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Keywords:

  • urinary diversion;
  • reflux;
  • orthotopic neobladder;
  • ureteroileal anastomosis;
  • renal function

Objective

  • To determine the long-term effects of the direct refluxing-type ureteroileal anastomosis technique with those of an antireflux technique on individual renal units, using diuretic scintigraphy in a prospectively randomized study.

Patients and Methods

  • Between 2002 and 2006, a prospective randomized study was conducted on 102 patients undergoing radical cystectomy and urinary diversion.
  • In every patient, both ureters were randomized to be implanted using a direct refluxing technique or an antireflux, serous-lined extramural tunnel (SLET) technique.
  • Renal function (RF) was evaluated using 99mTc-MAG-3 diuretic scintigraphy. The serial changes in corrected glomerular filtration rate (cGFR) for each technique and for each side were compared.

Results

  • Over a median follow-up of 6 years, the patients in both the direct refluxing and the SLET technique groups were found to have a significant reduction in mean (sd) cGFR between baseline and last follow-up: cGFR decreased from 59.4 (12.4) to 45.6 (15.3) mL/min (P < 0.001) and from 54.3 (11.2) to 46.3 (12.8) mL/min (P = 0.002), respectively.
  • Five patients (4.9%) in the SLET group developed obstruction (four left-sided and one right-sided) compared with one (0.9%) in the direct refluxing group (right-sided). The onset of obstruction was noted 1–7 months after radical cystectomy.
  • There was no significant difference between the groups in reductions in cGFR across the timepoints.
  • Comparison of the two techniques according to the side of ureter implantation showed that the direct refluxing technique trended towards better functional outcomes on the left side.

Conclusions

  • There was no observed difference in the RF of individual renal units between the SLET and the direct refluxing groups in the long term.
  • The need to incorporate an antireflux technique should be questioned and tailored according to the surgeon's experience and confidence.