Hybrid ileal pouch with concomitant anti-refluxing and refluxing ureteroileal anastomosis

Abstract

Purpose We report our preliminary experience of using a hybrid ileal pouch, assessing oncologic outcomes, complications, voiding, and renal function. Methods The study included 25 patients with bladder cancer treated with radical cystectomy with a hybrid ileal pouch with concomitant anti-refluxing and refluxing anastomosis, performed by a single surgeon. The patients were divided into two groups (first and last cases) according to the surgery date. Postoperative complications, separate renal function by renal scan, voiding function by uroflowmetry with residual urine, and oncologic outcomes were assessed. Results The surgery duration was shorter in the last cases than the first cases. The voiding volume increased with time. There were 23 cases of grade 3 complication in 12 patients and one case of grade 4 complication (sepsis). In the first cases, ureterovesical stenosis occurred in five cases, whereas in the last cases, there were no cases of stenosis. In separate renal function, there was no difference between the left and right side or between the first and last cases. Conclusions The hybrid ileal pouch showed acceptable oncologic and functional outcomes and complications; therefore, it can be used according to the appropriate surgical situation with a relatively short bowel segment during neobladder construction.

Is Anti-Reflux Anastomosis an Advantage in an Orthotopic Ileal Neobladder? A Systematic Review and Meta-Analysis

“…The main characteristics of the included studies are shown in Table 1, the surgical procedures are summarized in Table 2, and the postoperative complications and results are shown in Table 3. There were 5 RCTs [19, 23, 26-28] and 6 cohort studies [20-22, 24, 25, 29] out of the 11 studies. Patients who underwent RC and ONB as UD were included in the studies.…”

“…Patients who underwent RC and ONB as UD were included in the studies. Only 4 articles [21, 26, 27, 29] addressed the TNM staging of tumor. Five studies [19, 21, 23, 24, 28] reported briefly on suture material in ureteroileal anastomosis technique.…”

“…All 11 studies [19-29] assessed UEAS for the kidneys and ureters. Data collected from studies showed that the incidence of UEAS with anti-reflux anastomosis was significantly higher than that of direct anastomosis (OR = 2.84; 95% CI: 1.75–4.61, p < 0.0001) (Fig.…”

“…With moderate heterogeneity between studies ( I 2 = 50%), subgroup analyses were performed for publication type, retention of stent for the duration, and laterality of UEAS (Table 4). Publication type might be the reason for heterogeneity, and the difference between anti-reflux anastomosis and direct anastomosis was more obvious in cohort studies [20-22, 24, 25, 29] ( p = 0.006) (Fig. 2b).…”

“…Seven studies [19, 20, 22, 24, 25, 28, 29] that included 540 patients compared the number of pyelonephritis. The summary of data collected to assess pyelonephritis showed no significant difference between anti-reflux anastomosis and direct anastomosis (OR = 1.13; 95% CI: 0.65–1.99; p = 0.66, I 2 = 1%) (Fig.…”