Editorial comment to: Ileal versus sigmoid neobladder as bladder substitute after radical cystectomy for bladder cancer: A meta-analysis

In our opinion, the complications that could be objectively compared are those related to the neobladder such as metabolic imbalance, urolithiasis and absorption defects. Concerning urodynamic parameters, the greater volume and compliance of IN could represents a point of weakness. In fact over the long term this can result in a hyper-distention of the neobladder and it may cause urinary retention. On the contrary, the SN, thanks to its thicker wall, opposes itself to the hyper-distention as it lower post-void residual demonstrates.Since SN provides a better chance of spontaneous voiding over the long term, we could speculate that SN could represent an optimal alternative, especially for patients with long life expectancy after radical cystectomy. Concerning continence, SN provides a lower rate of continence compared to the IN. Yet, we underline that a definition of continence in neobladder patients has not been acknowledged [5]. We define continence as complete dryness with no need for pads or condom devices and, while reporting data in our series, we have not included patients who perform CIC among continent. In our opinion, they represent a distinct functional outcome, because their continence results from urinary retention due to neobladder hyper-distention, a complication toward which the IN is more prone ]. It is a remarkable finding that there were no difference when comparing serum creatinine, thus we can infer that both types of orthotopic neobladder do not affect the renal function.