title: Surgical complications following radical cystectomy and orthotopic neobladders in women.
abstract: OBJECTIVE
  Orthotopic neobladders have become the standard of care after radical cystectomy in select women with bladder cancer. We report early and late complications in 192 patients. Although medical complications were important, they were not the focus of this study.
  
  
  METHODS
  Between January 1995 and December 2003, 192 women with a mean age of 50.6 years received an orthotopic neobladder after radical cystectomy for bladder cancer. Standard radical cystectomy was done. Ileal reservoirs were used, mostly in the form of an ileal W-neobladder. We evaluated the patients for functional outcome, early and late complications, and treatment for these complications.
  
  
  RESULTS
  Two patients (1%) died of pulmonary embolism 1 to 2 weeks after cystectomy. Followup was 6 to 125 months (mean 54). Early complications included hemorrhage requiring reexploration in 1 case, postoperative blood transfusion in 1, wound infection in 8, prolonged ileus in 5, deep vein thrombosis in 5, pouch-vaginal fistula in 6, prolonged urinary leakage in 3, pouch-cutaneous fistula in 1 and early ureteral obstruction in 1. Of the 177 patients eligible for functional evaluation 62 experienced a total of 75 late complications, including stone disease in 18, ureteroileal stricture in 19, reflux in 22, intestinal obstruction in 2, incisional hernia in 2 and chronic pyelonephritis in 12. Early and late complications were treated accordingly with good outcomes.
  
  
  CONCLUSIONS
  Early and late complications develop in a significant number of patients. Most early complications may be treated conservatively, while late complications are mostly treated with endourological and/or open surgery. Close lifelong surveillance of patients is mandatory to detect and properly treat these complications.
authors.affiliation: Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt. balieldein@yahoo.com
authors.forename: Bedeir
authors.initials: B
authors.lastname: Ali-el-Dein
authors.forename: Atallah A
authors.initials: AA
authors.lastname: Shaaban
authors.forename: Raeid H
authors.initials: RH
authors.lastname: Abu-Eideh
authors.forename: Mohamed
authors.initials: M
authors.lastname: el-Azab
authors.forename: Albair
authors.initials: A
authors.lastname: Ashamallah
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*