Technique of Hautmann ileal neobladder with chimney modification: Interim results in 50 patients

Purpose: We report our 4-year experience with the chimney modification of t he Hautmann ileal neobladder. This modification involves use of an 8 to 12 cm. tubularized isoperistaltic ileal chimney for the ureterointestinal anas tomosis. Materials and Methods: Between April 1995 and March 1998, 50 men and women with invasive bladder cancer underwent radical cystectomy and creation of a Hautmann neobladder with chimney modification. Complications were assessed , divided as early and late, and subdivided as those related or unrelated t o the neobladder. Continence was evaluated using a detailed patient questio nnaire. Results: There were no intraoperative deaths. Early complications in 11 of the 50 patients were neobladder related in 5 (10%) and unrelated to the neo bladder in 6 (12%). The early reoperation rate was 6%. Late postoperative c omplications in 10 patients (20%) were neobladder related in 8 (16%) and un related to the neobladder in 2 (4%). After 1 year 93% and 86% of patients a chieved good day and nighttime continence, respectively. In 2 patients (4%) clean intermittent catheterization is performed and 1 required placement o f an artificial urinary sphincter. Ureterointestinal anastomotic strictures were detected in 6 of 100 ureteral units (6%), including 2 with failed ini tial endoscopic management. Open surgical revision of the ureterointestinal anastomotic site was easier due to the anterior position of the ureters, a nd identification and mobilization of the isoperistaltic limb. Conclusions: Our experience with the chimney modification of the Hautmann n eobladder compares favorably to other forms of orthotopic urinary diversion in regard to ureteral stenosis, early and late postoperative complications , urinary continence and simplification of the ureterointestinal anastomosi s.