Comparison of clinical and urodynamic outcome in orthotopic ileocaecal and heal neobladder

Objective: Aim of this study was to evaluate the clinical and urodynamic results in patients who had undergone orthotopic bladder substitution with ileocaecal (Mainz pouch procedure) or ileal (Abol-Enein and Ghoneim procedure) segments and who had a minimum follow-up of 12 months. Methods: Mainz pouch procedure (MP) was performed in 19 patients (mean age 62.4 years, median follow-up 36 months) and Abol-Enein and Ghoneim procedure (AG) in 36 patients (mean age 64.3 years, median follow-up 31 months). Complications and urodynamic findings were compared in both groups. Results: Complications related to the pouch were (MP and AG groups, respectively) ureterointestinal anastomotic stenosis (10.5% versus 5.7%), poucho-urethral anastomosis stenosis (5.3% versus 5.5%), poucho-ureteral reflux (7.9% versus 4.2%), and pyelonephritis (15.8% versus 13.8%). At 12 months postoperatively, daytime incontinence rates were 5.3% versus 5.5% and nighttime incontinence (twice weekly or more) rates were 21% versus 8.4% in MP and AG groups. In urodynamic evaluation, which was performed in 39 patients at 12 months postoperatively, both groups showed adequate bladder capacity, the mean values of which were 426 +/- 34 ml in MP group and 442 +/- 27 ml in AG group (p > 0.05). The mean value of maximal flow rate was 19.6 +/- 3.7 ml/s in MP group and 16 +/- 6.1 ml/s in AG group (p > 0.05). The mean residual urinary volume was 37 +/- 8.2 ml in MP group and 45 +/- 7.1 ml in AG group (p > 0.05). Conclusion: The comparison between two types of bladder substitution, namely ileocaecourethrostomy (Mainz pouch procedure) and ileal reservoir (Abol-Enein and Ghoneim procedure) has demonstrated that urodynamic findings showed no significant difference between two groups. (C) 2003 Elsevier Science B.V. All rights reserved.