Orthotopic neobladder in management of tubercular thimble bladders: initial experience and long-term results
Abstract
OBJECTIVES: To describe the indications and long-term results of orthotopic bladder replacement for tubercular thimble bladders.
METHODS: Four patients (3 women, 1 man; mean age 32 years) presented with markedly contracted bladders of tubercular etiology. The patients had marked lower tract symptoms, and the mean bladder capacity was 15 mL. All 4 patients had associated upper tract pathology. Four-drug antitubercular treatment (ATT) was started in all 4 patients, and all 4 underwent surgery 4 weeks later. The procedure performed was a cystectomy and orthotopic bladder reconstruction using the ileocecal segment in 3 patients and the sigmoid colon in 1. The ureters were implanted into the taenia of the cecum or the sigmoid in an antireflux fashion. ATT was continued for a total of 9 months.
RESULTS: All patients had an uneventful postoperative course. After a follow-up period ranging from 22 to 54 months (mean 38), the average bladder capacity in the 4 patients was 450 mL (range 400 to 600). The mean maximal flow rate was 18.3 mL/s. Potency was preserved in the man and all patients were continent at last follow-up. The male patient had hypercontinence requiring clean intermittent catheterization for a period of 3 months. At last follow-up all patients had residual-free micturition. The female patients were able to void to completion with a Valsalva maneuver. No patient had symptomatic urinary infection or deterioration in renal function. No patient had persistent ureteral…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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