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.

Keywords: Ileal neobladder; Orthotopic ureteral reimplantation; Radical cystectomy; Urinary diversion.

Fig. 1

The “spiral-shaped” neobladder and “sleeve-shaped” ureter. a During the surgery, the prepared ileal segment was closed in a “spiral-shaped” manner to construct the neobladder; b during the surgery, the end of the ureter was split 1 cm and everted in a “sleeve shape” for anti-refluxing; c a sketch map of the “spiral-shaped” neobladder; d a sketch map of the “sleeve-shaped” ureter

Fig. 2

Pathology results of a typical case in the follow-up. a Postoperative resection of a cancerous tissue; b hematoxylin–eosin staining showed typical features of urothelial carcinoma

Fig. 3

Imaging examination results of a typical case in the follow-up. a, b Cystoscopy examination results showed good ureteral opening; c, d frontal planes of intravenous pyelography examination results showed no hydronephrosis; e, f transverse planes of intravenous pyelography examination results showed no hydronephrosis

Fig. 4

ROC curve of urodynamics to predict death at 3 and 5 years after surgery. a ROC curve of urodynamics to predict death at 3 years after surgery. The area under the curve (AUC) was 0.859, 0.800, and 0.837 for pressure at maximum capacity, compliance, and post void residual urine, respectively, P < 0.001; b ROC curve of urodynamics to predict death at 5 years after surgery. The AUC was 0.875, 0.796, and 0.717 for pressure at maximum capacity, urinary compliance, and post void residual urine, respectively, P < 0.001