title: Perugia ileal neobladder: functional results and complications.
abstract: OBJECTIVE
  To evaluate the long-term functional results and complications of an orthotopic ileal neobladder, defined as perugia ileal neobladder (PIN), in a group of patients with bladder cancer who underwent radical cystectomy (RC).
  
  
  METHODS
  Between 1993 and 2009, 237 consecutive patients who underwent RC for non-metastatic bladder cancer and orthotopic ileal neobladder reconstruction were enrolled. The neobladder was created using a modified Camey-II technique and consisted of a detubularized ileal loop of 45 cm using a vertical "Y" shape. Complications (<90 days) were reviewed and staged according to Clavien-Dindo classification and evaluated at long-term follow-up. Standard monitoring for cancer recurrence (computerized tomography, bone scan), cystourethrography, urodynamics and frequency/volume charts were performed during follow-up.
  
  
  RESULTS
  The median follow-up was 64 months, and the 5-year overall survival rate was 64 %. Early complications were mostly grade I and II; grade III and IV complications were observed in 27 patients. Perioperative mortality rate was 1.6 %. The most frequent late complications were neobladder-ureteral reflux, urolithiasis and urethral anastomotic stricture. Daytime and nighttime urinary continence were 93.5 and 83.9 %, respectively. All patients were able to completely empty neobladders. Twenty patients were followed up for at least 10 years and presented satisfactory functional results.
  
  
  CONCLUSIONS
  Surgical morbidity of RC and orthotopic neobladder was significant; however, the rate of grade III-IV complications was low. The long-term functional results of the PIN were interesting, confirming that appropriate patients' selection, adequate surgical technique, accurate patients' counseling and follow-up are essential.
authors.affiliation: Urology Department, University of Perugia, Sant'Andrea delle Fratte, 06100 Perugia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zucchi
authors.forename: Michele Del
authors.initials: MD
authors.lastname: Zingaro
authors.forename: Ettore
authors.initials: E
authors.lastname: Mearini
authors.forename: Antonella
authors.initials: A
authors.lastname: Giannantoni
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000502:physiology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014563:Urodynamics / Q000502:physiology