CU 12. Initial experience of modified laparoscopic radical cystectomy and reconstruction of orthotopic Studer ileal neobladder

Objective: To introduce the initial experience of 11 cases of modified laparoscopic radical cystectomy and construction of orthotopic Studer ileal neobladder, and the oncological and functional results of this procedure.

Methods: From July 2008 through July 2011, 11 selected patients underwent modified radical cystectomy (1 cm apical capsule preserved and Wallace technique for ureter-neobladder anastomosis) and standard lymphadenectomy followed by construction of orthotopic Studer ileal neobladder by minilaparostomy for muscle invasive bladder cancer. Data were analyzed according to procedure time, blood loss, transfusion, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract, and status of urinary continence.

Results: Mean operating time was 6.17 (5.5-7.5) hrs, estimated blood loss 300 (0-800) mL, only one case need transfusion 400 mL, lymph nodes dissected 15 (5-30), no peri-operative death, peri-operative complications was found in 18% (2/11). Temporary dilation of upper urinary tract was observed in 18% (2/11) in 45 days post-operative, then disappeared spontaneously, Serum creatinine remained in normal range in all patients. With 15 (1-67) months follow-up, 1 case died of metastasis of squamous cell carcinoma. 91% (10/11) survived without local relapse or distal metastasis. Complete daytime continence rate was 90% (9/10); complete night-time continence rate 70% (7/10) and 1 pad in 20% (2/10).

Conclusions: With intermediate follow-up, the oncological and functional results are encouraging after modified laparoscopic radical cystectomy and construction of orthotopic Studer ileal neobladder by mini-laparostomy in selected cases; The afferent tubular segment of neobladder is effective to protect the morphology and function of upper urinary tract.