The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

Abstract

Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture.Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1-5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication.Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months.Hyper-continence with subsequent need for CISC was observed in 4%. CONCLUSIONIn our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an 'expected' complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.

Metabolic acidosis: neo-considerations for general surgeons

“…Martínez-Cornelio et al reported metabolic acidosis as the most frequent early complication of neobladder formation in their centre, demonstrated in 66% of patients 4 . In another case series, Neuzillet et al reported a 15% complication rate of metabolic acidosis and all of these cases responded well to oral medication 5 . In a large study involving 1,000 neobladders, Hautmann et al found that 70% of patients had metabolic acidosis in the early post-operative period, which was easily treated with sodium bicarbonate 6 .…”

Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature

“…In one study, the authors used a standardised definition of UTI, referring to the consensus conference of the AFSSAPS (Agence Française de Sécurité Sanitaire des Produit de Santé) . In the study of Hautmann et al.…”

“…Although most studies used SCr measurements, IVU , and CT for laboratory and morphological assessment of RFn, none provided absolute figures in the results section. Neuzillet et al.…”

“…Neuzillet et al. used creatinine clearance as a measure of RFn; however, in the methods section they did not provide information on how it was calculated. In one study, 51 creatinine ethylenediamine tetra‐acetic acid (EDTA) clearance was used to evaluate RFn .…”

Optimal use and outcomes of orthotopic neobladder reconstruction in men and women

“…The large contemporary orthotopic neobladder cohorts (mainly including male patients) have shown daytime continence rates of 87-95.9% [55][56][57][58][59] after a median follow-up of 32-57 months. Due to a loss of the detrusor-sphincter reflex increasing the outlet pressure of the sphincter during filling of the bladder, night-time continence rates are lower (72-95%).…”