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Vescica Ileale Padovana (VIP) / Padua Ileal Bladder (PIB)

The Vescica Ileale Padovana (VIP), or Padua ileal bladder, is a detubularized and reconfigured orthotopic ileal reservoir described by Pagano, Artibani and colleagues. The original 1990 report included 16 patients; later open, robotic and partly stapled modifications use different construction sequences and ureteral anastomoses.[1][2][3]

VIP is one of several neobladder configurations. The 2024 systematic review of robotic intracorporeal neobladders identified nine types and found no randomized trials or cohort studies comparing them. In the 2024 review’s included studies, evidence was insufficient to determine whether VIP had better or worse functional outcomes than other configurations.[4] Later observational cohorts compared Padua with FloRIN and Y-shaped reservoirs (n = 142) and with a modified Bordeaux reservoir (n = 79).[24][25] Early continence did not differ significantly, although the three-design cohort found different capacity and compliance; neither study established long-term superiority or equivalence.[24][25]

Historical Development​

PublicationMilestone
1989–1990Pagano, Artibani and colleagues describe VIP at Padova; the 16-patient report appears in 1990[1]
2009Ferriero and Simone (Rome) report 12- and 48-month urodynamics in a 46-man cohort; eight died before late assessment[5]
2010Novara and Artibani report validated-questionnaire outcomes in 113 patients alive and disease-free at 44-month follow-up[10]
2018Simone (Rome) report the first 45 totally intracorporeal robotic PIB, operated 2012–2014[3]
2019Cacciamani (Padova) report robot-assisted VIP (ra-VIP), reproducing the open principles intracorporeally[2]
2023Tuderti (Rome) report 251 patients treated with robotic cystectomy and intracorporeal diversion[11]
2024Tuderti reports a 10-year learning-curve analysis of 200 patients[12]

Anatomy and Construction​

Detubularization interrupts coordinated ileal contractions; reshaping creates a rounded reservoir with a dependent urethral outlet. The biological pouch can still contract, and neither its shape nor a favorable pressure measurement guarantees safe storage or complete emptying.[1][5]

The classic VIP has no Studer-type afferent limb. The original authors' operative chapter describes a detubularized reservoir and dependent funnel for urethral connection. It says the authors later replaced Le Duc implantation with the Abol-Enein serous-lined extramural tunnel after published complications.[6] The original-author chapter describes no separate afferent limb.[6] Shimizu et al. described a hybrid modified VIP with a 10-cm afferent limb.[26]

Operative framework​

  1. Select well-perfused ileum that reaches the retained urethra without tension; the original-author chapter describes a 40–60 cm segment with its distal end approximately 15–20 cm from the ileocecal valve.[6]
  2. Isolate the segment, restore bowel continuity and open the reservoir bowel along the antimesenteric border.
  3. In the original authors' sequence, form an approximately 5-cm dependent funnel with anterior and posterior running sutures. Fold the proximal opened limb medially and sew adjacent edges side-to-side to form the posterior wall and dome of the rounded reservoir.[6]
  4. Perform the planned ureteral implantation, preserving ureteral blood supply and avoiding angulation or constriction.
  5. Connect the dependent reservoir to the urethra, complete closure and confirm drainage and watertightness. For limited mesenteric reach, the original authors describe placing the urethroileal anastomosis at the inferior end of the funnel's anterior suture to gain approximately 2 cm.[6]

For the serous-lined extramural variant, adjacent bowel surfaces form the trough; the ureter is anastomosed to intestinal mucosa and the edges close over it. See Mansoura Neobladder for the detailed tunnel discussion.[6]

Robotic VIP and Rome's partly stapled PIB are adaptations of these principles. Their dimensions, anastomoses and outcomes differ. Steps and results are reported here by the specific modification.[2][3]

Selection and Postoperative Care​

Use the same selection principles as other orthotopic bowel reservoirs: suitable bowel, adequate kidney and liver function, a usable sphincter or outlet, oncologic suitability of the retained urethra and the ability to manage emptying or catheterization. For orthotopic diversion, AUA/ASCO/SUO Statement 14 requires verification of a negative urethral margin.[8] Age alone is not an absolute contraindication.[7][8]

Plan pouch drainage, mucus care, leak assessment and catheter or stent removal around the actual reconstruction and healing. In the original authors' protocol, ureteral stents were removed on postoperative days 7–8, and a cystogram at 2–3 weeks preceded urethral catheter removal if no leak was seen.[6] After catheter removal, teach scheduled emptying, outlet relaxation, recognition of retention and intermittent catheterization when needed.[7][9]

Functional Outcomes​

Original open experience​

Pagano's initial 16 patients had 4–18 months of follow-up (mean ten months). Fourteen (87%) were continent by day and 13 (81%) reported dry sleep for 6–7 hours.[1] Capacity was 400–650 mL and mean pressure at capacity was 17 cmH₂O, but half had pressure waves of 30–50 cmH₂O at a threshold volume of 250 mL.[1] Reflux was absent, and patients emptied by abdominal straining and perineal relaxation. One ureteroileal and two urethroileal strictures were reported.[1] In a later original-author series, 188 of 209 patients were evaluable after at least six months (mean follow-up 24 months); urethroileal stenosis occurred in 21/188 (11%) and ureteroileal stenosis in 28/188 (15%).[23]

Patient-reported function​

Novara 2010 evaluated 113 patients alive and disease-free at approximately 44 months with the AUA Symptom Index, ICIQ-UI SF and IIEF-5. Sixteen of 113 (14%) used intermittent catheterization. Among the 97 voiding patients, lower urinary tract symptoms were mild in 48.5%, moderate in 40.2% and severe in 11.3%. Twenty patients (17.7%) were fully continent, and 31.9%, 35.4% and 15% had slight, moderate and severe incontinence. Roughly 90% by day and 80% by night used no pad or only a safety pad. The safety-pad category is broader than dryness. About 20% of the men were potent (IIEF-5 ≥ 17).[10]

ASA class (OR 9.0, p = 0.03) and BMI (OR 1.5, p = 0.023) independently predicted the need for catheterization, and age at surgery predicted symptom severity.[10] The authors concluded that functional outcomes may be significantly overestimated without patient-completed questionnaires. The cohort was cross-sectional, from a single center and limited to disease-free survivors.[10] In a separate 160-patient modified-VIP series with median follow-up of 73 months, one-year functional data were available for 107; 82/107 (76%) reported no daytime leakage and 28/107 (26%) no nighttime leakage.[22] This modification opened bowel near the mesenteric border, and continence was assessed by physician interview.[22]

Change over time​

Ferriero's urodynamic study began with 46 men; eight died of cancer before long-term assessment. Cystometric capacity and urethral closing pressure did not change between 12 and 48 months. End-filling pressure (p = 0.0005), pressure at peak flow (p = 0.0007) and residual urine (p = 0.013) were lower at 48 months. Involuntary contractions were more frequent (p = 0.0012) with comparable amplitude (p = 0.084). Daytime continence was 96% at 12 months and 90% at 48 months; nighttime continence was 60% at 48 months. The authors concluded that ileal tone persists despite detubularization and probably limits enlargement of the reservoir.[5]

Robotic Series and Experience​

ReportPopulation and interpretation
Cacciamani 2019 ra-VIP15 consecutive patients (2015–2017). Median operating time was 390 minutes (IQR 284–470), estimated blood loss 300 mL and hospital stay 17 days, with no conversions. Six patients had major complications within 90 days. Daytime continence at 12 months was 62%; 14 of 15 were alive at a mean follow-up of 17 months. One patient was readmitted after discharge; one patient reported a long-term sequela. The report establishes early feasibility.[2]
Simone 2018 partly stapled PIB45 consecutive patients operated on during 2012–2014. Median operating time was 305 minutes, blood loss 210 mL and stay 9 days, with no transfusion or conversion. Overall complications rose from 44.4% perioperatively and 57.8% by 30 days to 77.8% by 180 days; severe complications were 17.8%, 17.8% and 35.5% at those intervals. Two-year daytime and nighttime continence were 73.3% and 55.5%, and two-year disease-free, cancer-specific and overall survival were 72.5%, 82.3% and 82.4%. The later interval captures additional events and is not directly comparable with a 30- or 90-day series.[3]
Tuderti 2023251 patients underwent robotic cystectomy with intracorporeal diversion (2012–2020); 192 had an orthotopic neobladder. One-year continence estimates were 78.6% by day and 48.3% by night, and the trifecta rate was 64.1% in the neobladder group. Five-year disease-free, cancer-specific and overall survival were 66.5%, 65.4% and 61.5% for the whole cohort, which includes non-neobladder diversions.[11]
Mastroianni 2023 randomized open versus robotic PIBOf 116 randomized patients, 88 received an orthotopic neobladder. At one year, daytime and nighttime continence recovery probabilities were comparable; quantitative nighttime pad-use favored open surgery.[21]
Tuderti 2024 learning-curve study200 patients treated during 2013–2022, each with at least one year of follow-up. It examined changes in one-year outcomes across the program's decade, not ten-year recovery in every patient.[12]

The learning-curve study defined daytime continence as no pads, while nighttime continence allowed one safety pad with wetness of no more than 50 mL. Hospital stay (p = 0.002) and 30-day complications (p = 0.04) fell over the decade, and trifecta achievement improved (p < 0.001). The annual average percentage change in the one-year continence probability was 11.45% by day (p < 0.001) and 10.05% by night (p = 0.009). Case sequence independently predicted daytime (HR 1.008; p < 0.001) and nighttime continence (HR 1.004; p = 0.03).[12] The authors could not identify a case-volume plateau.[12]

In the 2023 Tuderti series, increasing age (HR 0.98; p = 0.03), female sex (HR 0.57; p = 0.008) and Clavien grade ≥III complications (HR 0.55; p = 0.03) were associated with a lower probability of daytime continence recovery.[11]

Late Complications and Renal Function​

Presicce 2021 studied 210 patients: 167 PIB and 43 ileal conduits, with mean follow-up of 30 months. Its overall 14% stricture and 52% renal-decline figures should not be labeled PIB-only outcomes. The published subgroup counts were:[13]

Outcome during follow-upPIB group, n = 167
Ureteroileal stricture25 (15%)
At least 20% eGFR reduction75 (45%)
Symptomatic UTI63 (38%)
Stones17 (10%)
Incisional hernia35 (21%)

Across all 210 patients, lymphocele occurred in 19 (9%), bowel occlusion in 4 (2%), metabolic acidosis in 3 (1%) and cardiovascular events in 2 (1%).[13] Among the 43 conduit patients, who were older and had more comorbidity, 5 (12%) had ureteroileal stricture, 34 (79%) had an eGFR reduction of at least 20% and none had stones. The authors describe the results as in line with historical open series; definitions, eligibility, follow-up and anastomotic methods differ between series, and between-diversion differences here are descriptive.[13]

Investigate obstruction, infection, poor emptying and other contributors when kidney function deteriorates. A technically patent or refluxing anastomosis does not eliminate the need for long-term renal and upper-tract surveillance.[9]

Metabolic and Bone Health​

Giannini's observational study compared 25 male VIP patients with 16 healthy controls. It found lower bicarbonate and lower bone density at selected femoral sites.[14] It did not test lifelong alkali treatment.[14]

Monitor electrolytes, bicarbonate and kidney function, and treat acidosis according to the actual findings and clinical context. Assess bone health according to acidosis, renal function and other risk factors. Measure vitamin B12 annually after bowel diversion, as EAU follow-up guidance advises (low levels reported in 17% of patients with bowel diversion; section 7.4 text, no strength rating).[9]

See Vitamin B12 supplementation, Urinary acidifiers & alkalinizers, and Mucus management.

Reconstruction in Women​

Tuderti's 2020 report included 11 highly selected women (cT ≤ 2 N0 M0, no tumor in the bladder neck, trigone or urethra at transurethral resection) undergoing sex-sparing cystectomy with PIB. Median operating time was 255 minutes and median stay 7 days. Four women (36.3%) had low-grade perioperative complications; no high-grade perioperative complication was reported. At a median follow-up of 28 months, none had new-onset CKD stage 3b. The one-year daytime and nighttime continence values of 90.9% and 86.4% were Kaplan–Meier recovery estimates, not simple percentages of eleven observations. Three women used intermittent catheterization twice daily; one developed a neobladder stone and one required ureteral reimplantation.[15]

Quality of life and physical and emotional functioning improved significantly over time (p ≤ 0.04). Urinary symptoms and sexual function worsened at three months and recovered significantly by one year. Eight of 11 women (72.7%) were sexually active at one year, but several sexual-function scores remained significantly below baseline.[15] Counsel about both leakage and retention, and base organ preservation on oncologic eligibility.[15][7]

Comparison with Other Reservoirs​

The Di Maida 2022 comparison enrolled 100 patients treated with robotic cystectomy and the Florence robotic intracorporeal neobladder (FloRIN), but only 69 had complete functional data and 28 had complete urodynamic data. Among the 69, 52 (75.4%) reached daytime continence (28, or 40.6%, with no pads) and 45 (65.2%) reached nighttime continence. Compared with a contemporary open VIP series from the same institution, only neobladder compliance differed on urodynamics (higher with FloRIN, p = 0.03). Urgency (p = 0.01), psychological status (p = 0.02) and physical self-acceptance (p = 0.02) scores favored FloRIN. The differences reflect both the approach (robotic vs open) and the reservoir construction.[16]

Zhu 2025 compared a separately devised anti-reflux ileum valve-pouch (IVP) with a modified Studer pouch in 127 patients at two centers (66 and 61 before matching; 42 per group after 1:1 propensity matching). Median follow-up was 44.5 and 35.5 months. Operating time, cancer-specific survival, overall survival and total complications did not differ. In the matched groups, UTI rehospitalization occurred in 10/42 with IVP versus 19/42 with modified Studer (p = 0.039). At 12 months, eGFR values differed (p = 0.031 in the Results text; p = 0.013 in Table 3), as did the frequency of the study-labeled renal-function-damage endpoint (19/42 versus 34/42; p < 0.001).[19] The valve-pouch is not the classic VIP, and the study does not test VIP itself.[19]

Similarly, Parekh's historical 100-patient series contained only 18 Padua reservoirs among five reconstruction types.[17]

The larger review of intracorporeal techniques found insufficient direct comparative evidence to favor one configuration. Choose with attention to the patient's goals, anatomy, self-care capability and the team's experience, without promising that every named reservoir has identical pressures, continence or renal outcomes.[4][8]

Long-Term Surveillance​

Continue functional assessment beyond the intensive cancer-surveillance period.[9][18]

  • Kidney and metabolic function: creatinine and eGFR, electrolytes and bicarbonate. AUA/ASCO/SUO Statement 31 advises laboratory assessment every 3–6 months for the first 2–3 years after treatment and then annually, adjusted for clinical need.[18]
  • Upper tract and emptying: imaging as indicated for obstruction, stones or deterioration; review residual urine, continence, catheterization and mucus management.
  • Nutrition: EAU advises annual B12 measurement.[9] NCCN post-cystectomy follow-up specifies annual testing after the first year based on clinical judgment (category 2A).[20] Evaluate unexplained anemia, neurologic symptoms, diarrhea or bone-health concerns.
  • Retained urothelium: risk-appropriate cancer follow-up, including monitoring of the retained urethra .[18]

See Renal function and metabolic surveillance.

See Also​

References​

1. Pagano F, Artibani W, Ligato P, et al. "Vescica ileale Padovana: a technique for total bladder replacement." Eur Urol. 1990;17(2):149–154. doi:10.1159/000464024

2. Cacciamani GE, De Marco V, Sebben M, et al. "Robot-assisted vescica ileale Padovana: a new technique for intracorporeal bladder replacement reproducing open surgical principles." Eur Urol. 2019;76(3):381–390. doi:10.1016/j.eururo.2018.11.037

3. Simone G, Papalia R, Misuraca L, et al. "Robotic intracorporeal Padua ileal bladder: surgical technique, perioperative, oncologic and functional outcomes." Eur Urol. 2018;73(6):934–940. doi:10.1016/j.eururo.2016.10.018

4. Piramide F, Turri F, Amparore D, et al. Atlas of intracorporeal orthotopic neobladder techniques after robot-assisted radical cystectomy and systematic review of clinical outcomes. Eur Urol. 2024;85(4):348–360. doi:10.1016/j.eururo.2023.11.017.

5. Ferriero M, Simone G, Rocchegiani A, et al. "Early and late urodynamic assessment of Padua ileal bladder." Urology. 2009;73(6):1357–1362. doi:10.1016/j.urology.2009.01.053

6. Pagano F, Artibani W, Passerini-Glazel G, Bassi P. Vescica ileale padovana. In: Atlante di Chirurgia Urologica, Le derivazioni urinarie, chapter VII. Fondazione Vincenzo Pansadoro. Original-author operative chapter.

7. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. 2026. Disease management, section 6.7.5, urinary diversion. Guideline.

8. American Urological Association / American Society of Clinical Oncology / Society of Urologic Oncology. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer. Amended 2024. Statements 13–14 and discussion, diversion selection and urethral margins. Guideline PDF.

9. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. 2026. Follow-up, section 7.4, functional outcomes and complications. Guideline.

10. Novara G, Ficarra V, Minja A, De Marco V, Artibani W. "Functional results following vescica ileale Padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires." Eur Urol. 2010;57(6):1045–1051. doi:10.1016/j.eururo.2010.01.007

11. Tuderti G, Mastroianni R, Chiacchio G, et al. "Long-term oncologic and functional outcomes following robot-assisted radical cystectomy and intracorporeal Padua ileal bladder: results from a single high-volume center." World J Urol. 2023;41(9):2359–2366. doi:10.1007/s00345-023-04523-8

12. Tuderti G, Mastroianni R, Anceschi U, et al. "Learning curve for intracorporeal robotic Padua ileal bladder: 10-year functional assessment from a high-volume single-centre series." BJU Int. 2024;134(1):103–109. doi:10.1111/bju.16328

13. Presicce F, Leonardo C, Tuderti G, et al. "Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion." World J Urol. 2021;39(6):1903–1909. doi:10.1007/s00345-020-03378-7

14. Giannini S, Nobile M, Sartori L, et al. "Bone density and skeletal metabolism in patients with orthotopic ileal neobladder." J Am Soc Nephrol. 1997;8(10):1553–1559. doi:10.1681/ASN.V8101553

15. Tuderti G, Mastroianni R, Flammia S, et al. "Sex-sparing robot-assisted radical cystectomy with intracorporeal Padua ileal neobladder in female: surgical technique, perioperative, oncologic and functional outcomes." J Clin Med. 2020;9(2):E577. doi:10.3390/jcm9020577

16. Di Maida F, Grosso AA, Tasso G, et al. "Robot-assisted radical cystectomy with Florence robotic intracorporeal neobladder (FloRIN): functional and urodynamic features compared with a contemporary series of open vescica ileale Padovana (VIP)." Eur J Surg Oncol. 2022;48(8):1854–1861. doi:10.1016/j.ejso.2022.04.007

17. Parekh DJ, Gilbert WB, Smith JA Jr. Functional lower urinary tract voiding outcomes after cystectomy and orthotopic neobladder. J Urol. 2000;163(1):56–58. PubMed. doi:10.1016/s0022-5347(05)67971-2

18. American Urological Association / American Society of Clinical Oncology / Society of Urologic Oncology. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer. Amended 2024. Statements 31–32 and discussion, laboratory follow-up and retained urethra. Guideline PDF.

19. Zhu Z, Zhu Y, Ying W, et al. Comparison of the anti-reflux ileum valve-pouch orthotopic neobladder and the Studer technique after radical cystectomy: surgical and renal functional outcomes. World J Surg Oncol. 2025;23(1):359. doi:10.1186/s12957-025-03699-0

20. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 3.2026. August 6, 2026. BL-E 3–4 of 6. Guideline.

21. Mastroianni R, Tuderti G, Ferriero M, et al. "Open vs robotic intracorporeal Padua ileal bladder: functional outcomes of a single-centre RCT." World J Urol. 2023;41(3):739-746. doi:10.1007/s00345-023-04312-3

22. Flack CK, Monn MF, Kaimakliotis HZ, Koch MO. "Functional and Clinicopathologic Outcomes Using a Modified Vescica Ileale Padovana Technique." Bladder Cancer. 2015;1(1):73-79. doi:10.3233/BLC-140002

23. Pagano F, Artibani W, Aragona F, Bassi P, Ruffato A, Mulonia A. "La vejiga ileal Padovana (VIP): técnica quirúrgica, evaluación funcional a largo plazo, complicaciones y conducta a seguir." Arch Esp Urol. 1997;50(7):785–793. PMID:9412385

24. Anceschi U, Basile S, Amparore D, et al. "Far beyond the shape: an early head-to-head comparative urodynamic analysis of three contemporary totally intracorporeal robotic orthotopic neobladder techniques." J Robot Surg. 2025;19(1):689. doi:10.1007/s11701-025-02821-4

25. Mastroianni R, Tuderti G, Anceschi U, et al. "Robotic intracorporeal modified Bordeaux versus Padua ileal bladder: head-to-head surgical technique, perioperative and functional outcomes." Minerva Urol Nephrol. 2026;78(3):430–437. doi:10.23736/S2724-6051.26.06906-5

26. Shimizu F, Muto S, Kitamura K, et al. "Robot-Assisted Radical Cystectomy with Modified Vesica Ileale Padovana (VIP) Neobladder Configuration Using a Hybrid Approach: Initial Experience." J Pers Med. 2023;13(5):802. doi:10.3390/jpm13050802