Mean follow up 10 ± 5 months. Mean length of harvested ileum 48 ± 6 cm. Overall PQOL were similar at both evaluations (55 ± 11 and 54 ± 15, respectively).
During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 ± 4 mL/sec, 246 ± 99 mL and 68 ± 74.9 mL and 10.4 ± 4.6 mL/sec, 234 ± 138 mL and 86 ± 146 mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 ± 244 mL, 50.5 ± 49.1 mL/cmH2O, 42 ±20 cmH2O and 22 ± 12 mm, and 468 ± 250 mL, 46.4 ± 47.5 mL/cmH2O, PLX3397 in vivo 52 ± 27cmH2O and 23 ± 12 mm, respectively. Patients with smaller pouch (r = 0.828; P = 0.0001), longer urethral length (r = −0.392; P = 0.023) and lesser incontinence PD0325901 molecular weight (r = 0.429; P = 0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P = 0.058), MUCP (P = 0.05) and bothersome incontinence (P = NS) was observed. None of the patients had any
obstruction or reflux of the upper tracts. The index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence. Removal of bladder and prostate (most commonly for bladder cancer) would mandate some form of urinary diversion (orthotopic or heterotopic, continent or conduit). During the past decade, greater attention to health-related quality of life (HRQOL) has prompted wider use of orthotopic neobladder in suitable
patients. No single technique is ideal for all patients and clinical situations. Orthotopic diversion relies on an intact rhabdosphincter for continence, whereas voiding is accomplished by relaxation of the pelvic floor and subsequently increasing intra-abdominal pressure. An ideal neobladder would most closely approximate the normal bladder: non-absorbing, non-refluxing and accommodative at low-pressure during storage-phase; and emptying to completion with low-pressure-high-flow. Current bowel neobladder are far from the ideal; absorptive and voiding is akin to a severely Olopatadine underactive detrusor. Nevertheless, in the current armamentarium, ileum is preferred because of its larger capacity, lower filling pressures, and better compliance. In the long term, Ileal segment develops mucosal atrophy, resulting in less reabsorption of hydrogen and chloride and better compensation of metabolic consequences as compared to other intestinal segments.[3, 4] Some of these patients may need intermittent catheterization, which increases bacterial colonization of the neobladder. Therefore, some form of antireflux mechanism has been suggested to limit incidence of pyelonephritis.[5-7] Various methods of non-refluxing type uretero-bowel anastomosis have been described; however, the effectiveness of most is low and the incidence of anastomotic stricture is high in most.