title: Modified orthotopic spiral ileal bladder substitution: surgical technique and long-term results.
abstract: OBJECTIVE
  The objectives of this study are to introduce the surgical technique of a modified spiral orthotopic ileal neobladder and to assess the long-term outcomes.
  
  
  METHODS
  Between January 1998 and January 2006, 44 male and 7 female patients with bladder cancer received radical cystectomy (RC) and pelvic lymphadenectomy. An ileal segment 40 cm to 45 cm long was isolated to create a spiral orthotopic ileal neobladder, and the ureters were implanted into the reservoir using a non-refluxing split-cuff nipple technique. Preoperative, perioperative, and postoperative data were collected. Complications were classified as early (less than 3 months after surgery) or late (more than 3 months after surgery). Continence incidence and urodynamic studies were evaluated 5 years after surgery. Duration of follow-up was an average of 95 months (range 60-156 months).
  
  
  RESULTS
  There were no perioperative deaths. The mean operative time was 315 ± 34 minutes. The mean blood loss was 783 ± 316 ml. There were 31 early complications in 21 patients (41%) and 42 late complications in 30 patients (59%). Urodynamic studies showed the maximum neobladder capacity to be 500 ± 71 ml, maximum flow rate to be 16 ± 5 ml/s and post-voiding residual (PVR) to be 50 ± 44 ml. Postoperative continence was excellent with a daytime continence rate of 90% and a nocturnal continence rate of 78% 5 years after surgery.
  
  
  CONCLUSIONS
  The modified spiral neobladder is easy to perform and allows for excellent long-term results with regard to complications and continence.
authors.affiliation: Department of Urology, The First People's Hospital of Huzhou, Affiliated Hospital of Huzhou Teachers' College, Huzhou, P.R. China.
authors.forename: Wei-Gao
authors.initials: WG
authors.lastname: Wang
authors.forename: Huan
authors.initials: H
authors.lastname: Zhong
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.forename: Jian-Er
authors.initials: JE
authors.lastname: Tang
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Min
authors.initials: M
authors.lastname: Cao
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Jin
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics; D014946:Wound Infection / Q000209:etiology