Results of the ureteral reimplantation with serous-lined extramural tunnel in orthotopic ileal W-neobladder.
BACKGROUND
Our experience in uretero-ileal anastomosis using the serous-lined extramural tunnel in orthotopic ileal W-neobladder is presented.


METHODS
Between June 1998 and November 2001, 42 patients (40 men and two women) underwent radical cystectomy and orthotopic ileal neobladder for invasive bladder cancer. The ureters were reimplanted into serous-lined extramural tunnels as described by Abol-Enein and Ghoneim. However, we made minor modifications during the ureteral reimplantation in cases that necessitated distal ureteral excision and with grossly dilated ureters. Evaluation included clinical and radiographic studies to determine functional and oncological outcomes.


RESULTS
There was no operative mortality. The mean follow-up period was 28 months (range 12-52). Early complications occurred in four patients (9.5%). An endarterectomy for acute popliteal arterial embolism, the excision of the pouchointestinal fistula and a temporary colostomy were performed in two of these four patients. The other two patients were treated conservatively. Late complications occurred in eight patients (19%). Reflux was observed in three renal units (3.7%), ureterointestinal strictures in another three renal units (3.7%) and urethroileal stenosis in two patients (4.8%). In all cases, stabilization or improvement of renal function was achieved. No metabolic complications were observed.


CONCLUSIONS
Ileal W-neobladder with a serous-lined extramural tunnel is a safe, reliable form of lower urinary tract reconstruction. The method can be carried out with equal ease in grossly dilated ureters and in cases that necessitate distal ureteral excision.
Türkölmez
Kadir
K
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Baltaci
Sümer
S
Göğüş
Cağatay
C
Bedük
Yaşar
Y
Göğüş
Orhan
O
D000328:Adult; D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics