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Orthotopic Bladder Substitution. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee DH, Song W. Surgical Outcomes of Transvaginal Neobladder-Vaginal Fistula Repair After Radical Cystectomy with Ileal Orthotopic Neobladder: A Case-Control Study. Cancer Manag Res 2020; 12:10279-10286. [PMID: 33116882 PMCID: PMC7585512 DOI: 10.2147/cmar.s277001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To present surgical methods and outcomes in women with bladder cancer (BCa) requiring correction of neobladder-vaginal fistula (NVF) after radical cystectomy (RC) with ileal orthotopic neobladder (IONB). Materials and Methods The medical records of 163 women who underwent RC with IONB for BCa between January 2010 and December 2018 were retrospectively reviewed. The presence of NVF was confirmed by cystoscopy and/or voiding cystography. NVF repair was performed using a transvaginal approach, which included circumferential incision of the fistula tract, creation of a plane between the neobladder serosa and the vaginal epithelium, and multi-layered transvaginal closure. Results During a median follow-up of 47.9 months, NVF was identified in 12 (8.8%) of the 163 included women. Eight (66.7%) fistulas were located in the proximal anterior vaginal wall and four (33.3%) in the vaginal apex. Median time from RC to NVF repair was 3.4 months (range, 2.1-5.6 months), median NVF size was 6.0 mm (range, 4.0-22.0 mm), and median duration of urethral Foley catheter indwelling was 24.0 days (range, 15.0-43.0 days). Initial repair of NVF was successful in ten (83.3%) patients. Two (16.7%) patients who relapsed retained IONB through the subsequent operation. Two (16.7%) patients developed severe urinary incontinence after NVF repair, requiring anti-incontinence surgery with a synthetic transobturator mid-urethral sling. Conclusion The transvaginal approach for NVF repair is feasible, yielding successful surgical outcomes. However, women should be counseled about the risks of relapse and urinary incontinence.
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Affiliation(s)
- Dong Hyeon Lee
- Department of Urology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW To describe the complexities of diagnosis and management of neobladder-vaginal fistula (NVF) following orthotopic urinary diversion in women. RECENT FINDINGS Multiple recent single-institution series confirm the variability of outcomes for NVF repairs and caution regarding comorbid stress urinary incontinence which may necessitate further interventions including conversion to alternate diversions. Although both abdominal and transvaginal approaches have been advocated for surgical management of NVF, contemporary series from reconstructive surgeons favor a vaginal approach to decrease overall operative morbidity. Patients should be carefully counseled regarding neobladder and sphincter function following fistula repair along with the risks of secondary urinary diversion.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urology, Vanderbilt Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA.
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Alcántara-Quispe C, Machado RD, Magnabosco WJ, Santos AC, Faria EF. Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder. Int Braz J Urol 2018; 44:1036-1041. [PMID: 30044598 PMCID: PMC6237524 DOI: 10.1590/s1677-5538.ibju.2018.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/05/2018] [Indexed: 11/21/2022] Open
Abstract
Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
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Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications. Actas Urol Esp 2018; 42:143-151. [PMID: 28587844 DOI: 10.1016/j.acuro.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. ACQUISITION OF EVIDENCE We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery. We identified those series that included more than 100 patients. SYNTHESIS OF THE EVIDENCE The literature regarding the prevention and treatment of complications after cystectomy is in general retrospective and nonstandardised. The level of evidence is generally low, and it is difficult to make evidence-based recommendations. CONCLUSIONS Progress has been made in recent years in reducing mortality and preventing the complications of cystectomy. The most common complications are gastrointestinal, for which significant efforts have been made to implement ERAS and Fast Track protocols. The complications that can most significantly change patients' quality of life are urinary stoma.
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Neobladder—Vaginal fistula: The University of Southern California experience. Neurourol Urodyn 2017; 37:1380-1385. [DOI: 10.1002/nau.23454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/30/2017] [Indexed: 01/25/2023]
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Wilson A, Pillay S, Greenwell T. How and why to take a Martius labial interposition flap in female urology. Transl Androl Urol 2017; 6:S81-S87. [PMID: 28791226 PMCID: PMC5522801 DOI: 10.21037/tau.2017.04.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Martius modified labial fat pad flap at nearly 90 years old is still very much part of the modern vaginal surgeon’s armamentarium. Here we describe this straightforward and adaptable technique, the avoidance of pitfalls, its advantages and uses in vaginal surgery, and outcomes both short and long term. Specifically patient reported outcomes related to scar perception and sexual function are explored.
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Affiliation(s)
- Ailsa Wilson
- Continence Matters, Calvary North Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samantha Pillay
- Continence Matters, Calvary North Adelaide Hospital, Adelaide, South Australia, Australia
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Flack CK, Monn MF, Kaimakliotis HZ, Koch MO. Functional and Clinicopathologic Outcomes Using a Modified Vescica Ileale Padovana Technique. Bladder Cancer 2015; 1:73-79. [PMID: 30561444 PMCID: PMC6218179 DOI: 10.3233/blc-140002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic and functional outcomes of a modified Vescica ileale Padovana (VIP) neobladder technique. METHODS Data for 160 patients at a single institution who underwent radical cystectomy and orthotopic VIP neobladder creation between 1998 and 2013 were analyzed. Modified VIP technique involved longitudinal opening of the small bowel close to the anterior mesenteric border instead of along the true anti-mesentery. This allowed for creation of a dependent neourethral funnel and a large serosal surface for ureteral anastomosis, distant from any suture lines. RESULTS Mean age for the entire cohort was 59.5, with 9% female and 64% with muscle invasive disease prior to cystectomy. Within 30 days of surgery, 16 patients (10%) developed a Clavien grade 3-4 complication and there were no deaths. Ninety-six percent reported minor or no daytime urinary leakage at 12 months, and 70% reported minor or no nighttime urinary leakage. Two- and five-year overall survival rates were 84.2% and 72.6% , respectively. Seven patients developed a ureteral stricture (4%), three (2%) had bladder neck contractures, two (1%) experienced urethral recurrence, and there were no vesicovaginal fistulas. CONCLUSIONS This modified VIP neobladder technique achieves favorable functional, survival, and recurrence outcomes similar to other published orthotopic continent diversions. Its near spheroidal shape lowers internal pressure, allowing for improved continence at physiologic filling capacity, and its offset bowel opening helps prevent unnecessary stretch to the native urethra, even in large individuals. The widened uretero-enteric anastomosis site distant from bowel suture lines contributes to decreased stricture rates and its placement on the dome of the neobladder facilitates endoscopic access should strictures occur. Finally, lack of posterior overlapping suture lines also mitigates the risk of fistulae formation in females should anterior vaginal wall excision or entry be unavoidable.
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Affiliation(s)
- Chandra K. Flack
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
| | - M. Francesca Monn
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
| | | | - Michael O. Koch
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN, USA
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Goldmark E, Ginsberg D. Evaluation, Treatment and Management of Urinary Incontinence in Patients with Orthotopic Neobladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vaginal Reconstruction in the Neobladder Patient: Fistula and Prolapse. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0209-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yokota N, Ito F, Ishikawa T, Yamashita K, Nakazawa H. [Neobladder-rectal fistula as early postoperative complication of radical cystectomy and orthotopic neobaldder construction]. Nihon Hinyokika Gakkai Zasshi 2013; 104:616-619. [PMID: 23971372 DOI: 10.5980/jpnjurol.104.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of neobladder-rectal fistula that developed as an early postoperative complication of radical cystectomy and orthotopic neobladder construction procedures. A 75-year-old man underwent a radical cystectomy and orthotopic neobladder construction using Studer's method for locally invasive bladder cancer (cT2N0M0). The patient had severe watery diarrhea on postoperative day 20, and was diagnosed with a neobladder-rectal fistula based on cystography findings. We inserted a Foley catheter into the neobladder, and performed conservative treatment. Four months after development of the fistula, cystography revealed that it had spontaneously closed. A neobladder-rectal fistula is an extremely rare complication, with no other known reports. Herein, we present this case of neobladder-rectal fistula and discuss its formation, diagnosis and treatment, along with reference to previous reports of neobladder-vaginal fistulas.
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Affiliation(s)
- Narushi Yokota
- Department of Urology, Tokyo Women's Medical University Medical Center East
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Ali-El-Dein B, Ashamallah A. Vaginal repair of pouch-vaginal fistula after orthotopic bladder substitution in women. Urology 2012. [PMID: 23206581 DOI: 10.1016/j.urology.2012.08.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report the diagnosis, technique, and treatment outcome of pouch-vaginal fistula (PVF) with particular stress on the vaginal repair. METHODS Between January 1995 and March 2010, 298 women (mean age, 52 years) underwent orthotopic neobladder reconstruction after radical cystectomy. A standard radical cystectomy was conducted in 283 patients and genitalia-sparing cystectomy in 15. Certain modifications were adopted after 100 patients to prevent chronic urinary retention and PVF. Hautmann or hemi-Kock pouch was used. Patients were oncologically and functionally evaluated and asked about any sexual complaint. Eight PVF (2.7%) were diagnosed by voiding radiography of the pouch and preoperative endoscopy. Transabdominal repair was used in 2 patients(high, large, vaginal atrophy) and the other patients underwent a vaginal repair in nonopposing layers 3 to 6 months after cystectomy. RESULTS The incidence of PVF was 5 of 100 (5%) before and 3 of 198 (1.5%) after the technical modifications. In one patient, repair of the fistula was conducted in 2 stages. After repair (mean follow-up, 146 months), all repaired patients were continent during daytime and only one had nocturnal incontinence. The urodynamic parameters were comparable to these in other women undergoing orthotopic neobladder reconstruction and not having a fistula. CONCLUSION Transvaginal repair of PVF is feasible with good functional outcome. It is recommended in low, small fistula and if postmenopausal vaginal atrophy is absent. The repair does not compromise the external urethral sphincter. However, these conclusions need to be consolidated in future studies including a larger number of patients.
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Affiliation(s)
- Bedeir Ali-El-Dein
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Anderson CB, Cookson MS, Chang SS, Clark PE, Smith JA, Kaufman MR. Voiding Function in Women with Orthotopic Neobladder Urinary Diversion. J Urol 2012; 188:200-4. [DOI: 10.1016/j.juro.2012.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 10/28/2022]
Affiliation(s)
| | - Michael S. Cookson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter E. Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A. Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Vaginal repair of neobladder–vaginal fistula: a case report and review of the literature. Int Urogynecol J 2012; 24:175-8. [PMID: 22237787 DOI: 10.1007/s00192-011-1636-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
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Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP. Prevention and Management of Complications Following Radical Cystectomy for Bladder Cancer. Eur Urol 2010; 57:983-1001. [DOI: 10.1016/j.eururo.2010.02.024] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/17/2010] [Indexed: 01/11/2023]
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