Functional evaluation of modified T pouch as ileal neobladder orthotopic reservoir.

BACKGROUND AND OBJECTIVE We report on the functional results of orthotopic modified T pouch ileal neobladder, incorporating serous-lined extramural ileal antireflux technique for urinary diversion after radical cystectomy. MATERIAL AND METHODS From September 1998 through November 2001, 42 patients of mean age of 49 years (range 45-54) having invasive bladder carcinoma underwent radical cystectomy and orthotopic ileal neobladder urinary diversion, the modified T pouch. Thirty-three patients were males while the remaining 9 were females. The mean follow up was 24 months (range 18-42). Preoperative uni or bilateral ureteral dilatation was noted in 13/42 (30.9%) patients. Follow up included clinical examination, laboratory, radiological and urodynamic investigations. RESULTS Early postoperative complications were recorded in 3 cases, that were managed conservatively. Day and night continence were achieved in 34/42 (81%) and 29/42 (69%) patients, night enuresis in 2 (4.8%), while satisfactory day and night continence were noted, respectively. Upper urinary tract (UUT) remained unchanged or improved in all cases. No need for clean intermittent catheterization (CIC). No evidence of reflux was detected. Pressure at maximum capacity (average 17 cm H2O at 600 ml). Mean flow rate was 17.6 ml/sec (range 15-24). Pelvic cancer recurrence was recorded in 5 patients at mean 24 months, respectively. CONCLUSIONS Modified T pouch has an excellent functional criteria as an orthotopic ileal neobladder reservoir. It is absolutely indicated in short and/or massively dilated ureter.