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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]

This page distinguishes the reservoir from the Le Duc–Camey ureteral implantation, which has also been used in other diversions. Selection, safe emptying, renal monitoring and cancer follow-up remain necessary regardless of the pouch's name; see Urinary Diversion Principles.[3]

From Camey I to Camey II​

The Camey I used intact tubular ileum. Its preserved bowel contractions and limited storage were important problems: Roehrborn's 14-man study reported nighttime enuresis in every participant. That was not a universal finding across all Camey I patients; a separate ten-patient urodynamic series included two men completely continent by day and night.[4][5]

Detubularization interrupts coordinated tubular contractions and permits a wider reservoir. It does not eliminate smooth muscle, guarantee low pressure or compensate for an incompetent outlet. Carini's nonrandomized comparison of 35 Camey I and 29 Studer reconstructions supported the functional rationale for detubularization but used different operations and follow-up durations; it was not a randomized Camey I–II trial.[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. Historical comparisons support the design rationale without defining a reliable outcome for every contemporary patient.[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. Segment lengths differ among published modifications.
  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 described a method intended to shorten construction. It did not randomize stapled versus hand-sewn reservoirs or establish superiority in operative time, leakage or long-term safety. Avoid extrapolating one small technical series into a standard stapler prescription.[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. The reported approximately 1 hour 45 minutes was neobladder construction plus ureteral implantation, not the entire cystectomy, and the 6.9% figure should not be used as a comprehensive standardized cystectomy-complication rate.[7]

Le Duc–Camey Ureteral Implantation​

The ureter is placed in a sulcus in the ileal mucosa and anastomosed to the bowel; the original authors described subsequent mucosal growth over it as part of the antireflux mechanism. This is distinct from the serous-lined extramural trough formed between adjacent bowel walls. Preserve ureteral perfusion and avoid angulation or a constricting implantation.[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 of 85% and stenosis of 1.5%.[8]
Same group, Ann Urol 1987A separate report described 260 implanted ureters, 85% 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]

Although Lugagne observed no new obstruction after two years in that cohort, long-term follow-up should continue. Other late complications, recurrent cancer and later deterioration are not excluded by that observation.[10][11]

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 dilated: 11 from stenosis and one from reflux. The 31% figure is not a reflux rate, and the study's short follow-up cannot establish long-term nipple-valve superiority.[12]
  • 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, not 12 years for all patients. 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, but this nonrandomized comparison does not establish the best technique for every ureter.[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. This compared two specific reservoirs; it did not test Le Duc–Camey against every refluxing anastomosis.[14]

Functional Outcomes and Their Limits​

The initial 57-patient Camey II series had only 3–24 months of follow-up. Reported combined day/night continence improved from 50% at three months to 90% at six months. The accessible abstract does not provide modern pad definitions or the denominator assessed at each visit; these figures should not be treated as a contemporary pad-free benchmark.[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. It reported day/night continence of 93.5%/83.9% and satisfactory emptying, but these selected institutional outcomes do not guarantee spontaneous emptying or represent the classic Camey II alone.[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, representing 1% of renal units, not 1% of patients. Neither the construction time nor the favorable uncontrolled outcome proves comparative superiority.[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; the 2006 update included 31 men, adding three Y reservoirs. These overlapping reports should not be pooled or their potency/ejaculation outcomes attributed to the pouch alone. They do not establish oncologic equivalence of organ-preserving and standard cystectomy.[17][18]

Urodynamic interpretation​

A published capacity or pressure is a measurement in a particular cohort, not a normal range for a named pouch. Continence also depends on outlet competence, filling behavior and emptying. The 1998 U/W/Studer comparison used different ileal lengths and ureteral implantation methods, so it cannot isolate folding as the cause of a superior outcome.[19]

Koraitim's study compared 33 intact ileocecal, 11 detubularized sigmoid and ten detubularized ileal reservoirs. It described declining pressure/contractions in the detubularized groups, but was not a direct Camey I–II comparison. Differences in bowel segment and configuration prevent treating it as proof that all modern neobladders are equivalent or always become safer with time.[20]

Complications and Follow-Up​

Early morbidity of cystectomy and bowel reconstruction includes infection, leakage, ileus and systemic complications. Small historical series reporting few events do not establish a low contemporary overall complication rate. 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. Detubularization does not eliminate retention or nighttime leakage.
  • 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. Do not describe acidosis as necessarily mild or assume that shorter bowel prevents it.[11]
  • Cancer and retained urethra: stage- and risk-appropriate surveillance after cystectomy. AUA recommends laboratory testing every 3–6 months during the first 2–3 years and then annually, with additional assessment when clinically indicated; retained-urethral monitoring is also required.[21]

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

Place Among Contemporary Reconstructions​

Camey II illustrates the functional value of detubularization and remains relevant to understanding later variants. Modern technique selection cannot be based on unadjusted tables combining pressure, continence and complications from unrelated series. Historical comparisons also do not establish current global usage or prove that one pouch replaced another for a single physiological reason.[2][19][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:10.1097/00005392-199709000-00019

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.

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.