A Modified Technique for Neourethral Anastomosis in Orthotopic Neobladder Reconstruction

Objectives To introduce a modified technique for urethral anastomosis in orthotopic neobladder reconstruction. Methods Between January 2002 and August 2008, about 141 consecutive patients (130 men and 11 women) underwent total cystectomy and orthotopic neobladder reconstruction in which a modified t...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2009-11, Vol.74 (5), p.1145-1149
Main Authors: Hou, Guo-Liang, Li, Yong-Hong, Zhang, Zhi-Ling, Xiong, Yong-Hong, Chen, Xiao-Feng, Yao, Kai, Liu, Zhuo-Wei, Han, Hui, Qin, Zi-Ke, Zhou, Fang-Jian
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical - methods
Cystectomy
Female
Humans
Male
Middle Aged
Urethra - surgery
Urinary Bladder Neoplasms - surgery
Urinary Reservoirs, Continent
Urologic Surgical Procedures - methods
Urology
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Summary:Objectives To introduce a modified technique for urethral anastomosis in orthotopic neobladder reconstruction. Methods Between January 2002 and August 2008, about 141 consecutive patients (130 men and 11 women) underwent total cystectomy and orthotopic neobladder reconstruction in which a modified technique was used to anastomosed the caudal-most part of the intestinal neobladder directly to the urethral remnant. The emptying of the neobladder, the early and late complications at the urethral anastomosis was evaluated. Results Mean patient age at surgery was 58.4 years (range, 33-83) and median follow-up was 42 months (range, 4-83 months). Early urine leakage at the vesicourethral anastomosis developed in 1 patient, and was cured by extending catheter drainage. A total of 138 patients had good emptying of the neobladder, with residual urine volume < 50 mL. Three patients had residual urine volume > 100 mL, and achieved good emptying after intermittent catheterization once a week for 6-12 months. No late complications occurred at the urethral anastomosis site. Daytime continence was good or satisfactory in 97.0% of patients and night-time continence was good or satisfactory in 88.5% of patients. Conclusions The clinical outcome of our modified technique for urethral anastomosis in orthotopic neobladder substitution was excellent, but the advantage of this technique needs prospective controlled study.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2009.06.082