Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation

Abstract

Purpose The purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery. Methods Between January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien-Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument. Results The total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05). Conclusion Spiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

“…The vast majority of articles included in our SR were retrospective, with only a few (28.8%) prospective trials [8,12,13,15,[21][22][23]25,33,46,48,49,53,60,[63][64][65]. Only 13 (22%) report institutional review board approval [8,[13][14][15][20][21][22]25,33,40,53,64,65].…”

“…Twenty (33.9%) studies [8,10,14,15,17,23,26,27,32,40,42,44,45,50,51,53,57,61,64,65] reported mean overall operating times. Only 6 studies (10.2%) [23,26,50,51,57,64] specified OT for the reconstructive part of the surgery.…”

“…Concerning the filling phase of the UDS, the most reported parameters (39 studies, 66.1%) were MCC and compliance [7,8,[12][13][14][15][16][19][20][21][22][23][24][25]29,30,[32][33][34][35]37,38,40,41,43,[45][46][47]49,[51][52][53]56,58,60,[62][63][64][65]. Thirteen studies [8,21,29,34,37,45,[48][49][50]52,56,59,…”

Comparison of the Y-pouch orthotopic neobladder and the Studer technique after radical cystectomy: surgical and functional outcomes from a single-center series

“…A radical cystectomy (RC) is an effective method for the treatment of invasive bladder cancer, with an ileal orthotopic neobladder (ONB) reconstruction being an ileal method of urinary diversion [ 1 , 2 ]. An orthotopic neobladder should enable normal bladder function, keep adequate capacity at low pressure, create a continence mechanism, and prevent upper urinary tract dilatation via an antireflux mechanism [ 3 ].…”

A Novel Neobladder-Urethral Drag-and-Bond Anastomosis Technique During Laparoscopic Radical Cystectomy for Ileal Orthotopic Neobladder: Surgical Technique and Initial Research

“…Radical cystectomy (RC) is an effective method for the treatment of invasive bladder cancer while ileal orthotopic neobladder (IONB) reconstruction is an ideal method of urinary diversion. 1 , 2 Due to the narrow and deep operation space behind retropubic, it is difficult to hold, insert, and withdraw the needle 3 If the neobladder-urethral anastomosis has some tension, the anastomosis will be more tedious. Therefore, neobladder-urethral anastomosis is considered as an important and critical step in these procedures.…”