Basic Research for Establishment of Ideal Orthotopic Neobladders. -Investigation using a computer simulating model-

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1.Voiding functions of several types of orthotopic neobladdersWe investigated voiding functions of 30 men who underwent orthotopic neobladder replacement after radical cystectomy due to invasive bladder cancers. Colonic Neobladder (CN) was created in 7 patients, ileocolic neobladder (ICN) in 10 patients, ileal neobladder (IN) in 10 patients, and sigmoid colonic neobladder (SCN) in 3 patients, and all were followed at least 5 years after surgery. Daytime continence was obtained in more than 90% in any type of neobladder, however, nocturnal continence was achieved better in patients with IN than other neobladders using colonic segments. This phenomenon is better compliance of the neobladder using ileal segment than those using colonic segments.2.Voiding functions in female patients with orthotopic neobladderIndication of orthotopic neobladder replacement was expanded to the female patients. We analyzed the voiding functions of female patients who underwent orthotopic neobladder replacement with CN(2), ICN(2), and IN(4). Continence was achieved satisfactorily, however, those with IN became hypercontinent and required clean intermittent catheterization. Thus for female patients neobladder using colonic segments is rationale.3.Calcium metabolism in the patients with orthotopic neobladdersCalcium metabolism and bone mineral density were measured in patients with orthotopic neobladders ; CN(2), ICN(8), and SCN(23). Patients with orthotopic neobladder were suffered from metabolic acidosis and demineralization of the bones to various extent. This phenomenon, if very slight, may become serious drawback of the orthotopic neobladder replacement. Thus we propose to start investigation to utilize tissue engineering technology to recreate true bladders.