Modified le bag pouch after radical cystectomy: continence, urodynamic results and morbidity.

OBJECTIVES

To revaluate ileocolonic pouch for orthotopic neobladder reconstruction, a cohort of patients with bladder cancer was selected to undergo radical cystectomy and modified Le Bag pouch. Evaluation concentrates on continence and associated morbidity observed on close follow-up.

PATIENTS AND

METHODS

A total of 37 patients including 16 females with T2-3 bladder cancer (19 transitional, 15 squamous and 3 adenocarcinoma) were treated by radical cystectomy and totally detubularized ileocolic neobladder. Post operative morbidity, continence and urodynamic studies were evaluated. Mean time to have full daytime continence was tested against age, gender, postoperative complications, technique of pouch creation either stapler or hand suture and adjuvant irradiation.

RESULTS

Cystometry 12 months post surgery showed 493 ml median capacity with basal and maximum reservoir median pressures of 16 and 38cmH2O respectively. Uroflowmetry had maximum voiding volume of 370ml, voiding time 45s and maximum flow rate of 11.6ml/s. Within the first 2 months post operative 44% were continent by day, 33% by night and 67% had stress incontinence. By 12 months post surgery 89% were continent by day, 73% by night and 27% had stress incontinence. Two years post surgery 94% were continent by day and 81% had complete day and night control of urine. Urinary leakage was the most frequent early complication (10.8%). Late complications were urinary tract infection (13.5%), metabolic acidosis (13.5%) and reflux (10.8%). Pouch over distension (5.4%) was consistent with bladder neck obstruction. Patient's gender and postoperative morbidity were statistically significant factors to increase the mean time to continence; whereas, age, use of stapler and adjuvant radiotherapy had no significant effect.

CONCLUSION

Modified Le Bag pouch is a simple technique with adequate pouch capacity that offers excellent slowly progressing continence rates with minor morbidity rate. Post operative morbidity and female sex delayed continence satisfaction.

KEY WORDS: Continent urinary diversion - Orthotopic neobladder - Ileo colonic pouch - Modified Le Bag pouch.