Clinical experience in a modified Roux‐Y‐ shaped sigmoid neobladder: assessment of complications and voiding patterns in 43 patients

Study Type – Therapy (case series)Level of Evidence 4 OBJECTIVE To evaluate the complications and urinary voiding patterns in patients with a new Roux‐Y‐shaped continent neobladder, using a modified sigmoid pouch. PATIENTS AND METHODS Between June 2003 and July 2008, 43 patients (26 men and 17 women, mean age 69.5 years) underwent a modified Roux‐Y‐shaped sigmoid continent neobladder reconstruction after radical cystectomy. The surgical procedures involved the construction of a Roux‐Y‐shaped sigmoid pouch, making an antifeces‐refluxing valve into the sigmoid urine reservoir and ureterosigmoidostomy using the Leadbetter method. This pouch method has not been described before. The patients’ clinical, biochemical, radiological and urodynamic variables were assessed. RESULTS During the mean (range) follow‐up of 24 (6–65) months, there were no deaths related to the procedure. In 16% of the patients, early complications occurred, whereas 12% had late complications. There were no cases with local recurrence and metastasis. Routine electrolyte evaluation revealed a slight metabolic acidosis in six patients (14%). Hypovitaminosis B12 did not occur in any patients. All patients were continent in the daytime and night‐time continence was poor in eight patients (19%). The mean (sd, range) neobladder capacity and residual urine volume was 330 (110, 120–410) mL and 48 (26, 25–80) mL, respectively. Moreover, the maximum urinary flow rate was 9.2–25.3 mL/s. CONCLUSION The modified Roux‐Y‐shaped sigmoid neobladder replacement provides a new simple surgical procedure with low complication rates. The procedure offers comparatively satisfactory daytime continence with low postvoid residual urine volumes and voiding patterns. This technique is a valid alternative to continent urinary diversion.