[Uretero-ileal anastomosis in orthotopic neobladder: antireflux versus direct techinique]

We report on the long-term functional results of the orthotopic VIP neobladder and compare the outcome of the antireflux technique for ureteral implantation versus direct anastomosis.

Between 1998 and 2009, 84 patients underwent cystoprostatectomy and orthotopic VIP neobladder for invasive bladder carcinoma. 96 renal units were reimplanted using the Enine-Ghoneim antirefluxing technique (group 1). The direct Nesbit end-to-side technique for ureteral reimplantation was applied in 72 renal units (group 2). The mean follow-up period was 54 months (range, 10-154 months).

Of the 96 renal units who underwent the Enine-Ghoneim technique, 12 (12.5%) had uretero-ileal anastomotic stricture and 4 (4.1%) had reflux. Of the 72 renal units who underwent direct anastomosis, 11 (15.2%) patients had reflux, 2 (2.7%) had uretero-ileal anastomotic stricture. The incidence of stricture formation in the Enine-Ghoneim technique is significantly higher than direct anastomosis. The incidence of reflux in preoperatively dilated ureters was significantly higher in direct ureteral anastomosis than antireflux technique. The incidence of stone formation, renal scaring and pyelonephritis was comparable in both groups.

Direct uretero-ileal anastomosis in orthotopic bladder replacement is more reasonable than the Enine-Ghoneim antireflux technique in non-dilated ureters. The benefit of the antireflux technique has been overestimated despite the frequency of stricture formation.