Comparison between a serous-lined extramural tunnel and T-limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial.
OBJECTIVE
To compare the functional results from a prospective randomized trial of two different reflux-prevention techniques for ileal bladder substitution.


METHODS
In all, 60 patients with invasive bladder cancer were randomized to receive either a serous-lined extramural tunnel (group 1) or T-limb ileal procedure (group 2) as an antireflux technique for the ileal substitute. The preoperative evaluation included intravenous urography, radioisotope renography to evaluate glomerular filtration rates (GFRs) and renal cortical imaging with 99mTc- dimercaptosuccinic acid to assess parenchymal scarring. Evaluable patients were re-assessed by the same imaging, and by ascending studies.


RESULTS
The follow-up included 27 patients (49 units) in group 1 and 23 (45 units) in group 2, with a mean (sd) follow-up of 6.3 (0.5) and 7.4 (1.9), respectively. Uretero-ileal strictures were diagnosed in one renal unit in each group (P = 0.5). Ascending studies showed no reflux in any patients in group 1, while 13 renal units (29%) in group 2 were refluxing (P < 0.01). There was progressive cortical scarring with or with no significant reduction in GFR (>25%) in three and four renal units in groups 1 and 2, respectively. Among the 13 refluxing units in group 2, three showed a significant deterioration in GFR and one renal unit was diagnosed with progressive cortical scarring.


CONCLUSIONS
Both procedures provided a low rate of anastomotic stricture, with acceptable preservation of renal function. The serous-lined extramural tunnel provided a more effective antireflux mechanism.
Osman
Yasser
Y
Urology & Nephrology Center, Mansoura University, Mansoura, Egypt. y_osman99@yahoo.com
Abol-Enein
Hassan
H
El-Mekresh
Mohsen
M
Gad
Hosam
H
Elhefnawy
Ahmed
A
Ghoneim
Mohamed
M
D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000517:prevention & control*