Ileal and colonic neobladders trade continence against voiding

Design

Systematic review and meta-analysis (1 randomised trial, 16 cohorts), GRADE-rated

Population

Patients undergoing ileal or colonic neobladder reconstruction after radical cystectomy

Primary outcome

Functional outcomes and complications by pouch type

Effect

Ileal: better nighttime continence, fewer early complications; sigmoid: better spontaneous voiding

After radical cystectomy, the choice of bowel segment for an orthotopic neobladder shapes continence and voiding for years. This meta-analysis of 17 studies (one randomised trial and 16 cohorts) compared ileal with colonic — sigmoid and ileocecal — neobladders.

The ileal neobladder gave significantly better nighttime continence and fewer early postoperative complications than the sigmoid pouch, with daytime continence and late complications comparable across types. The trade-off was voiding: ileal pouches had higher post-void residual volumes and more clean intermittent catheterisation than sigmoid pouches, which voided more spontaneously.

The message is that no single pouch is universally best, and the decision should be individualised to what matters most for a given patient — nighttime dryness and a smoother early recovery with ileum, or spontaneous voiding with sigmoid. The evidence is mostly observational and heterogeneous, so surgeon experience and patient priorities remain central.

• Meta-analysis of 17 studies (one randomised trial, 16 cohorts) of neobladder reconstruction.
• Ileal neobladder: better nighttime continence and fewer early complications than sigmoid.
• Daytime continence and late complications were comparable across pouch types.
• Ileal pouches had higher post-void residuals and more intermittent catheterisation than sigmoid.
• Individualise the choice to the patient's priorities; no pouch is universally superior.

Why it matters

It frames the pouch decision as an explicit trade-off between continence and voiding, to be matched to the individual patient.

Don't overread it

Mostly observational and heterogeneous; it informs an individualised choice rather than proving one pouch superior.

The statistics, in plain English

These are pooled comparisons dominated by cohort studies, so the differences are real but susceptible to how patients were selected for each pouch; the direction, not a precise effect size, is the usable finding.

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