Orthotopic ileal neobladder in treatment of bladder cancer: A report of 61 cases / 第二军医大学学报

ABSTRACT

Objective: To summarize our clinical experience on treating bladder transitional cell carcinoma with orthotopic ileal neobladder after radical cystectomy and to report the long-term follow-up results. Methods: From Jan. 1988 to Dec. 2006, 61 patients (49 male and 12 female) with a mean age of 64.0±5.6 years (range 54 to 78) were subjected to orthotopic ileal neobladder construction after cystectomy. The entire length of ileum was opened along the antimesenteric border, placed into a transverse "U" shape, and sutured with a running suture. The lateral borders of the "U" shape bottom were used to surround the urethra and were sutured with the interrupted suture from "inside" the neobladder for the ileourethral anastomosis. The ureters were implanted from inside the neobladder through a-small incision into the ileum at a convenient site, and were embedded in a mucosal sulcus. The perioperation mortality, complications, urinary continence, renal function, image findings, and urodynamic examination were all retrospectively evaluated. Results: One patient (1.6%) died during perioperation period and all the others were followed up for 12-168 months. Totally 13 patients (21.3%) died during follow-up. The complications included renal inadequacy (11 patients), ureteroileal obstruction (9 patients), ureteral reflux (6 patients), urine leakage (5 patients), bleeding (4 patients), incisional hernia (4 patients), urethral stricture (3 patients), and urethral recurrence (1 patient). After 60 months follow-up, 42 patients had a satisfactory urinary continence. Conclusion: After long-term follow-up, we conclude that the ileal neobladder is a satisfactory method for treatment of invasive bladder cancer after radical cystectomy; it has less complication and is clinically valuable.