Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up.

BACKGROUND: Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE: To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS: Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS: Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). CONCLUSION: Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.

Orthotopic neobladder in patient with locally advanced small cell carcinoma of the bladder: a case report and review of the literature.

Small cell carcinoma of the urinary bladder (SCCUB) is a rare, aggressive variant of neuroendocrine nonepithelial tumor. The best treatment results are achieved by combined cystectomy and chemotherapy. Same as in urothelial bladder cancer, a question remains about the urinary diversion in locally advanced disease. Studies on surgical treatment of patients with SCCUB most often do not clearly specify the type of urinary diversion performed, and we could not find information that orthotopic urinary diversion was performed in those patients. We present a 58-year-old patient with locally advanced SCCUB, treated by cystectomy and orthotopic urinary diversion (ileal neobladder-Hautmann) followed by six-cycle adjuvant chemotherapy. After 50-month follow-up, the patient showed no signs of relapse and the new bladder functioned perfectly well.