A Comparative Study On The Clinical Effect Of Neobladders Prepared From Different Lengths Of Ileum During Robotic-Assisted In Situ U-shaped Neobladder Surgery

Objective:To investigate the correlation between the capacity of the completely roboticassisted radical cystectomy and in situ U-shaped ileal neobladder and bladder function.Methods The clinical data of 88 patients undergoing robotic-assisted radical cystectomy+in situ U-shaped ileal neobladder in our hospital from May 2014 to May 2019 were retrospectively analyzed.The patients were divided into group 1(25-35 cm in length,including 35 cm)and group 2(35-45 cm in length of ileum)according to the different lengths of ileum cut during surgery.The basic data,perioperative conditions,complications,urinary continence and other conditions were compared between the two groups for analysis.Results Comparison of gender,age,body mass index,preoperative blood indexes(serum creatinine,albumin,hemoglobin,urea nitrogen),operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion,and postoperative hospital stay between the two groups The difference was not statistically significant(P>0.05).In the statistics of early postoperative complications,the proportion of patients in the two groups was similar.In the statistics of postoperative long-term complications,except for gastrointestinal-related complications and bladder stones,the incidence of complications was similar,and the remaining complications in group 2 were more than those in group 1.There was no significant difference in postoperative pathological data,including positive resection margin,number of lymph node dissection,positive lymph node results,and tumor grade between the two groups(P>0.05),and there was no significant difference in follow-up time between the two groups(P=0.264).There was no significant difference in the number of deaths between the two groups during follow-up(P=0.657).In terms of the use of urine pads,the patients in group 2 used less pads in the early follow-up period,and the difference between the two groups was statistically significant(P=0.044).In the second year after operation,the use of urine pads in the two groups was similar,and the difference was not statistically significant(P>0.05).From the third year after operation,the use of urine pads in group 1 was less than that in group 2,and the difference was statistically significant(P<0.05).In the comparison of the use of urine pads during the day and night,the patients in group 2 gradually developed from using only at night in the early follow-up period to using pads during the day and night,while most patients in group 2 started from using only at night or both during the day and night.The use of urine pads gradually developed into no use or only use of urine pads at night.Except for the second year of follow-up,there was a statistically significant difference in the use of urine pads during the rest of the follow-up period(P<0.05).There was a statistically significant difference in the maximum capacity of the neobladder between the two groups since follow-up(P<0.05),but there was no significant difference in the residual urine volume and maximum urinary flow rate in the short term(3,6,and 12 months)(P>0.05),from the second year after operation,the residual urine of patients in group 1 was less than that in group 2.In the later period of follow-up,the maximum urinary flow rate of patients in group 1 was gradually better than that in group 2,and the difference was statistically significant(P<0.05).Conclusions Compared with neobladders prepared from a longer ileum,neobladders prepared from a shorter ileum could maintain good bladder function for a longer period of time.Therefore,a 25-35 cm ileum can be recommended to make an in situ U-shaped ileal neobladder in clinical practice.