Abstract
PurposeThe purpose of this study was to analyze long-term complications, urodynamics, and quality of life (QoL) of patients after orthotopic ileal neobladder with orthotopic ureteral reimplantation to enrich clinical data and provide a basis for clinical use of this surgery.MethodsBetween January 2007 and January 2013, 72 consecutive patients who underwent spiral ileal neobladder following radical cystectomy were enrolled. The neobladder was created using a modified Camey-II technique. Complications were reviewed and staged according to Clavien–Dindo classification and evaluated in long-term follow-up. Urodynamics were performed, and QoL was assessed by the Functional Assessment of Cancer Therapy for Bladder Cancer (FACT-BL) instrument.ResultsThe total follow-up time was 60 months, and the total survival rates at 3 and 5 years after surgery were 76.4% (55/72) and 65.3% (47/72), respectively. There were 34 (47.2%) early complications in 23 (31.9%) patients and 42 (58.3%) late complications in 35 (48.6%) patients. The total satisfactory control rates were 69.1% and 66.0% at 3 and 5 years after the surgery, respectively. Urodynamic studies were performed in some patients, and the receiver operating characteristic curve analysis showed that pressure at maximum capacity, compliance, and post void residual urine had predictive value for mortality (P < 0.05). The total FACT-BL scores of patients at 1, 3, and 5 years postoperation were 125.0 ± 15.2, 127.0 ± 16.2, and 120.6 ± 13.5, respectively, and it decreased at 5 years postoperation (P < 0.05).ConclusionSpiral ileal neobladder with orthotopic ureteral reimplantation offers satisfactory long-term results, and urodynamic monitoring might have prognostic value.
Highlights
Global Cancer Statistics 2018 predicts that there will be 549,393 new cancer cases and 199,922 deaths due to bladder cancer worldwide in 2018 [1]
Previous studies have revealed that patients undergoing ileal neobladder surgery had better quality of life (QoL) than those who underwent ileal conduit [4], most of the patients who chose neobladder were younger and had less severe illness [5]
Because very few randomized controlled trials have compared the advantages of ileal neobladder surgery and traditional ileal conduit, it remains controversial whether the long-term QoL and renal function of patients after ileal
Summary
Global Cancer Statistics 2018 predicts that there will be 549,393 new cancer cases and 199,922 deaths due to bladder cancer worldwide in 2018 [1]. Radical cystectomy with urinary diversion is the best treatment option for patients with invasive bladder cancer. Previous studies have revealed that patients undergoing ileal neobladder surgery had better QoL than those who underwent ileal conduit [4], most of the patients who chose neobladder were younger and had less severe illness [5]. Because very few randomized controlled trials have compared the advantages of ileal neobladder surgery and traditional ileal conduit, it remains controversial whether the long-term QoL and renal function of patients after ileal. The indications for ileal neobladder surgery are strictly limited, and the cardiopulmonary function, blood glucose level, intestinal health status, and compliance of patients need to be strictly screened before treatment. We retrospectively analyzed the clinical and follow-up data of 72 patients after they underwent spiral orthotopic ileal neobladder to enrich the clinical data and provide a basis for the clinical use of ileal neobladder
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