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Background <p>Inverted-nipple ureteroneocystostomy (inverted-NU) is a novel technique for laparoscopic radical cystectomy with orthotopic neobladder reconstruction (LRC+ONB). For the traditional direct anastomosis (DA) technique, inverted-NU provides a more instructive clinical protocol.</p> Patients and Methods <p>Between 2020 and 2025, 84 patients were treated with LRC+ONB: 44 through inverted-NU and 40 through DA, respectively. Clinical features were compared including postoperative complications clinical symptoms, perioperative data, changes in renal function, urinary continence rates, and quality of life for the two groups. Here, postoperative low renal function has been analyzed via multivariate logistic regression.</p> Results <p>The mean follow-up period was 35 ± 18.4 months. Compared with the DA group, the inverted-NU group demonstrated a shorter operative time (410&#xa0;min versus 470&#xa0;min, <i>P</i> = 0.002), faster recovery of bowel function (5 days versus 5.5 days, <i>P</i> = 0.035), and less postoperative hydronephrosis (34.1% versus 77.5%, <i>P </i>&lt; 0.001). No uretero–neobladder anastomotic strictures were observed in the inverted-NU group compared with five cases in the DA group during follow-up (<i>P </i>= 0.021). As for postoperative renal function, lower levels of urea, creatinine, uric acid, and estimated glomerular filtration rate grading could be found in the inverted-NU group than DA group (<i>P </i>&lt; 0.05). Multivariate analysis revealed ureteroenteric anastomotic stricture (OR 12.74; 95% CI 1.25–130.07; <i>P </i>= 0.032) and non-urothelial carcinoma (OR 7.30; 95% CI 1.04–51.40; <i>P </i>= 0.046) as independent risk factors for postoperative low renal function. Additionally, inverted-NU demonstrated superior nighttime continence (<i>P </i>= 0.031), with similar quality of life between groups.</p> Conclusions <p>Inverted-NU was feasible with a low complication rate compared with the traditional DA technique. It significantly reduced the incidence of anastomotic stricture and hydronephrosis after orthotopic neobladder, and no trend toward postoperative renal function deterioration was observed.</p>

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Comparison Study of Inverted-Nipple Ureteroneocystostomy and Direct Anastomosis in U-Shaped Orthotopic Neobladder Reconstruction

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Qi Xing,
  • Yang-bing Wei,
  • Xin Wang,
  • Hai-feng Hao,
  • Jian-zhi Pang,
  • Fan Jia,
  • Peng-yu Yan,
  • Jia-wei Li,
  • Ming-quan Xu,
  • Shi-ze Zhang,
  • Hao-jun Zhang,
  • Shuai Li,
  • Quan-yong Liu,
  • Jing-hong He,
  • Xiao-feng Yang,
  • Chao Liu

摘要

Background

Inverted-nipple ureteroneocystostomy (inverted-NU) is a novel technique for laparoscopic radical cystectomy with orthotopic neobladder reconstruction (LRC+ONB). For the traditional direct anastomosis (DA) technique, inverted-NU provides a more instructive clinical protocol.

Patients and Methods

Between 2020 and 2025, 84 patients were treated with LRC+ONB: 44 through inverted-NU and 40 through DA, respectively. Clinical features were compared including postoperative complications clinical symptoms, perioperative data, changes in renal function, urinary continence rates, and quality of life for the two groups. Here, postoperative low renal function has been analyzed via multivariate logistic regression.

Results

The mean follow-up period was 35 ± 18.4 months. Compared with the DA group, the inverted-NU group demonstrated a shorter operative time (410 min versus 470 min, P = 0.002), faster recovery of bowel function (5 days versus 5.5 days, P = 0.035), and less postoperative hydronephrosis (34.1% versus 77.5%, P < 0.001). No uretero–neobladder anastomotic strictures were observed in the inverted-NU group compared with five cases in the DA group during follow-up (P = 0.021). As for postoperative renal function, lower levels of urea, creatinine, uric acid, and estimated glomerular filtration rate grading could be found in the inverted-NU group than DA group (P < 0.05). Multivariate analysis revealed ureteroenteric anastomotic stricture (OR 12.74; 95% CI 1.25–130.07; P = 0.032) and non-urothelial carcinoma (OR 7.30; 95% CI 1.04–51.40; P = 0.046) as independent risk factors for postoperative low renal function. Additionally, inverted-NU demonstrated superior nighttime continence (P = 0.031), with similar quality of life between groups.

Conclusions

Inverted-NU was feasible with a low complication rate compared with the traditional DA technique. It significantly reduced the incidence of anastomotic stricture and hydronephrosis after orthotopic neobladder, and no trend toward postoperative renal function deterioration was observed.