Commentary on '25 years of experience with 1,000 neobladders: Long-term complications.' Hautmann RE, de Petriconi RC, Volkmer BG, Department of Urology, University of Ulm, Ulm, Germany. J Urol 2011;185:2207-12.

摘要

We analyzed the long-term complications (greater than 90 days postoperatively) in a large, single center series of patients who underwent cystectomy and substitution with an ileal neobladder. A total of 1,540 radical cystectomies were performed at our center between January 1986 and September 2008. Of the patients, 1,013 received an ileal neobladder. Only the 923 patients with follow-up longer than 90 days (median 72 months, range 3 to 267) were included in the analysis. All long-term complications were identified. The complication rate was calculated using the Kaplan-Meier method. The overall survival rate was 65.5%, 49.8%, and 28.3% at 5, 10, and 20 years, respectively. The overall long-term complication rate was 40.8% with 3 neobladder-related deaths. Hydronephrosis, incisional hernia, ileus or small bowel obstruction, and feverish urinary tract infection were observed in 16.9%, 6.4%, 3.6%, and 5.7% of patients, respectively, 20 years postoperatively. Subneovesical obstruction in 3.1% of cases was due to local tumor recurrence in 1.1%, neovesicourethral anastomotic stricture in 1.2%, and urethral stricture in 0.9%. Chronic diarrhea was noted in 9 patients. Vitamin B12 was substituted in 2 patients. Episodes of severe metabolic acidosis occurred in 11 patients, and 307 of 923 required long-term bicarbonate substitution. Rare complications included cutaneous neobladder fistulas in 2 cases, and intestinal neobladder fistulas, iatrogenic neobladder perforation, spontaneous perforation and necrotizing pyocystis in 1 each.