Long-term outcomes of sigmoid neobladder after radical cystectomy in Indian population: a single centre experience

Background: Radical cystectomy with orthotopic neobladder is the standard of care for MIBC. Long-term data on sigmoid neobladder is limited. Sigmoid neobladder offers the advantage of low long-term metabolic and nutritional complications, due to sparing of ileum and ileo-caecal valve. We present our experience and long-term results of orthotopic sigmoid neobladder reconstruction after radical cystectomy.Methods: The study included 57 male patients who underwent radical cystectomy and orthotopic sigmoid neobladder for muscle-invasive carcinoma of bladder from January 2002 to December 2019. Data was collected with regards to complication rate, voiding patterns, continence status, recurrence-free and overall survival.Results: Mean age was 52.7 years (range 35 to 74). Median duration of follow-up was 62 months. There were 3 (5.3%) perioperative deaths. 15 patients (26.3%) developed early and 5 patients (8.7%) developed delayed complications. Node positive disease (N+) was found in 11 (19.3%) patients and 17 (29.8%) required adjuvant chemotherapy. 94.7% patients were continent and 42 (82.4%) patients had spontaneous voiding pattern. Daytime and nocturnal incontinence rate were 5.3% and 24.6%, respectively. Clean intermittent catheterization (CIC) was required in 8 (14.1%) cases. The recurrence-free survival (RFS) and overall survival (OS) were 57% and 50% at 5 years and 62.5% and 35.8% at 10 years, respectively.Conclusions: Sigmoid neobladder remains a viable form of orthotopic urinary diversion and provides satisfactory long-term continence and voiding results with acceptable rate of complications. Good long-term results in sigmoid neobladder in Indian population may be due to long sigmoid colons in Indian patients with low incidence of diverticulosis.