Ileal W-Neobladder in Women with Bladder Cancer: Early Experience

Kim, Sae Woong; Lee, Seung Ju; Lee, Ji Youl; Im, Pil Bin; Cho, Yong Hyun; Yoon, Moon Soo; Jung, Seung Eun

Abstract

PURPOSE
The anatomical and voiding functional outcomes of orthotopic neobladders in women with bladder cancer were investigated.
MATERIALS AND METHODS
Since July, 1998, 5 women (median age 64.8) underwent an orthotopic bladder substitution following a radical cystectomy for bladder cancer. The median follow-up was 19.6 months (range 12 to 35). After urethral sparing cystectomy, an ileal W-neobladder was constructed and supported by an omental flap. Both the early and late complications were analyzed. A pressure flow study was performed to evaluate the voiding function, and a radiologic study including a MRI was performed to observe the anatomy.
RESULTS
There were no perioperative deaths and no early and late complications related to the surgery except for acute pyelonephritis, which occurred in one patient 22 months after surgery. Four patients were continent day and night and one patient had nighttime incontinence. MRI showed that the urethra was connected to the dependent portion of the neobladder, which was supported by an omental flap in all patients. No recurrence of cancer in the native urethra was noted. All patients were satisfied postoperatively.
CONCLUSIONS
Orthotopic bladder substitution after a standard radical cystectomy in women provides satisfactory anatomical and functional outcomes. An omental flap could improve the voiding function by supporting the neobladder and making a urethroneobladder junction located in the dependent portion of the neobladder.