[Total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer].

ABSTRACT

OBJECTIVE: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. METHODS: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. After the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. RESULTS: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was 22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus. THe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. The mean follow-up was 15 months. One patient died of distant metastasis and pneumonia, while other patients survived without tumor. CONCLUSION: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the first option of urinary diversion after cystectomy. Postoperative management should focus on complications and follow-up.