Abstract
ABSTRACTPurpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes.Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration.Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively.Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority.
Highlights
Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the most effective treatment for patients with organ-confined, muscle-invasive, or recurrent high-grade bladder cance [1]
Various options are available for urinary ibju | Laparoscopic radical cystectomy with novel orthotopic neobladder diversion, among which the orthotopic neobladder has several advantages, including near-normal voiding mechanics, elimination of the need for external appliances, preservation of body image, and superior quality of life [7]
Preservation of renal function is of paramount importance following urinary diversion
Summary
Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the most effective treatment for patients with organ-confined, muscle-invasive, or recurrent high-grade bladder cance [1]. Recent advances in the development of laparoscopic instruments, improvements in surgical techniques, and improved surgical confidence and skills allow the application of laparoscopy to diseases of the pelvic organs, including malignant disease and cases requiring complex reconstruction [2, 3]. Various options are available for urinary ibju | Laparoscopic radical cystectomy with novel orthotopic neobladder diversion, among which the orthotopic neobladder has several advantages, including near-normal voiding mechanics, elimination of the need for external appliances, preservation of body image, and superior quality of life [7]. Preservation of renal function is of paramount importance following urinary diversion. It is important to reconstruct the orthotopic low-pressure neobladder so as to reduce long-term impairment of renal function. We report on our surgical techniques and preliminary results in 16 patients using LRC with a novel orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs
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