The Comparison Between Ileal Orthotopic Neobladder And Ileal Conduit After Radical Cystectomy

Objective: To investigate clinical efficacy of different urinary diversion(UD)methods in patients with muscle-invasive bladder cancer undergoing laparoscopic radical cystectomy.To provide valuable data for the rational selection and application of urinary diversion methods after radical cystectomy.Methods: The data of patients undergoing radical cystectomy and urinary diversion from September 2013 to May 2016 in The Second Hospital Affiliated to University of South China was collected.Twenty-four patients who underwent ileal orthotopic neobladder were divided to group A,and twenty-eight patients who underwent ileal conduit were divided to group B.Clinical baseline data,perioperative data,incidence of early postoperative complications(defined as less than90 days),incidence of late postoperative complications(defined as no less than 90 days)were recorded and compared between the two groups.While functional outcomes were only recorded for orthotopic neobladder.All patients were followed up for quality of life using the short-form 36 questionnaires.Results: Operative time(314.17±39.83 vs 281.96±35.94 min,P <0.05)and length of stay(11.08±1.67 vs 9.43±2.20 day,P<0.05)in group A were significantly longer than those in group B.There were no statistically significant differences between the two groups in intraoperative blood loss,intestinal function recovery time,and incidence of early and late postoperative complications rates(P > 0.05).Scores of physical function(78.13±12.49 vs 70.89±8.72,P < 0.05)and social function(76.04±10.37 vs 67.41±12.88,P < 0.05)of group A were significantly higher than those in group B(P < 0.05).Specific for ileal orthotopic neobladder,functional reservoir capacity and residual urine volume reached a plateau at 12 months,which were(481±64 ml)and(32.69±2.75ml)respectively.While average flow rate reached a plateau at 6 months,which was(14.63±2.15ml/s).The daytime urinary continence rates were 87.5% and 93.75% respectively after 12 and 24 months of follow-up.The nocturnal urinary continence rates were68.75% and 81.25% respectively after 12 and 24 months of follow-up.Conclusions: Ileal orthotopic neobladder is a safe and effective method of urinary diversion compared with ileal conduit.It will not increase the incidence of early and late postoperative complications and can contribute to the better postoperative quality of life.Its application should be recommended as bladder substitution in the patients withbladder carcinoma when possible.