Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: Experience with 450 patients

Purpose: We report functional results of the orthotopic ileal neobladder us ing a serous-lined extramural tunnel as an antireflux procedure. Material and Methods: One-stage radical cystectomy and orthotopic ileal W-s haped neobladder creation were performed in 353 male and 97 female patients for invasive bladder cancer. The ureters were reimplanted using a serous-l ined extramural tunnel for reflux prevention. Of the patients 344 were eval uable at a mean followup plus or minus standard deviation of 38 +/- 25 mont hs. Evaluation included clinical and radiographic studies to determine func tional and oncological outcomes, Results: Four patients (0.8%) died in the hospital, Early complications in 42 patients (9%) were treated conservatively but 3 women underwent vaginal repair of a pouch-vaginal fistula. During the observation period there were 90 oncological failures, of which 3 were isolated urethral recurrence, Lat e complications included pouch stones in 10 cases, outflow obstruction in 1 1, mucous retention in 2, adhesive bowel obstruction in 3 and hypercontinen ce in 9 females. The incidence of daytime and nighttime continence was 93.3 % and 80%, respectively. The upper tracts remain unchanged or improved in 9 6.2% of the reimplanted renal units, while reflux was observed in 3%. Conclusions: The serous-lined extramural tunnel has proved its efficiency a nd durability as an antireflux technique.