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Minerva Urology and Nephrology 2021 Jun 22

DOI: 10.23736/S2724-6051.21.04354-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Urethral fixation technique improves urinary continence recovery in male patients undergoing open radical cystectomy and ileal orthotopic neobladder

Vincenzo FICARRA 1 , Gianluca GIANNARINI 2, Giuseppe ALARIO 1, Gabriele TULONE 3, Marta ROSSANESE 1, Giuseppe MUCCIARDI 1, Claudio VALOTTO 2, Alchiede SIMONATO 3

1 Urologic Section, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy; 2 Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy; 3 Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy


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BACKGROUND: We assessed urinary continence recovery and perioperative complications in patients operated on with the novel urethral fixation technique during open radical cystectomy (RC) with ileal orthotopic neobladder (IONB).
METHODS: A retrospective cohort of 82 consecutive male patients undergoing open RC with IONB between 07/2013 and 06/2020 was analyzed. A study group of 48 patients operated on with the urethral fixation technique was compared with a control group of 34 patients receiving standard neovesico-urethral anastomosis. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of levator ani muscle postero-laterally in order to avoid urethral retraction/deviation. Urinary continence recovery and perioperative complications were assessed and compared between the two groups.
RESULTS: The two groups were comparable with regard to demographic, clinical and pathological variables. At the median follow-up of 36 months, 42 (87.5%) patients in the study, and 22 (64.7%) in the control group during daytime, and 32 (66.7%) patients in the study, and 15 (44.1%) patients in the control group during nighttime used no pads or a safety pad (p=0.01 and p=0.04, respectively). Ninety-day postoperative complications were observed in 14 (29.2%) patients in the study, and in 10 (29.4%) cases in the control group (p=0.77).
CONCLUSIONS: In our exploratory case-control study of male patients undergoing open RC with IONB, we observed a significant improvement in daytime and nighttime urinary continence recovery with no increase in perioperative complications using the novel urethral fixation technique compared to the standard neovesical-urethral anastomosis.


KEY WORDS: Bladder cancer; Radical cystectomy; Orthotopic neobladder; Urethra; Urinary sphincter; Urinary continence

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