Bladder cancer is one of the most common malignancies of the urinary system. Radical cystectomy remains one of the standard treatments, and urinary diversion is a crucial component of this complex procedure.Professor Xing Nianzeng and his team pioneered a novel laparoscopic-friendly orthotopic ileal neobladder reconstruction technique, known as the “Xing’s Neobladder.” This innovative approach utilizes a detubularized ileal segment to construct a spherical, orthotopic ileal neobladder with two peristaltic input loops, preventing urinary reflux and avoiding excessive tension or compression on the left ureter. The design helps preserve upper urinary tract function while ensuring physiological urine flow.During the National Cancer Center Urological Oncology Conference & Medical Frontier Forum (NCCU 2025), Oncology Frontier – Urology Frontier invited Professor  Yong Zhang from the National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, to share his insights on this groundbreaking technique. 

01 Oncology Frontier – Urology Frontier: The “Xing’s Technique” represents a major innovation in the surgical treatment of bladder cancer. In clinical practice, how do you determine whether a patient is a suitable candidate for this procedure?

Professor  Yong Zhang: Thank you to Oncology Frontier – Urology Frontier for the invitation. It’s my pleasure to discuss our clinical experience with bladder cancer surgery and the “Xing’s Neobladder” technique.When treating patients with muscle-invasive bladder cancer, if radical cystectomy is indicated, the next key decision involves choosing the appropriate form of urinary diversion. Because this is a technically demanding procedure with potential complications, no single method has become universally dominant — each has its advantages and drawbacks.Based on years of experience, Professor Xing Nianzeng integrated the strengths of multiple existing techniques to develop the “Xing’s Neobladder,” which, in my opinion, is one of the most rational and effective methods for orthotopic neobladder reconstruction. Its major advantages include:

• Optimal Design: The reconstructed bladder is spherical, providing an adequate and balanced reservoir capacity.

• Reflux Prevention: The two isoperistaltic input loops create a natural anti-reflux mechanism without requiring complex mechanical valves. This simplifies the operation and minimizes complications such as ureteroenteric strictures.

• Enhanced Flexibility: The dual-input design allows for anatomical adaptability — even when one ureter is short or compromised — and takes advantage of the ileum’s natural length adjustability, increasing intraoperative flexibility.

• Ideal for Minimally Invasive Surgery: The “Xing’s Neobladder” is particularly suitable for laparoscopic surgery. It shortens operation time, reduces surgeon fatigue, and improves overall surgical efficiency.Patient selection is critical to achieving good outcomes.  everal factors must be considered:

1. Oncological suitability: The tumor’s stage, grade, and location must allow for orthotopic bladder reconstruction without compromising oncologic safety.

2. Physical condition: Postoperatively, patients rely on increased intra-abdominal pressure to aid urination because the neobladder, constructed from ileum, lacks the natural contractility of a native bladder.   – Good pulmonary function is essential, as patients need sufficient respiratory capacity to generate abdominal pressure.   – Strong abdominal muscles are equally important to assist in voiding. With aging, muscle mass naturally declines, so I encourage especially middle-aged and older patients to maintain core strength through regular exercise, which not only benefits general health but also facilitates postoperative recovery.

3. Pelvic floor function: Healthy pelvic floor muscles are vital for maintaining continence and supporting pelvic organs. Regular pelvic floor training can help prevent postoperative complications such as urinary incontinence. Unfortunately, many in China overlook pelvic health, but both men and women — particularly over age 50 — should pay close attention to this aspect of wellness.In summary, careful patient selection that considers oncologic, physiological, and functional factors is essential to achieving optimal results and restoring a good quality of life after surgery.

02 Oncology Frontier – Urology Frontier: A key feature of the “Xing’s Technique” is its emphasis on anti-reflux design and preservation of upper urinary tract function. How do long-term outcomes (e.g., at 5 or 10 years) compare in terms of renal function, hydronephrosis, and urinary tract infections versus other orthotopic neobladder methods?

Professor  Yong Zhang: Under Professor Xing’s leadership, the “Xing’s Neobladder” has been in clinical use for about 13 years. Long-term follow-up of more than 30 patients has yielded very encouraging results.Most patients have shown stable renal function, with no evidence of hydronephrosis or recurrent urinary infections even 5 to 10 years after surgery. These findings demonstrate the technique’s excellent anti-reflux performance and efficient emptying capability, both of which significantly reduce infection risk.Such outcomes confirm that the “Xing’s Neobladder” not only provides oncological safety but also offers sustained protection of upper urinary tract function and greatly enhances patients’ postoperative quality of life.

03 Oncology Frontier – Urology Frontier: For young urologists aiming to master complex procedures like radical cystectomy and urinary diversion, what surgical mindset and skills — beyond technical proficiency in laparoscopy or robotics — are most important to develop?

Professor  Yong Zhang: That’s an excellent question. These procedures represent some of the most complex operations in urologic oncology — not necessarily because of high risk, but because they involve numerous critical steps, each with its own potential pitfalls.

Several aspects are essential for young surgeons to master:

1. Comprehensive technical competence: Since urinary diversion uses bowel tissue, surgeons must be skilled in intestinal resection and anastomosis. With minimally invasive approaches now mainstream, proficiency in intracorporeal suturing and reconstruction is also indispensable. Precise handling of ureteroenteric anastomoses is critical, as poor technique can cause early complications (like obstruction or leakage) and long-term issues (such as strictures or hydronephrosis), all of which can profoundly affect patient outcomes.

2. Progressive learning strategy:    – Remote observation: Start by watching surgical videos and masterclasses shared by leading experts. This helps develop theoretical understanding and spatial awareness.

– Hands-on experience: After acquiring basic skills, attend workshops or live surgery demonstrations to observe expert maneuvers up close and ask questions directly. As the saying goes, “One conversation with a master can be worth ten years of study.”

3. Patient communication: Surgical excellence must be paired with compassionate care. Radical cystectomy with diversion can lead to diverse complications — from mild discomfort to serious postoperative issues. Maintaining transparent and empathetic communication with patients is therefore crucial. Clearly explaining procedures, risks, and recovery expectations helps build trust and ensures better adherence and outcomes.

4. Teamwork and leadership: Radical cystectomy is a team-intensive operation requiring seamless collaboration. In experienced teams, the median operation time for an ileal conduit may be 5–6 hours; for highly efficient, well-coordinated teams, this can be shortened to 3–4 hours. However, for less experienced or poorly coordinated teams, the same surgery may extend to 8–9 hours, increasing fatigue-related errors and complications.

Establishing a dedicated, stable surgical team where each member specializes in specific steps fosters consistency and efficiency — a “virtuous cycle” in which more experience leads to higher precision, shorter operations, and better patient outcomes.

To summarize, excellence in urologic surgery requires not only technical skill, but also strategic learning, team synergy, and empathy for patients. Only by combining these elements can a surgeon truly excel and advance in this demanding yet deeply rewarding field.

Professor  Yong Zhang National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College