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Orthotopic ileal W-shaped neobladder: functional results and oncological outcome
1Varna Medical University, Department of Surgery, Division of Urology.
Introduction:
There still exists an ongoing debate regarding the optimal method of ureterointestinal reimplantation in continent urinary diversion. The main objectives of the present study was to analyze the long-term functional results and the oncological outcome after the construction of orthotopic ileal neobladders, based on the antireflux serous-lined extramural tunnel technique.
Materials And Methods:
A total of 32 bladder cancer patients (30 males and 2 females, mean age 588 years), who underwent between 1/9/1996 and 1/9/2006 extended pelvic lymphadenectomy and radical cystectomy, followed by the construction of orthotopic W-shaped ileal neobladder, entered the study. All ureters were reimplanted via serous-lined extramural tunnels for reflux prevention. Adjuvant systemic chemotherapy with gemcitabine plus cisplatin was applied in 17 cases. All patients were evaluable for follow up (mean follow up - 53.938 months). Evaluation included clinical, radiographic and urodynamical studies to determine functional and oncological outcomes.
Results:
None of the patients died in the hospital. Various early and late complications occurred in 18.8% and 21.9% of the patients, respectively. The overall incidence of day- and nighttime continence was 93.8% and 78.1%. Stenosis at the anastomotic site occurred in 2 uretero-ileal anastomoses (3.2%), while none of the patients showed evidence of pouchoureteral reflux. Renal function was stabilized or improved in 96.8% of the reimplanted renal units. Eight oncological failures were observed during follow-up: 1 local tumor recurrence and 7 metastatic tumor spreads. The overall and disease-specific patient survival was 72% and 81%, resp.
Conclusion:
The serous-lined extramural tunnel technique provides an effective and safe ureteroileal anastomosis, achieving nonobstructed unidirectional flow of urine. The results are durable and sustained with time. Therefore, this technique should be recommended whenever a construction of a continent intestinal urinary reservoir is considered.
