OBJECTIVE:We report on the functional outcomes and complications of the modified U-shaped ileal neobladder as a new technique following radical cystectomy.
MATERIALS AND METHODS:Between January 2005 and March 2010, 56 patients (36 men and 20 women, mean age 62.3 years) 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 a modified U-shaped ileal neobladder reservoir. Of the patients, 49 (87.5%) had transitional cell carcinoma; 7 had squamous cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. Functional outcomes and complications were all recorded in detail.
RESULTS:During the mean (range) follow-up of 26.3 (14-37) months, there were no deaths related to the procedure. Early complications developed in 15 patients, whereas 7 patients had late complications. Hyperchloremic metabolic acidosis occurred in 2 patients, but neither of them developed hypovitaminosis of B12. None of the patients had local and/or distant recurrences. The daytime continence rate was 96% and the nocturnal continence rate was 76%. The mean (SD, range) neobladder capacity and residual urine volume was 340.9 (240-450) and 22.7 (13-36) ml, respectively. The mean (SD, range) voided volume and maximum flow rate were 317.9 (226-431) and 16.2 (12.2-21.2) ml/s, respectively. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients.
CONCLUSIONS: The modified U-shaped ileal neobladder provides satisfactory functional outcomes and acceptable complication rate. It is considered a safe and technically feasible surgical procedure.
Zhong S, Zhu Z, Wang X, Pan C, Chen S, Shen Z. Are you the author?
Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Reference: Urol Oncol. 2012 Jun 30. Epub ahead of print.