Bladder Substitution By Ileal Neobladder For Women With Interstitial Cystitis

Main Category: Urology / Nephrology
Article Date: 30 Dec 2007 - 1:00 PDT

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UroToday.com- Kochakaru and colleagues from Thailand report one of the largest series to date of cystectomy and orthotopic diversion for bladder pain syndrome/interstitial cystitis. Thirty-five females with IC that met NIDDK criteria and failed to respond to conservative therapy agreed to undergo bladder removal. For cystectomy, the urethra was cut 0.5cm below the bladder neck, proximal to the pubourethral ligament, leaving the endopelvic fascia intact. An ileal segment of 65cm was used to create the neobladder with the Studer's technique.

The authors report a follow-up of 15-28 months (mean 28months). No intraoperative complications were reported. One case developed an intestinal obstruction at week 2 and was successfully treated conservatively. There was a highly significant increase in bladder capacity 6 months after surgery. Pain decreased after surgery reaching a nadir at 6-12 months. Both physical and mental quality of life measures significantly improved. At 6 months, diurnal and nocturnal continence were achieved in all patients. Three patients had episodes of pyelonephritis and 2 patients required intermittent catheterization. Thirty patients were sexually active of who 12 had mild dyspareunia.

These results are superb for this extremely difficult to treat population. A follow-up paper in a few years would add a lot to the literature and help to determine whether this procedure should have a more prominent place for treatment-resistant cases of interstitial cystitis.

Kochakarn W, Lertsithichai P, Pummangura W

Int Braz J Urol. 33(4):486-492, August 2007

Reported by UroToday.com Contributing Editor Philip Hanno M.D

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