Stapled W-shaped (Hautmann) Orthotopic Ileal Neobladder. Functional Results and Complications over a 13-year Period

Angelo Cormio; Nicola d'Altilia; Beppe Calò; Ugo Giovanni Falagario; Francesco Cinelli; Vito Mancini; Gian Maria Busetto; Carlo Bettocchi; Giuseppe Carrieri; Luigi Cormio

doi:10.1016/j.euf.2024.09.002

Stapled W-shaped (Hautmann) Orthotopic Ileal Neobladder. Functional Results and Complications over a 13-year Period

Eur Urol Focus. 2024 Sep 17:S2405-4569(24)00169-X. doi: 10.1016/j.euf.2024.09.002. Online ahead of print.

Affiliations

¹ Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy; Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona (AN), Italy.
² Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy.
³ Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy.
⁴ Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy; Urology Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: ugofalagario@gmail.com.
⁵ Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy; Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy.

PMID: 39294063
DOI: 10.1016/j.euf.2024.09.002

Abstract

Background and objective: The preferable technique for orthotopic bladder substitution after radical cystectomy is debated. The aim of this study was to describe our technique of a stapled W-shaped ileal neobladder and assess the complications and functional results in 100 patients. treated from December 2009 to July 2022.

Methods: The W-shaped ileal neobladder is created with lateral arms of 15 cm and central arms of 10 cm. Following an incision of the lower part of the two medial arms, a 10-cm GIA titanium stapler is used to detubularize the medial arms first and then the laterals to the medial arms. Urethral-neobladder anastomosis and end-to-end ureteroileal anastomosis are finally carried out. We reported on clinical data, complications, and urinary function outcomes assessed by the International Consultation on Incontinence Questionnaire (ICIQ)-Short Form and daytime/24-h pad test. Full urinary continence (UC) was defined as pad tests yielding 0 g.

Key findings and limitations: The median surgical time was 210 min. The early (up to 90 d) and late (>90 d) complication rates were 18% (2% grade ≥4) and 11.7% (2% grade ≥4), respectively. Two patients had "late" bladder stones due to chronic urinary retention, whereas none developed calcifications in the neobladder along the stapling lines. Daytime and 24-h UC rates were 74.7% and 72.4% at 12 mo, 82.7% and 72.4% at 36 mo, respectively. Median ICIQ scores were in line with pad test results, being 0 in patients with full UC.

Conclusions and clinical implications: Our stapled W-shaped ileal neobladder technique was found to be simple and fast to shape, with a low complication rate, and yielded favorable long-term functional outcomes.

Patient summary: This study details the surgical technique, complications, and functional outcomes of patients who underwent open cystectomy with a stapled W-shaped ileal neobladder. Our results indicate that this approach is safe and provides favorable long-term functional outcomes.

Keywords: Bladder cancer; Functional outcomes; Orthotopic neobladder; Radical cystectomy; Surgical staplers.