الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
In recent decades, orthotopic neo-bladder substitution following radical cystectomy has become increasingly common. Different intestinal segments with varying configurations have been used to construct the intestinal neobladder.
In this study, we used three different detubularized ileal pouches, Studer, U-shaped and W-shaped ileal neobladder and we studied the functional, metabolic and morbidity outcomes of these different ileal pouches to find the best type of ileal neo-bladder substitution.
In this study, 32 patients underwent radical cysto-prostatectomy and ileal bladder substitution at Urology department; Minia University and Ain Shams University; the patients were classified as 12 patients in Studer group, 10 patients in U-shaped group and 10 patients in W-shaped group.
Continence was evaluated both diurnally and nocturnally and the majority of patients were continent avoiding the need for external urostomy appliance of non-continent diversion, thus helping them to retain their body image.
Diurnal continence rates between 3 groups were nearly similar (P-value = 0.9), as well as nocturnal continence rates. So the change in ileal neobladder configuration from Studer, U-shaped and W-shaped reservoir did not improve diurnal and nocturnal continence significantly. Nocturnal incontinence was common problem in all studied groups.
The majority of the patients could empty their neobladder well and only few number of patients (4 patients: 1 patient in each Studer and W-shaped groups and 2 patients in U-shaped group) had significant residual urine and required regular clean intermittent self-catheterization.
Regarding post-operative morbidity rates, only few number of patients developed early post-operative complications in the different groups with nearly similar rates.
While late post-operative complications were higher in U-shaped group than in Studer group and least common in W-shaped neobladder with serous line extra-mural trough.
Uretero-ileal stricture had high incidence in Studer group compared to other groups and mostly unilateral stricture that was treated by interventional radiology with antegrade DJ stent placement.
Recurrent episodes of pyelonephritis with positive urine cultures had high incidence in U-shaped group compared to other groups mostly due to high risk of reflux and small pouch capacity.
Deterioration of renal functions tests was more frequent in both Studer and U-shaped groups and least in W-shaped group.
The need for re-admission were greater in U-shaped group than in Studer group and least common in W-shaped group mostly due to high incidence of recurrent episodes of pyelonephritis in U-shaped group.
With review of the available data and comparison between three groups, we found that W-shaped neobladder with serous line extramural trough has proved its feasibility and is easily conducted, excellent continence rate, less post-operative
complications, less deterioration of renal functions as regarding radiological and laboratory evidences and less incidence of uretero-ileal stricture or reflux thus it may become the favored approach.
In general, patients who meet the criteria for orthotopic neobladder reconstruction should be offered it with good functional outcomes and the results show that not only excellent continence rates, but there is no greater mortality and morbidity than with the present standard treatment of an ileal conduit and the orthotopic neobladder should now be considered with the ileal conduit as ‘best practice’ in urinary diversion after radical cystectomy.