Early and late urodynamic assessment of simplified Indiana pouch with multiple taeniamyotomies

Study Type – Therapy (outcomes research) Level of Evidence 2c What’s known on the subject? and What does the study add? Continent urinary diversion represents a valid alternative to orthotopic reconstruction when this is unsuitable. Inclusion criteria for continent cutaneous diversion are strict and patients must be carefully selected. To date, several continent urinary diversions have been used such as Mainz, Indiana and Miami pouches. Simplified Indiana Pouch with multiple taeniamyotomies (SIPMT) represents a valid continent cutaneous urinary diversion with stable urodynamic features along 4 years. Appendicostomies guarantees better continence than ileostomies. In our series the EORTC QLQ-C30 and QLQ-BLM30 questionnaires showed a good health related quality of life. OBJECTIVE To compare the early and late urodynamic assessment of simplified Indiana pouch with multiple taeniamyotomies (SIPMT). PATIENTS AND METHODS Between April 1999 and May 2005, 62 consecutive patients underwent radical cystectomy (RC) and SIMPT. Cystometry and efferent tract pressure profilometry were performed at 12 (early) and 48 (late) months after RC in 32 patients. The efferent tract of the reservoir was the appendix in 62.5% of patients and an ileum invagination nipple in 37.5%. All patients were asked to complete questionnaires on HRQL: the European Organization for Cancer Research and Treatment of Cancer Quality of life Questionnaire version 3.0 (EORTC QLQ-C30) and the bladder cancer-specific module (EORTC QLQ-BLM30). RESULTS There was no significant change in cystometric capacity (median 627.5 vs 607.5 mL, P= 0.79), while end-filling pressure (median 28 vs 18 cmH2O) and amplitude of involuntary contractions (median 38 vs 32 cmH2O; both P < 0.001) decreased. Efferent tract-closing pressure increased in the appendicostomies (median 74.5 vs 91.0 cmH2O, P= 0.029) and decreased in the ileostomies (median 72.5 vs 63 cmH2O, P= 0.015), also the leakage rates during the pressure peaks decreased from 15% to 5% in appendicostomies, while there was no change in those with ileostomies (15%). At late evaluation, daytime and night-time continence rates were 94% and 88%, respectively, in patients with appendicostomies, and 90% and 85%, respectively, in those with ileostomies. A good HRQL was determined by the EORTC QLQ-C30 and QLQ-BLM30 questionnaires. CONCLUSIONS At 48 months after surgery SIPMT maintained an adequate capacity with low internal pressure, good continence rates and HRQL. When feasible, appendicostomy should be performed, as it was associated with better continence.