Issue: Vojnosanit Pregl 2016; Vol. 73 (No. 7)

Neobladder “Belgrade pouch”: Metabolic consideration

Authors:
Vladimir Bančević*†, Predrag Aleksić*†, Dušica Stamenkovi憇, Tomislav Pejčić§, Novak Milović*†, Božidar Kovačević║, Snežana Cerović†║

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 Background/Aim. The ileal neobladder should be a low-pressure reservoir with acceptable volume and relatively small resorptive surface. A larger inner surface of the ileal pouch is associated with the high resorption of urine me-tabolites through intestinal mucosa and systemic metabolic disturbances, while a too small pouch results in a higher frequency of voiding and incontinency. The aim of this study was to investigate it is possible to create a neobladder from a shorter ileal segment compared to standard surgical techniques, and reduce metabolic complications. Methods. This prospective study included 77 male patients, scheduled for radical cystectomy and orthotopic neobladder deriva-tion. The patients were divided into two groups: the stan-dard pouch (SP) group of 37 patients scheduled for stan-dard orthotopic neobladder, using a 50−70 cm long termi-nal ileum segment; the “Belgrade pouch” (BP) group of 40 patients scheduled for original, orthotopic urinary reservoir, using a 25−35 cm long terminal ileum segment. We meas-ured neobladder capacity, acidosis, base excess and bicar-bonate concentration in the postoperative month 3rd, 6th, 12th and 15th. Results. At the end of the study, the pa-tients from the SP group had much higher neobladder ca-pacity than the natural bladder − 750 mL (range 514−2,050 mL); in contrast, the patients from the BP group had aver-age capacity of 438 mL (range 205−653 mL) (p < 0.001). At the end of the study, there were more patients with acidosis (37.8% : 2.5%), base excess (35.1% : 7.5%) and low bicar-bonate level (40.5% : 20.0%) in the SP group, than in the BP group, respectively (p < 0.001). Conclusion. “Belgrade pouch”, make from 25−35 cm long terminal ileum segment may obtain adequate capacity and lower rate of metabolic disturbances than standard, high capacity orthotopic neob-ladders.