A Comparative Study of Functional Outcomes in Orthotopic Ileal W-Neobladder with Serous-lined Extramural Ureteric Implantation: Does a Shorter Ileal Segment Improve Results?

ABSTRACT Introduction: The orthotopic ileal W-neobladder is a standard for urinary diversion post-cystectomy. While functional results are good, postoperative clean intermittent catheterization (CIC) can be a significant burden. We evaluated the impact of reducing the ileal segment length from 45 cm to 35 cm on functional outcomes and complication rates. Materials and Methods: This single-center study compared two groups. Group A (first 15 cases, historical cohort) underwent reconstruction using a 45-cm ileal segment. Group B (subsequent cases) consisted of 18 patients, where a 35-cm segment was used. Outcomes assessed included operation time, hospital stay, early/late complications, continence, voiding patterns, post-void residual urine, and CIC requirement. Results: The study cohort comprised 26 males and females with a median age of 59 years. Operative time was shorter in Group B (5.30 ± 0.75 vs. 6.34 ± 0.86 h, P < 0.001). The requirement for CIC at 1 year was dramatically lower in Group B: 44.4% required no CIC versus 11.1% in Group A ( P = 0.009). Continence rates were satisfactory and comparable between groups (daytime continence: 88.8% vs. 85.7%; night time: 77.7% vs. 71.4%). Early morbidity was higher in Group B (44.4% vs. 13.3%), though this difference was not statistically significant (P = 0.333), and resolved conservatively by 3 months. Late complication rates, including reflux (16.67% vs. 20%) and pouch stone formation (5.5% vs. 6.66%), were similar. Conclusion: Constructing an orthotopic ileal W-neobladder with a shorter ileal segment (35 cm) significantly reduces the need for postoperative CIC without compromising continence or increasing major long-term complications. This modification, along with a refined surgical protocol, also leads to a significant reduction in operation time, representing an optimization of the technique.