistula, or urinary stones (p > 0.05). Postoperative haemoglobin and serum chloride decreased significantly (p < 0.05), while other biochemical parameters remained largely unchanged, except for an increase in blood urea nitrogen. Urodynamic assessments showed that by 12 months, neobladder maximum capacity and urinary flow rate increased significantly (p < 0.05), storage-phase bladder pressure decreased below urethral closure pressure (p < 0.05), voiding-phase pressures were unchanged (p > 0.05), and post-void residual volume was reduced (p < 0.05).

CONCLUSIONS

Orthotopic ileocaecal neobladder reconstruction after radical cystectomy is a safe and feasible urinary diversion. With standardised rehabilitation and follow-up, patients achieve satisfactory continence and stable metabolic and bladder function. However, long-term outcomes require validation in larger studies.