Short ileal segment for orthotopic neobladder: A feasibility study

Objectives: The objective of this study was to present the construction of a neobladder with a modified pouch technique using 25–35 cm of terminal ileum. Methods: Thirty‐eight patients whose pouch was constructed from 25–35 cm of terminal ileum (short pouch [SP] group) were prospectively evaluated vs 41 patients whose pouch was constructed from 50–70 cm of terminal ileum (long pouch group). Pouch volume, post‐void residual (PVR) volume, need for catheterization, continence and voiding frequency were evaluated at 3 and 12 months after surgery. Results: SP group patients had significantly smaller pouch capacity (440 vs 840 mL, P < 0.001) at month 12, and smaller PVR at postoperative months 3 (11 [0–43]vs 40 [0–147] mL, P < 0.001) and 12 (10 [0–90]vs 72 [0–570] mL, P < 0.001). SP group patients had significantly higher voiding frequency on postoperative month 3 (10 vs 9, P < 0.001) and 12 (7 vs 6, P < 0.005). Continence was significantly improved in the SP group compared with the long pouch group after 12 months (63.2% vs 34.1%, respectively, P = 0.034). Full continence improved significantly over time (P < 0.001) in the SP group, from 26.3% at month 3 to 63.2% at month 12. Conclusion: A pouch constructed from 25–35 cm of terminal ileum provides adequate capacity, smaller PVR, satisfactory continence and a better 24‐h voiding frequency pattern during the first postoperative year.