Long-term results of a prospective randomized study comparing two different antireflux techniques in orthotopic bladder substitution.

Abstract

We compared the long-term functional results following two different reflux prevention techniques in orthotopic ileal bladder substitution in a prospective controlled randomized study. The study included 60 patients for whom orthotopic bladder replacement was indicated. The treated patients were prospectively randomized into two groups: group I (30 patients) underwent ileal W neobladder with serous lined extramural tunnel and group II (30 patients) received hemi-Kock pouch with intussuscepted nipple valve. Laboratory evaluation included estimation of serum creatinine while radiological studies included IVU and voiding studies. Urodynamic evaluation was an integral part of our investigation. Patients and tumor characteristics were comparable between both groups. No operative or postoperative mortality were observed in either. Early complications were encountered in 5 (16.7%) and 4 (13.3%) patients in the two treated groups respectively (p=0.72) and most were treated conservatively. Twenty patients in group I and 19 in group II were evaluable. The mean follow up was 73.9+/-6.6 and 72.9+/-5.6 months in the treated groups respectively. Day and night time continence was comparable between both groups. Ascending studies demonstrated reflux in 3 (7.7%) of the reimplanted units in group I versus 2 (5.3%) in group II (p=0.81); IVU showed uretero-ileal anastomotic strictures in 2 renal units with both the serous lined extramural tunnel (5.1%) and the ileal nipple valve (5.3%) techniques (p=0.98). One patient in group I had pouch stone compared with 5 in group II (p=0.08). Urodynamic characteristics were also comparable in both groups. The study provided evidence that the long-term functional results following serous lined extramural tunnel are as equal as the nipple valve. Furthermore, it spares the use of extra-bowel length, does not need staples and allows retrograde endoscopic procedures.