title: The Z-shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients.
abstract: Study Type - Therapy (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  To evaluate the results in terms of functional results and morbidity of Z-shaped ileal neobladder performed in a single center.
  
  
  METHODS
  329 consecutive male patients who had an orthotopic bladder replacement using the Z-shaped ileal neobladder between May 1990 and January 2009.
  
  
  RESULTS
  The mean age of the patients was 64.4 ± 9.6 years, with a mean follow-up of 59.4 ± 55 months. Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture. Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1-5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication. Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months. Hyper-continence with subsequent need for CISC was observed in 4%.
  
  
  CONCLUSIONS
  In our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an 'expected' complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.
authors.affiliation: Department of Urology, Hopital Foch, Suresnes, France. y.neuzillet@hopital-foch.org
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: Laurent
authors.initials: L
authors.lastname: Yonneau
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Herve
authors.forename: Martine
authors.initials: M
authors.lastname: Butreau
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D013537:Sutures; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000517:prevention & control