Uterus-, fallopian tube-, ovary-, and vagina-sparing cystectomy followed by U-shaped ileal neobladder construction for female bladder cancer patients: oncological and functional outcomes.

OBJECTIVES

To evaluate oncological outcomes and voiding functions after orthotopic neobladder reconstruction with preservation of gynecologic organs in female bladder cancer patients.

METHODS

A total of 30 consecutive female patients who underwent radical cystectomy and U-shaped ileal neobladder (constructed using 40 cm of a double-folded ileal loop) substitution were retrospectively analyzed. Of the 30 patients, 29 had urothelial carcinoma and 1 had leiomyosarcoma. Computed tomography was performed every 6 months. Urethroscopic examination was performed at 3-month intervals during the first and second years, and at 6-month intervals thereafter. Pressure flow studies, including urethral pressure profilometry, were performed 3, 6, 9, and 12 months after surgery.

RESULTS

During a median follow-up of 35.7 months, 1 patient exhibited local recurrence and 6 patients died of bladder cancer. Maximum neobladder pressure examined 12 months after surgery improved significantly as compared with that examined after 3 months (P<.01). Maximal urethral closure pressure also improved significantly 12 months after surgery as compared with that after 3 months (P<.05). The capacity of the ileal neobladder 3 months after operation was 204+/-84 mL, and it showed a gradual increase, reaching 311+/-95 mL at 12 months (P<.01). None of the patients required catheterization for residual urine. Twenty-four patients (80%) remained completely dry day and night, voiding once or twice during the night.

CONCLUSIONS

Orthotopic neobladder reconstruction with preservation of gynecologic organs is feasible for female bladder cancer patients. Although the follow-up period was not long, the present technique provided acceptable oncological outcome and voiding function.