title: Hand-assisted-drawing-needle running suture with a curved needle: an effective technique to create a W-ileal neobladder.
abstract: BACKGROUND
  An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture (HADNRS).
  
  
  METHODS
  Between April 1993 and December 2011, 347 patients (338 men and 9 women) aged 28 - 77 years (median age: 59 years) underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 (20 patients in 2003) were evaluated by urodynamic tests.
  
  
  RESULTS
  The operative time ranged from 110 to 310 minutes (mean 148 minutes), and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was (20.2 ± 4.3) minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients (0.8%) had neobladder abdominal fistula. No other early complications or injury to the surgeon's hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was (492.9 ± 177.8) ml, and the maximum pressure within the reservoir at the end of filling was (32.1 ± 8.6) cmH2O.
  
  
  CONCLUSIONS
  Reconstruction of W-ileal neobladder by HADNRS is effective and economical.
authors.affiliation: Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
authors.forename: Dan-Bo
authors.initials: DB
authors.lastname: Fang
authors.forename: Song-Liang
authors.initials: SL
authors.lastname: Cai
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Jin
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Bai-Ye
authors.initials: BY
authors.lastname: Jin
authors.forename: Xiang-Yi
authors.initials: XY
authors.lastname: Zheng
authors.forename: Chao-Jun
authors.initials: CJ
authors.lastname: Wang
authors.forename: Fu-Qing
authors.initials: FQ
authors.lastname: Tan
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.forename: Bo-Hua
authors.initials: BH
authors.lastname: Shen
authors.forename: Xuan-Wen
authors.initials: XW
authors.lastname: Zhu
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent