The gastroileal neobladder for renal insufficiency

Metabolic changes and urodynamic findings after continent urinary diversion

Methods of creating continent urinary diversions were developed in the mid-1980s (neobladder, pouch) providing patients with continence and anatomically appropriate voluntary urine discharge. In a follow-up investigation on 18 patients, the question to be clarified was whether continent urinary diversion meets the demands of an ideal bladder substitute. Follow-up examination showed normal clinical test values almost without exception. Only five out of 18 patients had discrete acidosis. Neither malabsorption syndrome nor any disorder of vitamin D3 metabolism was found. Ultrasonography and X-ray diagnostics showed normal conditions, without stones and reflux. Urodynamic investigations revealed that bladder emptying was almost free of residual urine, and continence was largely undisturbed. In accordance with these data, there is almost perfect patient acceptance. At present, there are still no sufficient data on the risk of tumour induction, since the latency period required (about 20 years) in most cases has not yet been reached. Since there are currently numerous publications on "urinary diversion carcinoma", consistent follow-up is necessary comprising not only the metabolic, but also the oncological risks of urinary diversion via intestinal segments.

Bladder substitution

Preliminary data have shown that composite reservoirs consisting of gastric segments in combination with ileum or colon may reduce metabolic problems. Orthotopic neobladders are the most natural way to reconstruct the urinary bladder and are a safe option in selected male and female patients. Experimental and preliminary clinical data about new methods using autologous muscle transfer and tissue engineering are promising.