PURPOSE: To evaluate the long-term functional results and complications of an orthotopic ileal neobladder, defined as perugia ileal neobladder (PIN), in a group of patients with bladder cancer who underwent radical cystectomy (RC). METHODS: Between 1993 and 2009, 237 consecutive patients who underwent RC for non-metastatic bladder cancer and orthotopic ileal neobladder reconstruction were enrolled. The neobladder was created using a modified Camey-II technique and consisted of a detubularized ileal loop of 45 cm using a vertical "Y" shape. Complications (<90 days) were reviewed and staged according to Clavien-Dindo classification and evaluated at long-term follow-up. Standard monitoring for cancer recurrence (computerized tomography, bone scan), cystourethrography, urodynamics and frequency/volume charts were performed during follow-up. RESULTS: The median follow-up was 64 months, and the 5-year overall survival rate was 64 %. Early complications were mostly grade I and II; grade III and IV complications were observed in 27 patients. Perioperative mortality rate was 1.6 %. The most frequent late complications were neobladder-ureteral reflux, urolithiasis and urethral anastomotic stricture. Daytime and nighttime urinary continence were 93.5 and 83.9 %, respectively. All patients were able to completely empty neobladders. Twenty patients were followed up for at least 10 years and presented satisfactory functional results. CONCLUSIONS: Surgical morbidity of RC and orthotopic neobladder was significant; however, the rate of grade III-IV complications was low. The long-term functional results of the PIN were interesting, confirming that appropriate patients' selection, adequate surgical technique, accurate patients' counseling and follow-up are essential.
PURPOSE: To evaluate the long-term functional results and complications of an orthotopic ileal neobladder, defined as perugia ileal neobladder (PIN), in a group of patients with bladder cancer who underwent radical cystectomy (RC). METHODS: Between 1993 and 2009, 237 consecutive patients who underwent RC for non-metastatic bladder cancer and orthotopic ileal neobladder reconstruction were enrolled. The neobladder was created using a modified Camey-II technique and consisted of a detubularized ileal loop of 45 cm using a vertical "Y" shape. Complications (<90 days) were reviewed and staged according to Clavien-Dindo classification and evaluated at long-term follow-up. Standard monitoring for cancer recurrence (computerized tomography, bone scan), cystourethrography, urodynamics and frequency/volume charts were performed during follow-up. RESULTS: The median follow-up was 64 months, and the 5-year overall survival rate was 64 %. Early complications were mostly grade I and II; grade III and IV complications were observed in 27 patients. Perioperative mortality rate was 1.6 %. The most frequent late complications were neobladder-ureteral reflux, urolithiasis and urethral anastomotic stricture. Daytime and nighttime urinary continence were 93.5 and 83.9 %, respectively. All patients were able to completely empty neobladders. Twenty patients were followed up for at least 10 years and presented satisfactory functional results. CONCLUSIONS: Surgical morbidity of RC and orthotopic neobladder was significant; however, the rate of grade III-IV complications was low. The long-term functional results of the PIN were interesting, confirming that appropriate patients' selection, adequate surgical technique, accurate patients' counseling and follow-up are essential.
Authors: Wassim Kassouf; Richard E Hautmann; Bernard H Bochner; Seth P Lerner; Renzo Colombo; Alexandre Zlotta; Urs E Studer Journal: Eur Urol Date: 2010-05-22 Impact factor: 20.096
Authors: N K Aaronson; S Ahmedzai; B Bergman; M Bullinger; A Cull; N J Duez; A Filiberti; H Flechtner; S B Fleishman; J C de Haes Journal: J Natl Cancer Inst Date: 1993-03-03 Impact factor: 13.506
Authors: Emily S Lukacz; Emily L Whitcomb; Jean M Lawrence; Charles W Nager; Richard Contreras; Karl M Luber Journal: Am J Obstet Gynecol Date: 2007-07 Impact factor: 8.661
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