Current Issue UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.02
Modified N-Shaped Ileal Neobladder After Radical Cystectomy
INTRODUCTION: The authors report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy.
METHODS: Between April 2000 and April 2006, 42 patients (36 male, 6 female) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by an ileal low pressure reservoir (N-shaped) with an afferent isoperistaltic tubular segment. Of the 42 patients, 36 (86%) had squamous cell carcinoma; 6 had transitional cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. Thirty-two males and 4 females were available for a median follow-up period of 24.8 months. Follow-up included clinical and radiographic studies to determine functional and oncological outcomes.
RESULTS: : Eleven patients (25%) had early complications during the period ≤ 3 months following surgery. Seven of these patients had complications such as wound infection, prolonged ileus, persistent urinary leakage, and deep venous thrombosis that were treated conservatively. One female patient developed a pouch-vaginal fistula that required repair. The remaining 3 patients had oncological failures, 1 of which was isolated urethral recurrence. Late complications occurred in 15 patients (37.5%). These included pouch stones, outflow obstruction, mucus retention, and adhesive bowel obstruction. Daytime and nighttime continence was achieved in 92% and 80% of the patients, respectively, and ureteroileal stricture was observed in 5%. The upper tracts remained unchanged or improved in 95% of the patients.
CONCLUSIONS: Ileal orthotopic bladder substitution (N- shaped) with an afferent ileal tubular segment offers good functional results with good preservation of the renal units. It is considered a safe and technically feasible surgical procedure.
KEYWORDS: N-pouch; Cystectomy; Orthotopic diversion
CORRESPONDENCE: Wael M Gamal, MD, Department of Urology, Sohag University, 31 el nasr Street, Sohag, Egypt (wael_saad_el_dien@hotmail.com).
CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.02
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