Comparison of clinical and urodynamic outcome in orthotopic ileocaecal and ileal neobladder.

Abstract

Aim of this study was to evaluate the clinical and urodynamic results in patients who had undergone orthotopic bladder substitution with ileocaecal (Mainz pouch procedure) or ileal (Abol-Enein and Ghoneim procedure) segments and who had a minimum follow-up of 12 months. Mainz pouch procedure (MP) was performed in 19 patients (mean age 62.4 years, median follow-up 36 months) and Abol-Enein and Ghoneim procedure (AG) in 36 patients (mean age 64.3 years, median follow-up 31 months). Complications and urodynamic findings were compared in both groups. Complications related to the pouch were (MP and AG groups, respectively) ureterointestinal anastomotic stenosis (10.5% versus 5.7%), poucho-urethral anastomosis stenosis (5.3% versus 5.5%), poucho-ureteral reflux (7.9% versus 4.2%), and pyelonephritis (15.8% versus 13.8%). At 12 months postoperatively, daytime incontinence rates were 5.3% versus 5.5% and nighttime incontinence (twice weekly or more) rates were 21% versus 8.4% in MP and AG groups. In urodynamic evaluation, which was performed in 39 patients at 12 months postoperatively, both groups showed adequate bladder capacity, the mean values of which were 426 +/- 34 ml in MP group and 442+/-27 ml in AG group (p > 0.05). The mean value of maximal flow rate was 19.6 +/- 3.7 ml/s in MP group and 16 +/- 6.1 ml/s in AG group (p > 0.05). The mean residual urinary volume was 37 +/- 8.2 ml in MP group and 45 +/- 7.1 ml in AG group (p > 0.05). The comparison between two types of bladder substitution, namely ileocaecourethrostomy (Mainz pouch procedure) and ileal reservoir (Abol-Enein and Ghoneim procedure) has demonstrated that urodynamic findings showed no significant difference between two groups.