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Updated: Aug 5, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Comparison Study of Inverted-Nipple Ureteroneocystostomy and Direct Anastomosis in U-Shaped Orthotopic Neobladder
Qi Xing1,2, Yang-Bing Wei1,2, Xin Wang1,2
1Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Background:
Inverted-nipple ureteroneocystostomy (inverted-NU) is a novel technique for laparoscopic radical cystectomy with orthotopic neobladder reconstruction (LRC+ONB). For the traditional direct anastomosis (DA) technique, inverted-NU provides a more instructive clinical protocol.
Patients And Methods:
Between 2020 and 2025, 84 patients were treated with LRC+ONB: 44 through inverted-NU and 40 through DA, respectively. Clinical features were compared including postoperative complications clinical symptoms, perioperative data, changes in renal function, urinary continence rates, and quality of life for the two groups. Here, postoperative low renal function has been analyzed via multivariate logistic regression.
Results:
The mean follow-up period was 35 ± 18.4 months. Compared with the DA group, the inverted-NU group demonstrated a shorter operative time (410 min versus 470 min, P = 0.002), faster recovery of bowel function (5 days versus 5.5 days, P = 0.035), and less postoperative hydronephrosis (34.1% versus 77.5%, P < 0.001). No uretero-neobladder anastomotic strictures were observed in the inverted-NU group compared with five cases in the DA group during follow-up (P = 0.021). As for postoperative renal function, lower levels of urea, creatinine, uric acid, and estimated glomerular filtration rate grading could be found in the inverted-NU group than DA group (P < 0.05). Multivariate analysis revealed ureteroenteric anastomotic stricture (OR 12.74; 95% CI 1.25-130.07; P = 0.032) and non-urothelial carcinoma (OR 7.30; 95% CI 1.04-51.40; P = 0.046) as independent risk factors for postoperative low renal function. Additionally, inverted-NU demonstrated superior nighttime continence (P = 0.031), with similar quality of life between groups.
Conclusions:
Inverted-NU was feasible with a low complication rate compared with the traditional DA technique. It significantly reduced the incidence of anastomotic stricture and hydronephrosis after orthotopic neobladder, and no trend toward postoperative renal function deterioration was observed.
