Chimney Modification Technique for Ureterointestinal Anastomosis after Radical Cystectomy: Preliminary Evaluation of Short-term outcome and Impact on Quality of Life
|Full paper||Not Available|
This study was designed to evaluate the short-term outcome of Chimney-modification technique of Hautmann ileal neobladder for uretero-intestinal anastomosis after radical cystectomy in cases of invasive bladder cancer, this study included 25 male patients with mean age of 61.2±6.6 years assigned for radical cystectomy. Neo bladder reservoir was fashioned using an deal loop assigned as a W-shape with both ends not detubularized and used as chimneys of 3-5 cm afferent limb on each side for implantation of the 2 cm spatulated ureter into each side using the technique of end-to-end anastomosis. Patients were observed for early postoperative (P0) complications and ascending cystography was performed before catheter removal for assessment of reflux and pouch integrity. PO follow-up assessment included evaluation of continence satisfaction, renal function judged by estimation of serum creatinine and intravenous urography for evaluation of development of ureteric stricture. Quality of life (QoL) was assessed using quality of life questionnaire (QLQ-C30). All patients passed smooth intraoperative course with a mean operative time of 308±53.2 minutes and mean intraoperative blood loss of 580±175 cc. No mortality was reported, however, 3 patients had PO wound infection, another 3 patients had prolonged ileus for >48 hours and one patient developed neo bladder leakage that was managed by prolonged uretheral catheterization for 5 weeks. Fourteen patients reported good continence by both day and night, 9 patients had good to satisfactory continence, while two patients had unsatisfactory continence. PO serum creatinine levels were nonsignificantly higher compared to preoperative measures. Urographic studies demonstrated no reflux or stricture in either of implanted ureters, or hydronephrosis after 12 months follow-up. Throughout the first 6 months of follow-up, all patients showed progressive increase of total QoL score with a significant difference compared to that recorded at the In month PO and the mean I2-months collective score was improved by a mean score of 14.4t5.4 than the recorded score at the Is' month PO. It could be concluded that Chimney-modification of Hautmann neobladder after radical cystectomy is simple, safe and free of ureteric stricture or reflux. Moreover, the applied technique improved patients PO quality of life. Keywords: Chimney modification, Hautmann neobladder, Cancer bladder.