Prevention And Management Of Complications Following Total Cystectomy And Neobladder

Objective:Summarize and discuss our experience about prevention and management of complications following modified total cystectomy and orthotopic ileal neobladder.Methods and Materials:252 patients had undergone modified total cystectomy and orthotopic ileal neobladder. Of the 252 cases, 164 cases were newly diagnosed and 88 cases were recurrent. Among the 252 cases, 104 cases were multiple tumors, 144 cases invasive tumor, and 4 cases carcinoma in situ. The classification of pathological outcomes was as follows: 241 cases were transitional cell carcinoma,1 case transitional cell carcinoma with poorly differentiated adenocarcinoma,3 cases adenocarcinoma,3 cases squamous cell carcinoma,1 cases clear cell carcinoma,1 cases small cell carcinoma,1 cases embryo-derived/alveolar mixed rhabdomyosarcoma. As for the WHO cell grades: G1 in 54 cases, G2 in 97 cases, G3 in 101 cases. As for TNM clinical stages: Tis in 4 cases, T1 in 64 cases, T2 in 102 cases, T3 in 66 cases, T4 in 16 cases. The mean operation time, the mean blood loss and blood transfusion volume, the intra/postoperative complications, the ileal neobladder function, oncological results were collected and analyzed.Results:There were 4(1.6%) perioperative deaths. The operative time was 4 to 7 hours with a mean of 4.5 hours. 221 cases had been followed up after total cystectomy for 3 to 84 months with a mean of 35 months. All of them had good micturition; 217(98.2%) cases had good continence in the daytime, 182(82.4%) cases had good continence in the nighttime. 7 cases died of tumor metastasis and 1 case died of renal failure. The main complications included 12 urethrointestinal anastomotic leakages, which were cured by conservative treatments; 2 neobladder-cutaneous fistulas and 2 neobladder-vaginal fistulas were treated by surgical revisions; 4 ureterointestina anastomotic strictures, which were treated by conservative therapies for 3 and surgical reimplantation for 1 successfully. 3 patients suffered from urethral tumor recurrences, which were treated by total urethrectomy and transurethral resection.Conclusions:The patients have high quality of lives, good continence and micturition after total cystectomy. But the operation has a high rate of morbility of surgical complications, the clinical doctors should pay enough attention to them and take positive prevention and management.