Supra-ampullar cystectomy and ileal neobladder

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Bladder cancer treatment often involves radical cystectomy, potentially impacting sexual function and continence.
• Supra-ampullar cystectomy (SAC) with orthotopic neobladder reconstruction offers an alternative approach.
• Evaluating the oncologic and functional outcomes of SAC is essential.

Purpose of the Study:

• To describe the open and laparoscopic surgical techniques for supra-ampullar cystectomy (SAC).
• To assess the oncologic outcomes and functional results (sexual function, urinary continence) of SAC with ileal orthotopic neobladder.

Main Methods:

• Step-by-step description of open and laparoscopic SAC techniques.
• Retrospective analysis of 31 patients undergoing SAC with ileal orthotopic neobladder (Camey I, II, Y) between 1984 and 2005.
• Median follow-up of 95 months for oncologic and functional outcomes.

Main Results:

• 31 patients with bladder tumors underwent SAC with ileal orthotopic neobladder; 3 had laparoscopic procedures.
• 10-year cause-specific survival rate was 76.7% with 2 local recurrences.
• Potency preserved in 90.3%, antegrade ejaculation in 48.3%, and daytime continence in all patients.

Conclusions:

• SAC with detubularized ileal orthotopic neobladder achieves good oncologic control.
• Preservation of sexual function and urinary continence is feasible in selected patients.
• Strict preoperative patient selection is paramount for successful outcomes.