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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 available neobladder configurations. Institutional series do not establish that it is the dominant robotic technique or that its functional results are superior to Studer, Hautmann or other designs. The 2024 systematic review of intracorporeal neobladders found no eligible randomized or comparative cohort studies comparing configurations.[4]

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 should not be described as a Studer-like reservoir with a mandatory intact 8–10 cm afferent limb. The original authors' operative chapter describes a detubularized reservoir, a dependent funnel for urethral connection and Le Duc implantation, with a later serous-lined extramural tunnel modification. An added afferent limb belongs to a particular modified design.[6]

Operative framework​

  1. Select well-perfused ileum that reaches the retained urethra without tension; the original-author chapter describes 40–60 cm, with appropriate terminal ileum preserved.
  2. Isolate the segment, restore bowel continuity and open the reservoir bowel along the antimesenteric border.
  3. Form the dependent outlet/funnel and reconfigure the opened bowel into the posterior wall and rounded reservoir.
  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.[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. This is not a mucosal Le Duc sulcus and does not require inventing a separate Studer afferent limb. See Mansoura Neobladder for the detailed tunnel discussion.[6]

Robotic VIP and Rome's partly stapled PIB are adaptations of these principles. Preserve the identity of the actual modification when documenting steps, outcomes or complications; do not combine their dimensions, anastomoses and outcomes into one fixed protocol.[2][3]

Selection and Postoperative Care​

Use the same essential selection principles as other orthotopic bowel reservoirs: suitable bowel, adequate kidney and liver function, a usable sphincter/outlet, oncologic suitability of the retained urethra and the ability to manage emptying or catheterization. A negative urethral margin must be verified. Age alone is not an absolute contraindication.[7][8]

Plan pouch drainage, mucus care, leak assessment and catheter/stent removal around the actual reconstruction and healing. After catheter removal, teach scheduled emptying, outlet relaxation, recognition of retention and intermittent catheterization when needed. Published low-pressure results do not replace residual-urine and upper-tract assessment.[7][9]

Functional Outcomes​

Original open experience​

Pagano's initial 16 patients had only 4–18 months of follow-up, mean ten months. Fourteen were continent by day and 13 reported dry sleep for 6–7 hours. Mean pressure at capacity was 17 cmH₂O, but half had pressure waves of 30–50 cmH₂O. One ureteroileal and two urethroileal strictures were reported. These observations describe an early cohort, not a universal pressure target or guarantee of continence and unobstructed drainage.[1]

Patient-reported function​

Novara 2010 evaluated 113 patients alive and disease-free at approximately 44 months. Sixteen required intermittent catheterization. Twenty patients (17.7%) reported no leakage, whereas roughly 90% by day and 80% by night used no pad or only a safety pad. These definitions measure different aspects of function; a safety-pad category is not synonymous with no leakage.[10]

The study supports using patient-completed instruments and clearly defined outcomes. It did not directly randomize or compare clinician versus patient reporting, so it cannot quantify a universal amount of clinician overestimation. Its selected disease-free population also limits generalization.[10]

Change over time​

Ferriero's urodynamic study began with 46 men; eight died of cancer before long-term assessment. At 48 months, filling pressure, pressure at peak flow and residual urine were lower than at 12 months, but involuntary contractions were more frequent, and continence did not uniformly improve. This supports continued functional assessment rather than a promise that every aspect of reservoir function improves with time.[5]

Robotic Series and Experience​

ReportPopulation and interpretation
Cacciamani 2019 ra-VIP15 patients; six experienced major complications within 90 days. It established early feasibility, not a predictable operative-time or continence result for every center.[2]
Simone 2018 partly stapled PIB45 consecutive patients operated on during 2012–2014. Median operating time was 305 minutes; overall complications rose from 57.8% by 30 days to 77.8% by 180 days. The later interval captures additional events and should not be compared directly with a 30- or 90-day series.[3]
Tuderti 2023251 patients underwent robotic cystectomy with intracorporeal diversion; only 192 had an orthotopic neobladder. One-year continence estimates were 78.6% by day and 48.3% by night in the neobladder group. Whole-cohort five-year survival estimates are not outcomes of 251 PIB patients each followed for five years.[11]
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. Outcomes and some perioperative measures improved with case sequence, but experience coincided with other changes over time. The authors could not identify a case-volume plateau. Annual trend estimates are not absolute percentage-point gains promised to an individual patient.[12]

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%)

The conduit patients were older and had more comorbidity. Neither between-diversion differences nor comparisons against historical open Studer/Hautmann percentages establish a causal advantage of one operation. Definitions, eligibility, follow-up and anastomotic methods differ.[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. It did not test lifelong alkali treatment or establish that every VIP patient needs indefinite supplementation or a fixed bone-density schedule.[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. A low rate of coded acidosis complications in a surgical series is not the same as systematically measured biochemical prevalence.[9][13]

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

Reconstruction in Women​

Tuderti's 2020 report included 11 highly selected women undergoing organ- and nerve-preserving cystectomy with PIB. 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]

Eight women reported sexual activity at one year, but several sexual-function scores remained significantly below baseline despite recovery from the early postoperative decline. A small nonrandomized comparison with substantially older patients undergoing standard surgery cannot establish that the preservation technique causes superior function or equivalent cancer control. Counsel about both leakage and retention, and base organ preservation on oncologic eligibility.[15][7]

Comparison with Other Reservoirs​

The Di Maida 2022 FloRIN comparison enrolled 100 robotic patients, but only 69 had complete functional data and 28 had complete urodynamic data. Reported differences from an open VIP cohort reflect both different approaches and different reservoir constructions. Observed compliance or quality-of-life differences do not by themselves establish superiority of one pouch.[16]

Similarly, Parekh's historical 100-patient series contained only 18 Padua reservoirs among five reconstruction types. It was an institutional experience, not a randomized multicenter equivalence trial.[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/eGFR, electrolytes and bicarbonate. AUA recommends 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: annual B12, with additional evaluation for unexplained anemia, neurologic symptoms, diarrhea or bone-health concerns.[9]
  • 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.

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.