Komplikationen nach Zystektomie und Anlage einer Ileum-Neoblase

Abstract

Purpose: Orthotopic urinary diversion via the ileal neobladder is the preferred form of bladder reconstruction in patients of both sexes undergoing cystectomy at the University of Ulm. A total of 754 patients undergoing this procedure from April 1986 through September 2003 were analyzed. Material and Methods: Complications were assessed, tabulated, subdivided into early (3 months or less postoperatively) and late types, and further categorized with respect to relationship to neobladder construction. The evaluation was realized via a patient questionnaire and phone interviews with patients, relatives and physicians. Results: The 3-months mortality rate was 3 %. There were 257 neobladder related early complications (34 %) and 299 late complications (40 %). 119 early complications (16 %) and 32 late complications (4 %) were dependent on the exclusion of the bowel segment. Early complications of the pelvic lymphadenectomy occurred in 134 cases (18 %) and late complications in 30 cases (4 %). There were 168 general early complications (22 %) and 29 late complications (4 %). Tumor related neobladder complications were late complications and occurred in 25 cases (3 %). 13 % of early complications and 9 % of late complications required open surgical revision. Early complications were observed in 58 % of the patients and late complications in 47 % of the patients. The most frequent of clinically relevant early complications were the rate of prolonged urinary leakage (5 %), ileus symptoms (5 %), stenosis of the ureteroneovesical anastomosis (4 %) and disorder of lymphatic drainage (4 %); late complications were stenosis of the ureteroneovesical anastomosis (5 %) and stricture of the neovesicourethral anastomosis (3 %). Conclusion: The ileal neobladder can be constructed with acceptable complications. This data suggest that although it is not a complication-free procedure, its use should be advocated when possible.