Objectives: To evaluate the short-term outcome of chimney
modification technique of the Hautmann ileal neobladder
for ureterointestinal anastomosis after radical cystectomy in
cases of invasive bladder cancer. Patients and Methods: The
study included 25 male patients with a mean age of 61.2 ±
6.6 years assigned for radical cystectomy. A neobladder reservoir
was fashioned using an ileal loop in a W-shape with
both ends not detubularized and used as chimneys of 3–5
cm for the 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 complications and ascending cystography
was performed before catheter removal for assessment of
reflux and pouch integrity. Postoperative follow-up assessment
included evaluation of continence satisfaction, renal
function was judged by estimation of serum creatinine and
intravenous urography for evaluation of development of
ureteric stricture. Quality of life (QoL) was assessed using
the Quality of Life Questionnaire (QLQ-C30). Results: All patients
passed a smooth intra-operative course with a mean
Osama Abdelwahab, MD
Departments of Urology, Faculty of Medicine
Benha University
Benha (Egypt)
E-Mail osama_abdelwahab@yahoo.com
Chimney Modification Technique for
Ureterointestinal Anastomosis after Radical
Cystectomy: Preliminary Evaluation of Short-Term
Outcome and Impact on Quality of Life
Osama Abdelwahaba Mohamed Mahmoud Mohamed Ahmedb
Departments of aUrology and bGeneral Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Original Paper
Received: January 13, 2010
Accepted: April 9, 2010
Published online: November 10, 2010
operative time of 308 ± 53.2 minutes and mean intra-operative
blood loss of 580 ± 175 ml. No mortality was reported,
however, 3 patients had postoperative wound infection,
another 3 patients had prolonged ileus for >48 hours and
one patient developed neobladder leakage that was managed
by prolonged uretheral catheterization for 5 weeks.
Fourteen patients reported good continence for both day
and night, 9 patients had good to satisfactory continence,
while two patients had unsatisfactory continence. Postoperative
serum creatinine levels were non-significantly higher
compared to preoperative measurements. Urographic studies
demonstrated no reflux or stricture in either of the implanted
ureters, or hydronephrosis after 12-month followup.
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 first month
post-operation and the mean 12-month collective score was
improved by a mean score of 14.4 ± 5.4 than that of the first
month post-operation. Conclusion: Chimney modification
of the Hautmann neo-bladder after radical cystectomy is
simple, safe and free of ureteric stricture or reflux. Also, the
applied technique improved patient’s postoperative QoL |
