Functional Evaluation of Different Ileal Neobladders and Ureteral Reimplantation Techniques

Abstract

Objectives: To compare and assess the function of ileal neobladders with different reconfiguration and with several types of ureteral reimplantation. Methods: Forty-five male patients underwent radical cystectomy and detubularized ileal neobladder. In 20 patients an ileal neobladder was carried out according to Studer’s technique, in 12 a ‘W’- and in 13 a ‘U’-shaped neobladder. In the Studer’s patients 60 cm of ileum was used, in the ‘W’ 40 and in the ‘U’ 30 cm. For the uretero-ileal anastomosis Nesbit’s technique was utilized in the Studer’s, in the ‘W’ and ‘U’ neobladders Camey Le Duc’s technique was performed instead. Four patients underwent a serous-lined extramural tunnel reimplantation. Follow-up included a functional and morphological study of the urinary system and a urodynamic study. Results: All Nesbit’s uretero-ileum anastomoses resulted refluent when the reservoir was filled up, 15 of 50 ureteral reimplantations according to the Camey Le Duc technique showed reflux at full filling. At 3, 6 and 12 months follow-up, the double reconfiguration reservoirs (Studer’s and ‘W’) showed a larger capacity and a lower maximum pressure than neobladders with a single bending. At 12 months, continence and the voiding interval time was significantly higher in the double reconfiguration than in the ‘U’ neobladders. Conclusion: The double reconfiguration of the reservoir (‘W’) might be preferable to that with a single one. As for the type of ureteral anastomosis to select, the problem is still debatable even if in our case-control study we have had better results in terms of reflux and stenosis with the uretero-enteric anastomosis with Nesbit’s and associated afferent long tubular ileal limb than with Studer’s technique.