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Camey II Detubularized Orthotopic Ileal Neobladder

The Camey II is a detubularized, U-shaped ileal reservoir connected to the native urethra. Reports from the Camey group describe its use from 1987, followed by a 57-patient initial series and a 110-patient update. It developed the original tubular Camey reservoir into a configuration intended to improve storage and nighttime control.[1][2]

The Le Duc–Camey ureteral implantation is a separate technique that has also been used in other diversions, including the Kock pouch and Hautmann's ileal neobladder.[8][23][24] Selection, safe emptying, renal monitoring and cancer follow-up apply regardless of the reservoir; see Urinary Diversion Principles.[3]

From Camey I to Camey II​

The Camey I used intact, non-detubularized U-shaped ileum; Camey's group reviewed 84 patients over 25 years.[22] Preserved bowel contractions and limited storage were the main problems. In Roehrborn's 14 men, mean pressure at capacity was 37 cm H₂O, mean capacity 362 mL and the voiding interval 2.2 hours.[4] Nocturnal enuresis occurred in every patient, and segmental and peristaltic contraction waves persisted at 2 years.[4] Reflux was prevented in 86% of renal units, and metabolic acidosis occurred in 43% of patients.[4] In a ten-patient urodynamic study, all but 2 neobladders had contractions at 50 to 200 mL, and the 2 men who were continent by day and night had none.[5]

Detubularization interrupts coordinated tubular contractions and permits a wider reservoir. Carini's nonrandomized comparison of 35 Camey I and 29 Studer reconstructions (mean follow-up 27 and 13.6 months) found smaller capacity, higher pressure, shorter voiding intervals, near-uniform enuresis and more reflux with the Camey I, and a slight metabolic acidosis in both groups that was treated with oral alkalinization.[6]

The 1996 Camey II report reviewed 110 patients treated during 1987–1991 and described improved capacity and nighttime control relative to the earlier Camey I experience.[2]

Operative Framework​

  1. Select a suitable ileal segment and confirm reach. Preserve its mesenteric blood supply and ensure that the future dependent outlet reaches the urethra without tension or twisting. During cystectomy for muscle-invasive bladder cancer, verify a negative urethral margin before constructing the orthotopic reservoir .[21] Reported ileal lengths differ among modifications: 30 cm for the U-shaped neobladders in Minervini's comparison, 45 cm for the Perugia Y and 70 cm for Hautmann's original W reservoir.[19][15][24]
  2. Isolate the planned segment and restore bowel continuity. Preserve appropriate terminal ileum and verify mesenteric orientation.
  3. Detubularize along the antimesenteric border. Arrange the opened segment in a U configuration and approximate the medial edges to form the posterior plate.
  4. Implant the ureters using the selected technique. The classic reports use Le Duc–Camey mucosal implantation; later modifications use other antireflux or refluxing anastomoses.
  5. Create the dependent urethral anastomosis and close the reservoir. Maintain a tension-free outlet, watertight closure and reliable drainage. The closure sequence depends on the chosen modification.[1][2][7]

The early stapled Camey II series (GIA staplers) was intended to save time and give watertight suture lines.[1]

Muto's stapled modification with a serous-lined extramural tunnel included 43 men followed for a median 38 months. One reflux event and two ureteroileal strictures were reported. Neobladder construction plus ureteral implantation took about 1 hour 45 minutes, not the entire cystectomy. The authors reported a 6.9% complication rate for the reconstruction.[7]

Le Duc–Camey Ureteral Implantation​

A sulcus is created in the ileal mucosa, and the spatulated ureter is laid in the sulcus and sutured to its edges. The original authors described progressive mucosal growth over the ureter as part of the antireflux mechanism. This differs from the serous-lined extramural trough formed between adjacent bowel walls. Ureteral perfusion is preserved, and angulation or a constricting implantation is avoided.[8][9]

Historical reports used different populations and should remain separate:

ReportPopulation and result
Le Duc, Camey and Teillac, J Urol 198751 patients and 97 ureters followed for 3–8 years; reported antireflux effectiveness in 85% of patients and stenosis of 1.5%.[8]
Same group, Ann Urol 1987A separate report described 260 implanted ureters, 85% antireflux effectiveness, and stenosis below 2%. It is not the same 97-ureter denominator.[9]
Lugagne 1997Retrospective series of 158 men, comprising 109 tubular and 49 detubularized reservoirs, with 313 implantations; 123 men had at least two years of follow-up. Reported anastomotic stenosis was 4.9% in that follow-up group.[10]

Lugagne detected no new obstruction beyond two years in that cohort; all strictures were at the anastomotic site, 3.7% of patients needed ureteral reimplantation and 2% needed nephrectomy for chronic obstruction.[10]

Comparative evidence​

  • Shaaban 1992 randomized 40 men with normal preoperative upper tracts to an intussuscepted nipple or Le Duc implantation. The nipple group had no observed reflux or radiographic dilation during 6–18 months of follow-up. In the Le Duc group, 12 of 38 renal units (31%) dilated: 11 from stenosis and one from reflux.[12]
  • Yamamoto 1995 applied the Camey–Le Duc technique to Kock pouches in 41 patients (78 renal units; 30 cutaneous, 11 urethral). At a mean of 23 months, 73 renal units (93.6%) had no dilatation and no patient had reflux. Among renal units whose last IVP was at 6 months, dilatation was seen in 4 of 23; among a separate group whose last IVP was at 12 months or later, it was seen in 1 of 55.[23]
  • Minervini 1998 compared Studer (Nesbit implantation), W-shaped and U-shaped (Le Duc) ileal neobladders in 45 men. All Nesbit anastomoses refluxed at full filling, as did 15 of 50 Le Duc implantations. Double-reconfiguration reservoirs (Studer and W) had larger capacity and lower maximum pressure than the single-fold U reservoirs at 3, 6 and 12 months, with better continence and longer voiding intervals at 12 months.[19]
  • Hassan 2007 compared direct Nesbit implantation in 58 patients with Le Duc in 62 patients receiving a Y-neobladder. Mean follow-up was 72 months (range 36–144). Six Le Duc patients developed a unilateral stricture versus none in the direct group; overall reflux did not differ significantly. A subgroup with dilated ureters favored Le Duc for reflux.[13]
  • USC-STAR provides the larger randomized antireflux comparison: 484 patients randomized to Studer or T-pouch, 423 with baseline outcome data and 260 with three-year renal data. The T-pouch showed no significant renal benefit and had more diversion-related intervention.[14] In a meta-analysis of 11 studies of orthotopic ileal neobladders after cystectomy for bladder cancer, antireflux implantation was associated with more ureteroenteric strictures (OR 2.84, 95% CI 1.75–4.61) and less reflux (OR 0.24, 95% CI 0.10–0.59) than direct anastomosis.[26] No statistically significant difference was detected in renal-function impairment or pyelonephritis; reflux results had substantial heterogeneity (I² = 75%).[26]

Functional Outcomes and Their Limits​

The initial 57-patient Camey II series had only 3–24 months of follow-up. There was no operative mortality and 5 perioperative complications. Reported combined day/night continence improved from 50% at three months to 90% at six months, without a stated pad definition or denominator at each visit.[1]

The Perugia ileal neobladder is a specified modification using 45 cm of detubularized ileum in a vertical Y shape. Its 237-patient report had a median follow-up of 64 months; only 20 patients reached ten years. The 5-year overall survival was 64% and perioperative mortality 1.6%; grade III–IV early complications occurred in 27 patients. Day/night continence was 93.5%/83.9%, and all patients emptied completely. The most frequent late complications were reflux, urolithiasis and urethral anastomotic stricture.[15]

The Fontana Y-neobladder is another distinct reconstruction. Its 50-patient technical series reported a 15–20 minute reconstruction time and one ureteroenteric stricture (1% of renal units), with day/night continence good or satisfactory in 90%/85%.[16]

Organ-preserving cystectomy reports​

Terrone's reports combined the reservoir with highly selected supra-ampullar cystectomy, preserving sexual structures. The 2004 cohort included 28 men with 26 Camey II and two Camey I reservoirs (median follow-up 90.5 months).[17] Potency was preserved in 26 (92.8%) and antegrade ejaculation in 15 (53.5%); 16 of 27 evaluable patients had day and night continence, and one Camey I was converted to a conduit for excessive capacity, high residual urine and pyelonephritis.[17] The 2006 update included 31 men, adding three Y reservoirs (median follow-up 95 months): 10-year cause-specific survival was 76.7%, potency was preserved in 28 (90.3%), and antegrade ejaculation in 15 (48.3%).[18] The two reports overlap.[17][18]

Urodynamic interpretation​

Continence also depends on outlet competence, filling behavior and emptying.[19] In the 1998 U/W/Studer comparison, the reservoirs differed in ileal length (30, 40 and 60 cm) and in ureteral implantation method.[19]

Koraitim's study compared 33 intact ileocecal, 11 detubularized sigmoid and ten detubularized ileal reservoirs. With time, capacity increased in all three groups, but the intact ileocecal reservoirs showed rising pressure and persistent involuntary contractions, whereas the detubularized sigmoid and ileal reservoirs showed falling pressure and fewer contractions. The authors attributed the capacity increase to overdistension, which was greater in detubularized (109% to 112%) than in tubular (79%) segments.[20]

Complications and Follow-Up​

Early morbidity of cystectomy and bowel reconstruction includes infection, leakage, ileus and systemic complications. The Leandri series reported no operative mortality and 5 perioperative complications in 57 patients; the Perugia series reported perioperative mortality of 1.6%, mostly grade I–II early complications and grade III–IV complications in 27 of 237 patients.[1][15] In a historical cohort of 131 ileal-conduit patients who survived at least five years, 45% developed conduit-related complications within five years.[27] EAU reports benign ureteroenteric strictures after urinary diversion in up to 20%.[11] Late problems include ureteroenteric and urethral-outlet stricture, retention, stones, infection, mucus obstruction, metabolic acidosis and nutritional deficiency.[10][15][11]

Follow-up should address:

  • Emptying and continence. Scheduled voiding, residual urine, catheterization needs, leakage and mucus/drainage care. NCCN describes nighttime incontinence and retention requiring intermittent catheterization after orthotopic diversion.[25]
  • Renal and upper-tract status. Serum creatinine/eGFR, electrolytes and appropriate imaging for obstruction or other deterioration.
  • Metabolic and nutritional effects. Bicarbonate and annual vitamin B12 measurement after bowel diversion (EAU follow-up guidance, section 7.4 text; low levels reported in 17% of patients with bowel diversion, no strength rating).[11] Acidosis occurred in 43% of Camey I patients in Roehrborn's series, and a slight acidosis treated with oral alkalinization was reported in Carini's Camey I and Studer groups.[11][4][6]
  • Cancer and retained urethra: stage- and risk-appropriate surveillance after cystectomy. The AUA/ASCO/SUO guideline states that patients should undergo laboratory assessment at three to six month intervals for two to three years and then annually , and that clinicians should monitor the urethral remnant for recurrence after cystectomy with a retained urethra .[21]

See Renal function and metabolic surveillance, Vitamin B12 supplementation, Urinary acidifiers & alkalinizers, and Mucus management.

Place Among Contemporary Reconstructions​

Camey II demonstrated the functional value of detubularization. Hautmann's ileal neobladder (70 cm of ileum opened along the antimesenteric border, ureters implanted by the Le Duc–Camey method; 11 patients, pressure below 30 cm H₂O) extended the same principle.[24] In Minervini's comparison, double-reconfiguration reservoirs had larger capacity and lower pressure than single-fold U-shaped reservoirs, and the Perugia and Y-neobladders are later modifications of the Camey II.[19][15][16][2][3]

See Also​

References​

1. Leandri P, Rossignol G, Gautier JR, et al. "Ileal low-pressure bladder replacement: Camey type II. Stapling technique and preliminary results (57 cases, 1987–1989)." Eur Urol. 1990;18(3):161–165. doi:10.1159/000463900

2. Barre PH, Herve JM, Botto H, Camey M. "Update on the Camey II procedure." World J Urol. 1996;14(1):27–28. doi:10.1007/BF01836341

3. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. 2026. Disease management, section 6.7.5, urinary diversion. Guideline.

4. Roehrborn CG, Teigland CM, Sagalowsky AI. "Functional characteristics of the Camey ileal bladder." J Urol. 1987;138(4):739–742. doi:10.1016/s0022-5347(17)43357-x

5. Goldwasser B, Rife CC, Benson RC, Furlow WL, Barrett DM. "Urodynamic evaluation of patients after the Camey operation." J Urol. 1987;138(4):832–835. doi:10.1016/s0022-5347(17)43389-1

6. Carini M, Serni S, Scelzi S, et al. "Orthotopic ileal bladder: clinical, urodynamic and metabolic evaluation." Eur Urol. 1992;22(2):99–105. doi:10.1159/000474733

7. Muto G, Bardari F, D'Urso L. "New serosal-lined antireflux ureteroileal implantation technique on a GIA stapler detubularised ileal neobladder: technical considerations and results." Eur Urol. 2005;48(5):826–830. doi:10.1016/j.eururo.2005.03.011

8. Le Duc A, Camey M, Teillac P. "An original antireflux ureteroileal implantation technique: long-term followup." J Urol. 1987;137(6):1156–1158. doi:10.1016/s0022-5347(17)44433-8

9. Le Duc A, Camey M, Teillac P. Antireflux uretero-ileal implantation via a mucosal sulcus. Ann Urol (Paris). 1987;21(1):33–34. PubMed.

10. Lugagne PM, Hervé JM, Lebret T, et al. "Ureteroileal implantation in orthotopic neobladder with the Le Duc-Camey mucosal-through technique: risk of stenosis and long-term follow-up." J Urol. 1997;158(3 Pt 1):765–767. doi:10.1016/S0022-5347(01)64311-8

11. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. 2026. Follow-up, section 7.4, functional outcomes and complications. Guideline.

12. Shaaban AA, Gaballah MA, el-Diasty TA, Ghoneim MA. "Urethral controlled bladder substitution: a comparison between the intussuscepted nipple valve and the technique of Le Duc as antireflux procedures." J Urol. 1992;148(4):1156–1161. doi:10.1016/s0022-5347(17)36847-7

13. Hassan AA, Elgamal SA, Sabaa MA, Salem KA, Elmateet MS. "Evaluation of direct versus non-refluxing technique and functional results in orthotopic Y-ileal neobladder after 12 years of follow-up." Int J Urol. 2007;14(4):300–304. doi:10.1111/j.1442-2042.2006.01716.x

14. Skinner EC, Fairey AS, Groshen S, et al. "Randomized trial of Studer pouch versus T-pouch orthotopic ileal neobladder in patients with bladder cancer." J Urol. 2015;194(2):433–439. doi:10.1016/j.juro.2015.03.101

15. Porena M, Mearini L, Zucchi A, et al. "Perugia ileal neobladder: functional results and complications." World J Urol. 2012;30(6):747–752. doi:10.1007/s00345-012-0985-z

16. Fontana D, Bellina M, Fasolis G, et al. "Y-neobladder: an easy, fast, and reliable procedure." Urology. 2004;63(4):699–703. doi:10.1016/j.urology.2003.11.015

17. Terrone C, Cracco C, Scarpa RM, Rossetti SR. "Supra-ampullar cystectomy with preservation of sexual function and ileal orthotopic reservoir for bladder tumor: twenty years of experience." Eur Urol. 2004;46(2):264–269. doi:10.1016/j.eururo.2004.03.006

18. Terrone C, Porpiglia F, Cracco C, et al. "Supra-ampullar cystectomy and ileal neobladder." Eur Urol. 2006;50(6):1223–1233. doi:10.1016/j.eururo.2006.07.049

19. Minervini R, Morelli G, Fontana N, Minervini A, Fiorentini L. "Functional evaluation of different ileal neobladders and ureteral reimplantation techniques." Eur Urol. 1998;34(3):198–202. doi:10.1159/000019712

20. Koraitim MM, Atta MA, Foda MK. Early and late cystometry of detubularized and nondetubularized intestinal neobladders: new observations and physiological correlates. J Urol. 1995;154(5):1700–1702. PubMed. doi:10.1097/00005392-199511000-00027

21. American Urological Association / American Society of Clinical Oncology / Society of Urologic Oncology. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer. Amended 2024. Statements 31–32 and discussion, laboratory follow-up and retained urethra. Guideline PDF.

22. Lilien OM, Camey M. "25-year experience with replacement of the human bladder (Camey procedure)." J Urol. 2017;197(2S):S173–S179. doi:10.1016/j.juro.2016.10.106

23. Yamamoto A, Kanayama H, Naruo S, Takigawa H, Kagawa S. "The Camey-Le Duc antireflux technique for the Kock pouch: evaluation of the upper urinary tract." Eur Urol. 1995;27(3):236–240. doi:10.1159/000475168

24. Hautmann RE, Egghart G, Frohneberg D, Miller K. "The ileal neobladder." J Urol. 1988;139(1):39–42. doi:10.1016/s0022-5347(17)42283-x

25. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 3.2026. August 6, 2026. Discussion MS-18. Guideline.

26. Zhang Y, Ding H, Zhang Y, et al. "Is anti-reflux anastomosis an advantage in an orthotopic ileal neobladder? A systematic review and meta-analysis." Urol Int. 2023;107(1):1–14. doi:10.1159/000525017

27. Madersbacher S, Schmidt J, Eberle JM, et al. "Long-term outcome of ileal conduit diversion." J Urol. 2003;169(3):985–990. doi:10.1097/01.ju.0000051462.45388.14