Efficacy evaluation of urethral dragging-and-adhesion anastomosis in ileal orthotopic neobladder reconstruction following laparoscopic radical cystectomy: a dual-center retrospective study.

BACKGROUND: Urethra-neobladder anastomosis following laparoscopic radical cystectomy combined with an ileal orthotopic neobladder is a pivotal step that significantly influences postoperative urinary continence, urodynamic performance, and the risk of surgical complications. PURPOSE: This study aims to evaluate the effects of a modified urethral dragging-and-adhesion anastomosis technique on postoperative urodynamic parameters, urinary continence recovery, and immune function, with emphasis on its potential benefits in reducing surgical trauma, enhancing functional outcomes, and mitigating immune suppression. PATIENTS AND METHODS: A retrospective analysis was performed on 55 patients with bladder cancer who underwent laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction at Jiangxi Provincial People's Hospital (35 cases) and the Second Affiliated Hospital of Nanchang University (20 cases) between June 2016 and January 2021. Of these, 30 patients received urethral dragging-and-adhesion anastomosis (observation group), while 25 patients underwent conventional interrupted anastomosis (control group). The study compared operative time and intraoperative blood loss between the two groups and evaluated postoperative urodynamic parameters, including maximum bladder capacity, postvoid residual, maximum flow rate (Q-max), and average flow rate (Q-ave). In addition, this study evaluated the recovery of daytime and nighttime urinary control in patients 3 months, 1 year, and 2 years after the surgery, along with immune function indicators 1 week after the surgery, namely, the proportions of CD3+, CD4+, and CD8+ T cells and the CD4+/CD8+ ratio. RESULTS: There were no significant differences in preoperative general data or immune-related parameters between the two groups. The observation group demonstrated significantly shorter operative times (279.80 ± 45.32 min vs. 382.60 ± 45.94 min, p < 0.01) and urethral anastomosis times (18.37 ± 7.05 min vs. 61.80 ± 11.35 min, p < 0.01) compared with the control group, in addition to reduced intraoperative blood loss (274.00 ± 85.48 mL vs. 336.80 ± 72.44 mL, p < 0.01). No statistically significant differences were observed in urodynamic parameters between the two groups at 3 months, 1 year, or 2 years postoperatively (p > 0.05). Regarding urinary continence recovery, no significant differences were observed between the observation and control groups in daytime and nighttime continence rates at any postoperative time point (p > 0.05). Immune function tests revealed that the observation group had significantly higher postoperative levels of CD3+ T cells (57.63 ± 3.41% vs. 53.68 ± 3.05%, p < 0.01), CD4+ T cells (28.43 ± 2.66% vs. 24.56 ± 2.53%, p < 0.01) and an increased CD4+/CD8+ ratio (0.98 ± 0.15 vs. 0.83 ± 0.09, p < 0.01) compared with the control group. No significant difference was observed in CD8+ T-cell levels between the two groups (29.30 ± 3.04% vs. 29.72 ± 1.43%, p > 0.05). In addition, both groups showed significant postoperative reductions in CD3+, CD4+, and CD8+ T-cell counts, and in the CD4+/CD8+ ratio, compared to preoperative levels (p < 0.01). CONCLUSION: Urethral dragging-and-adhesion anastomosis is a safe and effective modified technique for urethral reconstruction during laparoscopic radical cystectomy with an ileal orthotopic neobladder. It enables speedy surgical completion and urethral anastomosis while preserving urodynamic and urinary continence functions comparable to those of traditional methods. In addition, it may contribute to better preservation of patients' immune function.