Detubularized sigmoid colon for bladder replacement after radical cystectomy: Long term clinical, urodynamic and metabolic results

We present the long term clinical, urodynamic and metabolic follow-up data of a group of 24 patients submitted to total bladder substitution using a detubularized tract of sigmoid colon. Early daytime continence was achieved in 95.8% (23/24) of patients and was maintained with time. Nocturnal incontinence occurred in 46.9% (13/24) and 29.2% (17/24) of cases at the 9 and 18 month follow-up respectively and did not improve further with time. Patients were evaluated at 9 and 18 months with urodynamic tests. Fourteen patients were submitted to urodynamic tests at a longer follow-up. The mean neobladder capacity was 400 cc and 480 cc respectively and showed no evidence of increase with time. Endoluminal pressure at the maximum reservoir capacity was 31 cm H20 (range 16-42) and did not change significantly at 18 months and further. Minimal post voiding residual was evidenced in all but one patient and was maintained with time. No severe metabolic acidosis, nor serum electrolyte changes were diagnosed even in those patients who refused alkalinizing therapy. We conclude that despite a slightly higher percentage of nocturnal urinary incontinence as compared to other forms of orthotopic reservoirs, the sigmoid colon neobladder is given an advantage by the tendency to stabilize its maximal capacity early in time and by the absence of postvoidal urinary residual volume.