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The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients
Author(s) -
Neuzillet Yann,
Yonneau Laurent,
Lebret Thierry,
Herve JeanMarie,
Butreau Martine,
Botto Henry
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.10000.x
Subject(s) - medicine , cystectomy , surgery , urination , urinary continence , urinary diversion , anastomosis , pouch , perioperative , urinary system , urology , bladder cancer , prostatectomy , prostate , cancer
Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the results in terms of functional results and morbidity of Z‐shaped ileal neobladder performed in a single center. PATIENTS AND METHODS 329 consecutive male patients who had an orthotopic bladder replacement using the Z‐shaped ileal neobladder between May 1990 and January 2009. RESULTS The mean age of the patients was 64.4 ± 9.6 years, with a mean follow‐up of 59.4 ± 55 months. 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%. CONCLUSION In 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.