Radical cystectomy and W-shaped ileal orthotopic neobladder reconstruction with serosa-lined tunneled ureteroileal anastomoses: A critical analysis of the short-term voiding patterns and urodynamic and functional outcomes

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.

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

Zhong

Shen

Yao

et al. 2019

Int Urol Nephrol

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Indication and functional outcome of orthotopic neo-bladder reconstruction following radical cystectomy for bladder cancers in a specialist hospital in north-west Cameroon

Ngwa-Ebogo,

Nchomboh,

Mbouche

et al. 2024

Afr J Urol

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Background Radical cystectomy (RC) and urinary diversion are treatment modalities for muscle invasive bladder cancer (MIBC). However, in Cameroon, there is little information on orthotopic neo-bladder (ONB) reconstruction in the literature. Objective We aimed to share our indications for ONB reconstruction, evaluate the functional outcomes, and enumerate the surgical complications. By sharing our experience with ONB reconstruction, we hope to broaden the understanding of this procedure and aid in anticipating its various outcomes. Methods A retrospective assessment of medical records was conducted for all patients who underwent ONB reconstruction after RC for bladder cancer from January 2020 to April 2023 at Nkwen Baptist Hospital. Data collected included socio-demographic details, clinical and pathological data, indications for surgery, voiding, and metabolic outcomes at 6 and 12 months postoperatively. Data analysis was performed using IBM-SPSS version 26.0. Results Eighteen patients (66.7% male) with a mean age of 60.50 (± 6.90) years were included. Indications for ONB were 56% for pT2b, 23% for pT2a, and 23% for multifocal T1 disease without ureteral, urethral, or bladder neck extension. At 12 months, 77.8% had acceptable diurnal continence, and 72.2% had acceptable nocturnal continence. Peak urinary flow rates and post-void residual volumes were acceptable in 77.8% and 83.3% of patients, respectively. Additionally, 88.9% had normal sodium levels, 94.4% had normal potassium levels, and 94.4% had normal chloride levels at 12 months post-ONB creation. Conclusions ONB reconstruction provides satisfactory continence and minimal rates of electrolyte derangement, contributing valuable insights into the functional outcomes of this procedure.

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

Asimakopoulos,

Finazzi Agrò,

Piechaud

et al. 2024

Cancers

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Introduction: The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. Objective: To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. Methods: A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001–December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Results and Conclusion: Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9–433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5–25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7–89.1%) and 61.7% (95% CI: 51.9–71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.

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Radical cystectomy and W-shaped ileal orthotopic neobladder reconstruction with serosa-lined tunneled ureteroileal anastomoses: A critical analysis of the short-term voiding patterns and urodynamic and functional outcomes

Cited by 3 publications

References 27 publications

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

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

Indication and functional outcome of orthotopic neo-bladder reconstruction following radical cystectomy for bladder cancers in a specialist hospital in north-west Cameroon

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

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