A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy

Abstract

Background: The aim of this study is to describe a modified technique in ileal orthotopic bladder substitution with a new ureteroileal anastomosis. Case presentation: After a classic open radical cystectomy with bilateral pelvic lymphadenectomy was performed extraperitoneally, a 56-cm ileal segment was used to construct the spheroidal shape bladder substitution. The 8-cm long proximal and distal ends of the ileal segment were used as afferent limbs. Two-centimeter ileal segments of afferent limbs were detubularized and transversally tubularized. The elongated ileal tube was anastomosed with the ureter in an end-to-end fashion. The pathway of the ureteroileal anastomosis was placed between the abdominal cutaneous fat and the anterior rectus muscular sheath. Perioperative data and long-term functional outcomes were assessed. Between December 2011 and December 2015, seven male patients underwent this procedure with a median 46 (30-77) months follow-up in our hospital. There was no difference between preoperative and postoperative estimated glomerular filtration rates (Z = − 1.693, P = 0.09). One of 14 sides had ureteroileal anastomotic stenosis; two of 14 sides in one patient had ureteroileal anastomotic stenosis caused by invasion of pelvic recurrence 15 months postoperatively. Reflux was completely prevented by placing pressure on the corresponding point on the abdominal surface when voiding urine in all patients. Conclusions:We describe a feasible technique modification in detail, which provides some advantages for effective anti-reflux by mechanical finger pressing and abdominal contraction, a low incidence of stricture, and ease for a secondary operation in the long-term follow-up period.

A comparative study of perioperative and survival outcomes of robot-assisted radical cystectomy in patients over 80 and under 80 years old

“…Although current guidelines for treatment of MIBC do not exclude the possibility of RC for old patients, they suggest that life expectancy should still be taken into account [ 5 ]. More minimally invasive approaches and modified techniques are underscored to reduce the surgical risk of RC [ 6 ]. In recent years, laparoscopic and robotic-assisted laparoscopic surgeries have been more and more applied to the treatment of bladder cancer [ 7 ].…”

Chronic kidney disease and Charlson comorbidity index predict complications after robot‐assisted radical cystectomy: A single‐center study in Japan

“…In recent years, minimally invasive surgery has been promoted to reduce the risks associated with RC. 4 Minimally invasive surgeries have the potential to reduce the incidence of perioperative complications without sacrificing oncologic outcomes. 5 RARC is significantly associated with lower perioperative transfusion rates, lower rates of serious complications, and shorter hospital stays than open radical cystectomy.…”

“…On the contrary, it has been reported that a majority of patients with untreated muscle layer invasive bladder cancer die of bladder cancer within 5 years, 3 suggesting that radical treatment should be offered whenever possible. In recent years, minimally invasive surgery has been promoted to reduce the risks associated with RC 4 . Minimally invasive surgeries have the potential to reduce the incidence of perioperative complications without sacrificing oncologic outcomes 5 .…”