Ileal neobladders keep patients drier at night; sigmoid pouches empty better

Design

Systematic review and meta-analysis (1 RCT, 16 cohorts)

Population

17 studies of patients with ileal or colonic neobladder after cystectomy

Primary outcome

Continence, voiding and complications

Effect

Ileal: better night continence, fewer early complications vs sigmoid; more self-catheterisation

This meta-analysis, published 20 September in the Urology Journal, pooled 17 studies — one randomised trial and 16 cohorts — comparing ileal with colonic (sigmoid or ileocaecal) neobladders after radical cystectomy.

Early complications were less frequent with ileal than sigmoid neobladders, with no difference between ileal and ileocaecal. Late complications and daytime continence were similar across all types. Ileal neobladders gave better night-time continence than colonic ones. But ileal pouches had higher post-void residual volumes and more need for clean intermittent self-catheterisation than sigmoid pouches.

The choice is a trade-off to discuss with the patient: better night continence and fewer early complications with ileum, against a greater chance of needing to self-catheterise.

• Ileal neobladders were associated with better night-time continence than colonic pouches.
• Early complications were lower with ileal than sigmoid neobladders.
• Ileal pouches were associated with higher residuals and more self-catheterisation than sigmoid.
• Discuss night continence and self-catheterisation when counselling on pouch type.

Why it matters

Turns a surgeon-preference choice into one the patient can weigh.

Don't overread it

Mostly observational cohorts with notable heterogeneity; the pooled differences may reflect selection.

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