Bigazzi, B.

Filocamo, M. T.

Martini, A.

Nicita, G.

Saieva, C.

Stomaci, N.

Tosto, A.

Villari, D.

English

Florence Research

Author’s ReplyResponse to Editorial Comment to Use of sigmoid colon in orthotopic neobladderreconstruction: Long-term resultsWe thank Dr Abe for the opportunity to focus on someaspects of our article.1Our index of early complications depends above all on astudied selection of candidates. As we had stated, just19.1% of cystectomy patients receive a sigmoid neobladder.Any candidate not in optimal health with severe comorbidi-ties was excluded, as noted in the text.2 Regarding postop-erative management, all patients are admitted to a recoveryroom until they are fully awake, then they are admitted tosubintensive care (or intensive care when required) untilnormal bowel function resumes. They receive parenteralhypercaloric nutrition during the first few postoperativedays. Another protective factor could be surgical constancy– all patients were operated on by the same two experi-enced surgeons.Regarding pouch perforation, we have encountered thisproblem only once and it did not represent a life-threateningscenario. The patient was managed conservatively, withneobladder catheterization for 5 weeks. In fact, the thick sig-moidal wall probably prevents perforation.We agree that follow up of these patients never ends, itcontinues until death because in the long term, changes intheir body can alter organ functionality and metabolism. Inreality, we never interrupt contact with our patients.Regarding continence, we underline that no consensus onthe definition of continence in patients who have undergoneneobladder reconstruction has been formulated, and this factimpacts standards in reported data.Our continence standards are stringent: the definition ofcontinence signifies no pads or condom devices during theday and at night. Furthermore, patients who carry out cleanintermittent catheterization are separated from the continentgroup into a category of their own. We recognize them ashaving a distinct functional outcome.Therefore, had we counted as continent patients who carryout clean intermittent catheterization or use up to two pads/day (as do some authors3) our continence rates would havebeen higher.Giulio Nicita M.D.,1 Alberto Martini M.D.,1Maria Teresa Filocamo M.D.,2 Calogero Saieva M.D.,3Aldo Tosto M.D.,1 Niceta Stomaci M.D.,1Barbara Bigazzi M.D.1 and Donata Villari M.D.11Department of Urology, Careggi Hospital, University ofFlorence, Florence, 2Department of Urology, AziendaSanitaria Locale Cn1, Savigliano, and 3Molecular andNutritional Epidemiology Unit, Cancer Research andPrevention Institute, Florence, Italygnicita@unifi.itDOI: 10.1111/iju.13230Conflict of interestNone declared.References1 Abe T. Editorial comment to use of sigmoid colon in orthotopic neobladderreconstruction: Long-term results. Int. J. Urol. 2016; 23: 990.2 Nicita G, Martini A, Filocamo MT et al. Use of sigmoid colon in ortho-topic neobladder reconstruction: Long-term results. Int. J. Urol. 2016; 23:984–90.3 Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, PaissT. The ileal neobladder: complications and functional results in 363 patientsafter 11 years of followup. J. Urol. 1999; 161: 422–7.© 2016 The Japanese Urological Association 991Long-term results of the sigmoid neobladder

Response to Editorial Comment to Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results

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Response to Editorial Comment to Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results

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