OBJECTIVES:The objectives of this study are to introduce the surgical technique of a modified spiral orthotopic ileal neobladder and to assess the long-term outcomes.
PATIENTS AND METHODS: Between January 1998 and January 2006, 44 male and 7 female patients with bladder cancer received radical cystectomy (RC) and pelvic lymphadenectomy. An ileal segment 40 cm to 45 cm long was isolated to create a spiral orthotopic ileal neobladder, and the ureters were implanted into the reservoir using a non-refluxing split-cuff nipple technique. Preoperative, perioperative, and postoperative data were collected. Complications were classified as early (less than 3 months after surgery) or late (more than 3 months after surgery). Continence incidence and urodynamic studies were evaluated 5 years after surgery. Duration of follow-up was an average of 95 months (range 60-156 months).
RESULTS: There were no perioperative deaths. The mean operative time was 315 ± 34 minutes. The mean blood loss was 783 ± 316 ml. There were 31 early complications in 21 patients (41%) and 42 late complications in 30 patients (59%). Urodynamic studies showed the maximum neobladder capacity to be 500 ± 71 ml, maximum flow rate to be 16 ± 5 ml/s and post-voiding residual (PVR) to be 50 ± 44 ml. Postoperative continence was excellent with a daytime continence rate of 90% and a nocturnal continence rate of 78% 5 years after surgery.
CONCLUSIONS: The modified spiral neobladder is easy to perform and allows for excellent long-term results with regard to complications and continence.
Written by:
Wang WG, Zhong H, Yu B, Tang JE, Chen Y, Cao M, Jin XD. Are you the author?
Department of Urology, The First People's Hospital of Huzhou, Affiliated Hospital of Huzhou Teachers' College, Huzhou, P.R. China.
Reference: Urol Oncol. 2012 Apr 3. Epub ahead of print.
doi: 10.1016/j.urolonc.2012.02.010
PubMed Abstract
PMID: 22481020
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