Function of the orthotopic urinary reservoir formed from the ileocecal angle in the long term after radical cystectomy in women

Objective: to study the long-term functional results of creating an orthotopic urinary reservoir from the ileocecal angle in comparison with the Studer technique of creating a urinary reservoir after radical cystectomy in women.

Materials and methods. From 2004 to 2018 radical cystectomy for bladder cancer was performed in 120 women. In 71 (59.2 %) patients, an orthotopic urinary reservoir was formed: 48 (67.6 %) from the ileum, 23 (32.4 %) from segments of the colon. This study included 11 patients who had a reservoir formed from the ileocecal angle, including by their own modification, and 13 patients who had a reservoir forme by Studer. The average age of the patients was 62.6 ± 2.6 (29—82) years. The average follow-up time was 77.1 ± 10.5 (19—184) months. The presence and degree of urinary incontinence was assessed using a questionnaire and a Pad test. 12 months or more after the operation, a complex urodynamic study was performed.

Results. The overall 5-year survival rate was 92.3 %: in the Studergroup it was 90.9 %, in the ileocecal angle group it was 100 % (p = 0.317). In the general population of patients, 37.5 % were completely continent. Women after plastic surgery by Studer retained urine better than after plastic surgery by ileocecal angle (46.2 % vs 27.3 %), the difference was only for mild urinary incontinence, which was more common in the ileocecal angle group. The frequency of severe urinary incontinence in both groups was the same. Nocturnal urinary incontinence was more common in patients in the Studer group (46.2 %). In the group of patients with ileocecal angle plastic surgery, there was no chronic urinary retention requiring intermittent catheterization, and in the group of Studer plastic surgery — in 1 (7.7 %) case. Analysis of urodynamic parameters revealed the presence of a greater physiological capacity of the urinary reservoir in the group of patients after plastic surgery according to Studer (p = 0.043). In the group of patients with ileocecal angle plastic surgery, higher values of the maximum pressure of the reservoir wall, “leakage pressure” and maximum expulsion pressure are observed, possibly associated with a more pronounced muscle layer of the intestinal segment used.

Conclusion. The functional results of the orthotopic reservoir formedfrom the ileocecal angle are comparable to the results of urine derivation using the classical Studer method. Complex urodynamic study showed a direct influence of various characteristics of the reservoir on the nature and degree of urination disorders in patients.

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