Antireflux Technique of Ureteroileal Implantation Used in the Construction of Artificial Orthotopic Neobladder

Abstract

Introduction: The optimal technique of ureteroileal implantation used in the construction of artificial orthotopic neobladder still remains unclear and continues to be a subject of lively discussion. The basic aim of the present report is to analyze the long-term functional results after a total cystectomy and the construction of orthotopic neobladder with the implementation of the antireflux serous-lined extramural tunnel technique. Materials and methods: The study comprises a total of 98 patients with bladder cancer (90 men and 8 women, mean age 59±8 years), who underwent total cystectomy with subsequent construction of orthotopic W-shaped ileal neobladder within the period from 1996 to 2016. All ureters were implanted via a subserous extramural tunnel aiming to prevent vesicoureteral reflux. The follow-up included clinical, laboratory, imaging and urodynamic studies for evaluation of the functional and oncological results.Results: The perioperative mortality rate in the whole series was 1.0%, and the percentage of the early and late complications - 17.3% and 22.4%, respectively. 91.8% and 76.5% of the patients remained continent, at day and night, respectively. Late stenosis at the anastomosis site was registered in 5 cases (5.1%), while pouchoureteral reflux was observed in none of the patients. The renal function was stabilized or improved in 94.9% of the reimplanted renal units. The disease progressed in 12 patients: 1 developed local recurrence, and other 11 patients developed distant metastases. The overall and cancer specific survival in the whole series was 67.3% and 79.6%, respectively.Conclusion: The serous-lined extramural tunnel technique offers effective and safe ureteroileal anastomosis, providing nonobstructive unidirectional urinary flow. The results are durable and do not change with time. Therefore, we conclude that this technique should be widely popularized and routinely applied in the construction of continent intestinal urinary reservoirs.