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. 2023 Jul 22;21(1):218.
doi: 10.1186/s12957-023-03112-8.

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

Sarayuth Boonchai  1 , Monthira Tanthanuch  1 , Tanan Bejrananda  2
Affiliations

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

Sarayuth Boonchai et al. World J Surg Oncol. .

Abstract

Background: To explore a method of constructing an orthotopic ileal neobladder (ONB) in the Y-pouch configuration. We describe the steps followed to create the Y-pouch ileal orthotopic neobladder (ONB) and compared the perioperative, functional, and urodynamics outcomes with the Studer neobladder technique.

Methods: A retrospective cohort study of 90 bladder cancer patients, who received open radical cystectomy with the ONB performed at a hospital from June 2009 to May 2020. These patients were divided into two groups-the Y-pouch and the Studer neobladder groups. Perioperative, functional outcome, complication, renal function data outcomes, and pressure-volume study were used to evaluate the treatment outcomes after a radical cystectomy.

Results: Ninety patients (54 Studer and 36 Y-pouch neobladder) were enrolled. The median patient age was 62.6 (± 11) years. The mean operative time for the Studer technique was 290 (242.5-350) min, and the Y-pouch technique was 300 (271.2-335) min) (p = 0.826). At 30 days postoperatively, the Clavien-Dindo classification of surgical complications revealed grade-2 urinary infections in two patients (5.6%) and six patients (11.1%) for the Y-pouch and Studer techniques, respectively. Intermediate complications (30-90 days) were reported in 4 (11.1%) and 18 patients (44.4%) in the Y-pouch and the Studer techniques, respectively (p = 0.062). In the urodynamics study (UDS), the Y-pouch group had a mean postvoid residual volume of 20 mL and Studer of 40 ml (p = 0.06). A mean capacity of 462 (380-600) mL compares to the Studer neobladder group with 495 (400-628) mL. The average mean compliance of the Studer group was 35.5 (28-52) ml/cm H2O and 33 (30-43) ml/cm H2O for Y pouch, and most patients had > 30 ml/cm H2O compliance (80/90 patients).

Conclusions: The Y-pouch neobladder technique in an RC with an orthotopic neobladder provides perioperative and functional outcomes compared to those of the Studer orthotopic neobladder resulting in similar intermediate-term. Therefore, the Y-pouch ileal neobladder is both feasible and safe to be used as a standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy and needs confirmation with long-term results.

Keywords: Bladder cancer; Orthotopic neobladder; Radical cystectomy; Studer neobladder; Y-pouch neobladder.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surgical steps in the creation of the Y-pouch neobladder. A Harvest of 40 cm of ileal segment. B Creation of Y-pouch configuration. C Separation of the ileal segment at the antimesenteric border for detubularization. D Continuous suturing of medial edges of the ileal loop. E Anastomosis of uretero-neobladder. F Suturing of the anterior wall of the neobladder and performance of urethroileal anastomosis over a transurethral 20-French catheter
Fig. 2
Fig. 2
Small bowel suturing of the Y-pouch ileal neobladder. A Medial edges and B lateral edges of the ileal loop were sutured
Fig. 3
Fig. 3
Comparison of changes in serum creatinine levels (A) and the estimated glomerular filtration rate (GFR) (B) with the standard deviation over time up to 12 months between the Y-pouch and Studer techniques
See this image and copyright information in PMC

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