Chimney Modification Technique for Ureterointestinal Anastomosis after Radical Cystectomy: Preliminary Evaluation of Short-Term Outcome and Impact on Quality of Life

Objectives: To evaluate the short-term outcome of chimney modification technique of the Hautmann ileal neobladder for ureterointestinal anastomosis after radical cystectomy in cases of invasive bladder cancer. Patients and Methods: The study included 25 male patients with a mean age of 61.2 ± 6.6 years assigned for radical cystectomy. A neobladder reservoir was fashioned using an ileal loop in a W-shape with both ends not detubularized and used as chimneys of 3–5 cm for the afferent limb on each side for implantation of the 2 cm spatulated ureter into each side using the technique of end-to-end anastomosis. Patients were observed for early postoperative complications and ascending cystography was performed before catheter removal for assessment of reflux and pouch integrity. Postoperative follow-up assessment included evaluation of continence satisfaction, renal function was judged by estimation of serum creatinine and intravenous urography for evaluation of development of ureteric stricture. Quality of life (QoL) was assessed using the Quality of Life Questionnaire (QLQ-C30). Results: All patients passed a smooth intra-operative course with a mean operative time of 308 ± 53.2 minutes and mean intra-operative blood loss of 580 ± 175 ml. No mortality was reported, however, 3 patients had postoperative wound infection, another 3 patients had prolonged ileus for >48 hours and one patient developed neobladder leakage that was managed by prolonged uretheral catheterization for 5 weeks. Fourteen patients reported good continence for both day and night, 9 patients had good to satisfactory continence, while two patients had unsatisfactory continence. Postoperative serum creatinine levels were non-significantly higher compared to preoperative measurements. Urographic studies demonstrated no reflux or stricture in either of the implanted ureters, or hydronephrosis after 12-month followup. Throughout the first 6 months of follow-up, all patients showed progressive increase of total QoL score with a significant difference compared to that recorded at the first month post-operation and the mean 12-month collective score was improved by a mean score of 14.4 ± 5.4 than that of the first month post-operation. Conclusion: Chimney modification of the Hautmann neo-bladder after radical cystectomy is simple, safe and free of ureteric stricture or reflux. Also, the applied technique improved patient’s postoperative QoL.