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Ghodoussipour S, Ladi Seyedian SS, Jiang D, Lifton J, Ahmadi H, Wayne K, Miranda G, Cai J, Djaladat H, Schuckman A, Bhanvadia S, Daneshmand S. Predictors of need for catheterisation and urinary retention after radical cystectomy and orthotopic neobladder in male patients. BJU Int 2021; 128:304-310. [PMID: 33348465 DOI: 10.1111/bju.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the prevalence of catheterisation and urinary retention in male patients with bladder cancer after radical cystectomy (RC) and orthotopic neobladder (ONB) and to identify potential predictors. PATIENTS AND METHODS Using an Institutional Review Board approved, prospectively maintained bladder cancer database, we collected information using a diversion-related questionnaire from 299 consecutive male patients with bladder cancer upon postoperative clinic visit. Urinary retention was defined as ≥3 catheterisations/day or a self-reported inability to void without a catheter. Uni- and multivariable Cox regression analysis was performed to identify predictors of catheterisation and urinary retention. RESULTS Self-catheterisation was reported in 51 patients (17%), of whom, 22 (7.4% of the total patients) were in retention. Freedom from any catheterisation at 3, 5, and 10 years after RC was 85%, 77%, and 62%, respectively. Freedom from retention at 3, 5, and 10 years after RC was 93%, 88%, and 79%, respectively. Multivariable Cox regression showed that higher body mass index (BMI; ≥27 kg/m2 ) significantly increased the need for catheterisation (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.26-4.32) as well as retention (HR 5.20, 95% CI 1.74-15.51). Greater medical comorbidity (Charlson Comorbidity Index score ≥2) correlated with the need for any catheterisation (HR 1.84, 95% CI 1.02-3.3), but not retention. Pathological stage and type of diversion were not significant predictors of the need to catheterise or urinary retention. CONCLUSION In males undergoing RC with ONB, retention requiring catheterisation to void is uncommon. Patients with a BMI of ≥27 kg/m2 are at significantly increased risk of retention and need for self-catheterisation.
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Affiliation(s)
- Saum Ghodoussipour
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.,Section of Urologic Oncology Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Seyedeh Sanam Ladi Seyedian
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Daniel Jiang
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jacob Lifton
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hamed Ahmadi
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kevin Wayne
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anne Schuckman
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Sumeet Bhanvadia
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Ghodoussipour S, Daneshmand S. Voiding Dysfunction After Neobladder Urinary Diversion. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-019-00573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kwan ML, Leo MC, Danforth KN, Weinmann S, Lee VS, Munneke JR, Bulkley JE, Rosetti MO, Yi DK, Banegas MP, Wagner MD, Williams SG, Aaronson DS, Grant M, Krouse RS, Gilbert SM, McMullen CK. Factors That Influence Selectionof Urinary Diversion Among Bladder Cancer Patients in 3 Community-based Integrated Health Care Systems. Urology 2019; 125:222-229. [PMID: 30471370 PMCID: PMC6389399 DOI: 10.1016/j.urology.2018.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/06/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the relative contributions of patient and surgeon factors for predicting selection of ileal conduit (IC), neobladder (NB), or continent pouch (CP) urinary diversions (UD) for patients diagnosed with muscle-invasive/high-risk nonmuscle invasive bladder cancer. This information is needed to enhance research comparing cancer survivors' outcomes across different surgical treatment options. METHODS Bladder cancer patients' age ≥21 years with cystectomy/UD performed from January 2010 to June 2015 in 3 Kaiser Permanente regions were included. All patient and surgeon data were obtained from electronic health records. A mixed effects logistic regression model was used treating surgeon as a random effect and region as a fixed effect. RESULTS Of 991 eligible patients, 794 (80%) received IC. One hundred sixty-nine surgeons performed the surgeries and accounted for a sizeable proportion of the variability in patient receipt of UD (intraclass correlation coefficient = 0.26). The multilevel model with only patient factors showed good fit (area under the curve = 0.93, Hosmer-Lemeshow test P = .44), and older age, female sex, estimated glomerular filtration rate <45, 4+ comorbidity index score, and stage III/IV tumors were associated with higher odds of receiving an IC vs neobladder/continent pouch. However, including surgeon factors (annual cystectomy volume, specialty training, clinical tenure) had no association (P = .29). CONCLUSION In this community setting, patient factors were major predictors of UD received. Surgeons also played a substantial role, yet clinical training and experience were not major predictors. Surgeon factors such as beliefs about UD options and outcomes should be explored.
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Affiliation(s)
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Kim N Danforth
- Kaiser Permanente Department of Research & Evaluation, Pasadena, CA
| | | | | | | | | | | | - David K Yi
- Kaiser Permanente Department of Research & Evaluation, Pasadena, CA
| | | | - Matthew D Wagner
- Department of Urology, Kaiser Permanente Sunnyside Medical Center, Clackamas, OR
| | - Stephen G Williams
- Department of Urology, Kaiser Permanente Riverside Medical Center, Riverside, CA
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | | | - Robert S Krouse
- University of Pennsylvania School of Medicine, University & Woodland Aves., Philadelphia, PA
| | - Scott M Gilbert
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Abstract
Patient selection and preoperative counseling are critical aspects of determining which urinary diversion to perform and should be emphasized at each stage of preoperative planning. The surgeon must have a thorough understanding of the patient's disease process, functional and psycho-emotional status, and social support network so that they can set appropriate expectations. It is also crucial to have a multidisciplinary team of individuals who are experienced with all aspects of urinary diversion care, including ostomy nurses, nurse navigators, and urologic surgeons skilled at teaching and trouble-shooting self-catheterization for continent cutaneous diversion and orthotopic diversion in the setting of hypercontinence.
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Affiliation(s)
- Elysia Sophia Spencer
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew D Lyons
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Luchey AM, Agarwal G, Espiritu PN, Lockhart JL, Pow-Sang JM, Spiess PE, Sexton WJ, Poch MA. Patient and disease-specific factors and their influence on urinary reconstruction choice at a referral center. World J Urol 2015; 33:1763-8. [PMID: 25774005 DOI: 10.1007/s00345-015-1532-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate potential socioeconomic and demographic factors that may influence or be associated with various types of urinary reconstruction (UR) following a radical cystectomy (RC) accounting for existing clinical variables. METHODS There were 828 patients that underwent a RC and UR between 2000 and 2013. After excluding patients that did not meet medical or surgical criteria for a continent urinary reconstruction (CUR-orthotopic neobladder or continent catheterizable pouch), there were 714 patients available for analysis. Socioeconomic and demographic data along with disease-specific variables were recorded preoperatively and analyzed to determine a correlation with a particular type of UR. RESULTS Non-continent urinary reconstruction (ileal conduit or cutaneous ureterostomies) and CUR accounted for 78.3 % (559/714) and 21.7 % (155/714) of UR following RC, respectively. On univariate analysis, younger age, marital status, employment status, type of insurance, ASA score, and preoperative glomerular filtration rate were significantly associated with CUR (p < 0.01). Travel distance, race, and education level were not factors for UR type. Additionally, there was no significant difference between males and females receiving a CUR. On multivariate analysis, older age [odds ratio (OR) 0.85, p < 0.01], marital status (OR 0.28, p < 0.01), insurance status (OR 0.22, p = 0.04), and higher ASA score (OR 0.50, p < 0.01) remained independent predictors of those less likely to receive a CUR. CONCLUSION Predictable socioeconomic and demographic influences exist between the choice of UR after RC. Increasing age corresponds to a decreasing likelihood of receiving a CUR. No significant difference was seen between men and women in undergoing a CUR.
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Affiliation(s)
- Adam M Luchey
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
| | - Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Patrick N Espiritu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Jorge L Lockhart
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Julio M Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
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Patient Selection, Operative Technique, and Contemporary Outcomes of Continent Catheterizable Diversion: the Indiana Pouch. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zahran MH, El-Hefnawy AS, Zidan EM, El-Bilsha MA, Taha DE, Ali-El-Dein B. Health-related quality of life after radical cystectomy and neobladder reconstruction in women: impact of voiding and continence status. Int J Urol 2014; 21:887-92. [PMID: 24684718 DOI: 10.1111/iju.12452] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess health-related quality of life, and the impact of night-time incontinence and chronic urinary retention on health-related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder. METHODS The study included 74 women who underwent radical cystectomy and orthotopic neobladder, and completed 1 year of follow up. Health-related quality of life was evaluated using the questionnaires of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form. Health-related quality of life was compared with an age-matched control group. The impact of night-time incontinence and chronic urinary retention on health-related quality of life was assessed. RESULTS The study group included 18 completely continent patients with spontaneous voiding, 29 with night-time incontinence and 27 with chronic urinary retention. The study group was statistically significantly lower in all domains of health-related quality of life than the control group. In all domains of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and Functional Assessment of Cancer Therapy bladder cancer-specific form, completely continent women were comparable with those with chronic urinary retention. Women with night-time incontinence had a significantly worse health-related quality of life than completely continent women, shown by the mean global health score (P = 0.038), social functioning score (P = 0.012), pain European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire score (P = 0.04), and functional well-being Functional Assessment of Cancer Therapy bladder cancer-specific form (P = 0.049) score. CONCLUSIONS After radical cystectomy and orthotopic neobladder in women, health-related quality of life is lower than that of the normal population. Night-time incontinence has a negative impact on social life and most domains of health-related quality of life. Thus, night-time incontinence has a higher social impact than chronic urinary retention.
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Affiliation(s)
- Mohamed H Zahran
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Ahmadi H, Skinner EC, Simma-Chiang V, Miranda G, Cai J, Penson DF, Daneshmand S. Urinary Functional Outcome Following Radical Cystoprostatectomy and Ileal Neobladder Reconstruction in Male Patients. J Urol 2013; 189:1782-8. [DOI: 10.1016/j.juro.2012.11.078] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Hamed Ahmadi
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Eila C. Skinner
- Department of Urology, Stanford University, Stanford, California
| | - Vannita Simma-Chiang
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Gus Miranda
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Jie Cai
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siamak Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California
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A Totally Intracorporeal Approach Will Improve Patient Choice. Eur Urol 2013; 63:644-5. [DOI: 10.1016/j.eururo.2012.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/22/2022]
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Horst M, Madduri S, Milleret V, Sulser T, Gobet R, Eberli D. A bilayered hybrid microfibrous PLGA--acellular matrix scaffold for hollow organ tissue engineering. Biomaterials 2012. [PMID: 23177021 DOI: 10.1016/j.biomaterials.2012.10.075] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Various synthetic and natural biomaterials have been used for regeneration of tissues and hollow organs. However, clinical outcome of reconstructive procedures remained challenging due to the lack of appropriate scaffold materials, supporting the needs of various cell types and providing a barrier function required in hollow organs. To address these problems, we have developed a bilayered hybrid scaffold comprising unique traits of polymeric microfibers and naturally derived acellular matrices and tested its potential for hollow organ regeneration in a rat bladder model. Hybrid scaffolds were fabricated by electrospinning of PLGA microfibers directly onto the abluminal surface of a bladder acellular matrix. Stability of this bilayered construct was established using modified spinning technique. The resulting 3-dimensional framework provided good support for growth, attachment and proliferation of primary bladder smooth muscle cells. Histological analysis in vivo at 4 and 8 weeks post implantation, revealed regeneration of bladder tissue structures consisting of urothelium, smooth muscle and collagen rich layers infiltrated with host cells and micro vessels. Furthermore, hybrid scaffolds maintained normal bladder capacity, whereas BAM recipients showed a significant distension of the bladder. These results demonstrate that this adaptable hybrid scaffold supports bladder regeneration and holds potential for engineering of bladder and other hollow organs.
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Affiliation(s)
- Maya Horst
- Tissue Engineering and Stem Cells Therapy, Department of Urology, University Hospital, 8091 Zurich, Switzerland
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Urinary Incontinence and Retention in the Female Neobladder Why Does This Occur and Treatment Options? CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0158-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Daneshmand S, Bartsch G. Improving selection of appropriate urinary diversion following radical cystectomy for bladder cancer. Expert Rev Anticancer Ther 2011; 11:941-8. [PMID: 21707291 DOI: 10.1586/era.11.19] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Radical cystectomy represents the gold-standard of treatment for invasive bladder cancer. Following cystectomy, various options for urinary diversion may be offered to patients. This article represents an overview of the history of urinary diversion, explains the current selection criteria used at one of the most experienced bladder cancer centers worldwide, and provides an update on the current understanding of continence mechanisms. Furthermore, we review the current literature on quality of life for patients with different forms of urinary diversion. Excellent functional results can be achieved with continent forms of urinary diversion. It is important to consider the relative and absolute contraindications when choosing any form of urinary diversion. Proper patient selection and thorough standardized preoperative counseling is critical in achieving optimal results.
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Affiliation(s)
- Siamak Daneshmand
- Norris Comprehensive Cancer Center, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, CA 90089, USA.
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Gilbert SM, Montie JE. Determining when to recommend continent urinary diversion. Can Urol Assoc J 2011; 2:407-9. [PMID: 18781217 DOI: 10.5489/cuaj.840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Scott M Gilbert
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Mich
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Mauney JR, Cannon GM, Lovett ML, Gong EM, Di Vizio D, Gomez P, Kaplan DL, Adam RM, Estrada CR. Evaluation of gel spun silk-based biomaterials in a murine model of bladder augmentation. Biomaterials 2010; 32:808-18. [PMID: 20951426 DOI: 10.1016/j.biomaterials.2010.09.051] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
Abstract
Currently, gastrointestinal segments are considered the gold standard for bladder reconstructive procedures. However, significant complications including chronic urinary tract infection, metabolic abnormalities, urinary stone formation, bowel dysfunction, and secondary malignancies are associated with this approach. Biomaterials derived from silk fibroin may represent a superior alternative due their robust mechanical properties, biodegradable features, and processing plasticity. In the present study, we evaluated the efficacy of a gel spun silk-based matrix for bladder augmentation in a murine model. Over the course of 70 d implantation period, H&E and Masson's trichrome (MTS) analysis revealed that silk matrices were capable of supporting both urothelial and smooth muscle regeneration at the defect site. Prominent uroplakin and contractile protein expression (α-actin, calponin, and SM22α) was evident by immunohistochemical analysis demonstrating maturation of the reconstituted bladder wall compartments. Gel spun silk matrices also elicited a minimal acute inflammatory reaction following 70 d of bladder integration, in contrast to parallel assessments of small intestinal submucosa (SIS) and poly-glycolic acid (PGA) matrices which routinely promoted evidence of fibrosis and chronic inflammatory responses. Voided stain on paper analysis revealed that silk augmented animals displayed similar voiding patterns in comparison to non surgical controls by 42 d of implantation. In addition, cystometric evaluations of augmented bladders at 70 d post-op demonstrated that silk scaffolds supported significant increases in bladder capacity and voided volume while maintaining similar degrees of compliance relative to the control group. These results provide evidence for the utility of gel spun silk-based matrices for functional bladder tissue engineering applications.
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Affiliation(s)
- Joshua R Mauney
- Department of Urology, Urological Diseases Research Center, Children's Hospital Boston, Boston, MA 02115, USA
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Daneshmand S. Editorial Comment. Urology 2010; 76:1001. [DOI: 10.1016/j.urology.2009.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 10/19/2009] [Accepted: 10/23/2009] [Indexed: 11/25/2022]
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Ashley MS, Daneshmand S. Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy. BJU Int 2010; 106:654-7. [DOI: 10.1111/j.1464-410x.2009.09183.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Health related quality of life after radical cystectomy: Comparison of ileal conduit to continent orthotopic neobladder. Eur J Surg Oncol 2009; 35:858-64. [DOI: 10.1016/j.ejso.2008.08.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 08/12/2008] [Accepted: 08/19/2008] [Indexed: 11/18/2022] Open
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Jensen JB, Kiesbye B, Jensen KME. Terminal patients with urinary diversion: are there specific treatment or nursing care problems in the primary healthcare sector? J Wound Ostomy Continence Nurs 2009; 36:424-7. [PMID: 19609164 DOI: 10.1097/won.0b013e3181aaf1d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the treatment and nursing care problems related to the type of urinary diversion in terminal patients experienced by the primary healthcare sector. METHODS A questionnaire about treatment and nursing care problems related to urinary diversion was sent to general practitioners (GPs) and district nurse units (DNUs) that had been in contact with 1 of 71 patients who died following cystectomy in a 5-year period. The patients had 1 of 3 types of urinary diversion: ileal conduit (IC), Indiana pouch (IP), or Hautmann orthotopic neobladder (NB). RESULTS Both GPs and DNUs reported significant difference in problems associated with the 3 types of urinary diversion favoring the IC (P = .049 and .025, respectively). However, clinical decisions about urinary diversion types are often based on incontinent versus continent diversions. When divided into continent versus incontinent diversions, the analysis revealed no differences in the number of problems (P = .31 and .052, respectively). Comparing IC and NB alone made the difference even less significant (P = .82 and .23, respectively). CONCLUSIONS It seems that there are no major disadvantages with one type of urinary diversion when compared to the other as perceived by primary healthcare providers. Relevant and thorough information should be provided to GPs and DNUs in order to minimize problems with all forms of urinary diversion.
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Continent Diversion: QOL of Orthotopic Diversion vs. Ileal Conduit. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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May M, Braun KP, Richter W, Helke C, Vogler H, Hoschke B, Siegsmund M. [Radical cystectomy in the treatment of bladder cancer always in due time?]. Urologe A 2007; 46:913-9. [PMID: 17676301 DOI: 10.1007/s00120-007-1361-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to examine how the survival rates for patients with muscle-invasive bladder carcinoma are influenced by the tumor stage at initial presentation. PATIENTS AND METHODS This study examined the clinical course of 452 patients who underwent radical cystectomy for bladder carcinoma from 1992 to 2004. The patients were divided into three groups according to the histological results of the initial and final transurethral tumor resection (TURB). In group 1 (n=114) patients who presented with a superficial bladder carcinoma which had a high likelihood of progressing underwent radical cystectomy. Group 2 included (n=92) patients who displayed a superficial tumor stage when they first presented and developed progressive muscle-invasive bladder carcinoma under conservative treatment. Group 3 (n=246) comprised patients who were already at the muscle-invasive tumor stage in the course of primary TURB. The histopathological characteristics of all transurethral tumor resections and radical cystectomy were recorded. Progression-free survival rates and overall survival rates in the three groups were then compared. RESULTS The average patient age at cystectomy was 64.3 (35-80) years, and the average follow-up period was 49 months. Progression-free survival and overall survival of all 452 patients were 56.1 and 53.6%, respectively, after 5 years. The best outcome was a progression-free 5-year survival rate of 78.4% with organ-confined, lymph node-negative tumors (n=213). This result was statistically significant (p<0.01) compared with the progression-free 5-year survival rate of 42.3% for non-organ-confined, lymph node-negative tumors (n=112). Lymph node-positive patients (n=127) achieved a progression-free 5-year survival rate of 29.0% regardless of the tumor infiltration. Group 1 patients achieved a progression-free survival rate of 71.3% and an overall survival rate of 69.1% after 5 years. Group 2 patients achieved a progression-free survival rate of 52.9% and an overall survival rate of 51.4% after 5 years. Group 3 patients achieved a progression-free survival and overall survival of 50.2% and 47.1%, respectively, after 5 years. There was no significant difference between groups 2 and 3 with regard to their progression-free or overall survival rates (p>0.45). However, both groups displayed significantly poorer progression-free and overall survival rates compared with group 1 (p<0.01). CONCLUSION Our results show that patients with superficial bladder carcinoma with tumor progression to muscle invasion do not have a better prognosis after radical cystectomy than patients presenting initially with muscle-invasive bladder carcinoma. Survival rates in this group can only be improved by singling out patients on the basis of risk factors at an earlier stage and carrying out cystectomy. Due to these results we must expect that waiting for a muscle invasion in patients with superficial bladder carcinoma with a high risk profile results in a significant impairment of prognosis.
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Affiliation(s)
- M May
- Urologische Klinik, Carl-Thiem-Klinikum Cottbus, Lehrkrankenhaus der Universitätsklinik Charité zu Berlin, 03048, Cottbus.
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Wright JL, Porter MP. Quality-of-life assessment in patients with bladder cancer. ACTA ACUST UNITED AC 2007; 4:147-54. [PMID: 17347659 DOI: 10.1038/ncpuro0750] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 01/24/2007] [Indexed: 11/12/2022]
Abstract
Health-related quality of life (HRQOL) in patients with bladder cancer is important, because radical cystectomy and urinary diversion significantly affect urinary and sexual function, and lead to associated sex-specific morbidity. This article reviews the current methods for defining HRQOL, describes the specific challenges in measuring HRQOL in patients with bladder cancer, and critically analyzes the existing literature on bladder cancer HRQOL. Previous studies have been limited by study design, generalizability, and by the different instruments used, namely nonvalidated questionnaires that are not specific for bladder cancer. To date, only two prospective studies with baseline HRQOL data have been published and few conclusions can be drawn from these cross-sectional, retrospective studies. On the basis of the published literature, there is no convincing evidence that superior HRQOL is achieved with a particular type of urinary diversion after cystectomy for bladder cancer. Patients should be counseled on all reconstructive alternatives and a diversion chosen on the basis of patient preference, patient anatomy and tumor status, rather than on a potential difference in HRQOL. Prospective studies with appropriate adjustment for confounding factors, which use validated and disease-specific questionnaires, are needed for HRQOL research on bladder cancer.
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Affiliation(s)
- Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA 98108, USA
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Reyes MA, Nieder AM, Kava BR, Soloway MS, Manoharan M. Does Body Mass Index Affect Outcome After Reconstruction of Orthotopic Neobladder? Urology 2007; 69:475-8. [PMID: 17382148 DOI: 10.1016/j.urology.2006.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 09/06/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the impact of body mass index (BMI) on outcome after orthotopic neobladder (NB) reconstruction. METHODS We performed a retrospective analysis of patients who underwent radical cystectomy and NB from 1992 to 2004. The patients were categorized according to BMI into group 1, BMI less than 25 kg/m2; group 2, BMI 25 to 29.9 kg/m2; and group 3, BMI greater than 30 kg/m2. The relationships among the BMI categories, the predominant complications (eg, urinary tract infection [UTI]; pyelonephritis; ureteral, bladder neck, and urethral stricture), other complications, and continence were analyzed. RESULTS Of the 343 patients who underwent radical cystectomy, 116 had an NB. The patient characteristics among the BMI groups were similar. Group 1 had fewer complications compared with the other groups (P <0.012). The principal complications observed were UTI, stricture, and pyelonephritis. The incidence of UTI, pyelonephritis, and wound infection were less in group 1 than in the other groups, with statistically significant differences (P = 0.001, P = 0.04, and P = 0.04, respectively). At the last follow-up visit, only 10% of the patients required clean intermittent catheterization to empty the NB, and no statistically significant differences were found in the continence status and voiding pattern among the groups. CONCLUSIONS An increased incidence of UTI, pyelonephritis, and wound infection was found in patients with increased BMI. However, they were transient and not life threatening. The continence and voiding patterns were relatively similar. Hence, an NB can be offered to patients with an increased BMI, and they should be formally counseled.
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Affiliation(s)
- Martha A Reyes
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA
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Jensen JB, Lundbeck F, Jensen KME. Complications and neobladder function of the Hautmann orthotopic ileal neobladder. BJU Int 2006; 98:1289-94. [PMID: 17034505 DOI: 10.1111/j.1464-410x.2006.06449.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the complications and function of the Hautmann orthotopic ileal neobladder . PATIENTS AND METHODS In a 6.5-year period, 67 patients had an ileal neobladder constructed after radical cystectomy as treatment for invasive carcinoma of the bladder. All complications were reported systematically. Neobladder function was assessed by patient interviews, uroflowmetry and cystometric analyses. RESULTS There were early complications in 41 patients (61%), and late complications in 32 (48%); 23 (34%) had both early and late complications and 17 (25%) had none. Eighteen of the patients (27%) required a re-operation for complications. At the 4-month follow-up, 90% were continent during the day and 65% during the night; at 1 year after surgery 95% were continent during the day and 73% during the night. The functional bladder capacity and maximum cystometric capacity were close to the natural bladder volume (median 450 and 480 mL, respectively). CONCLUSIONS Despite the high rate of complications in this study, most were considered as minor and could be treated by conservative or minimally invasive methods. The neobladder had an acceptable resemblance to the native bladder in capacity and function. Consequently the ileal neobladder might be preferred as a urinary diversion after radical cystectomy, if no contraindications are present.
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Hautmann RE, Volkmer BG, Schumacher MC, Gschwend JE, Studer UE. Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 2006; 24:305-14. [PMID: 16830152 DOI: 10.1007/s00345-006-0105-z] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 04/24/2006] [Indexed: 11/30/2022] Open
Abstract
Over the past 20 years orthotopic urinary reconstruction with the techniques developed at Ulm and Bern has become a widely accepted form of urinary diversion. So far, both centers together have performed more than 1,300 orthotopic bladder substitutions with an overall rate of neobladder formation in 58% of all cystectomized patients. Today, the absolute contraindications for this procedure are urinary stress incontinence, damaged rhabdosphincter, severely impaired renal and liver function, severe intestinal diseases or an oncologic situation requiring urethrectomy. In patients treated for transitional cell carcinoma of the bladder, the rate of urethral recurrence in both centers was 1.5 and 5%, respectively, and the rate of upper urinary tract recurrence was 2-3%. Local tumor recurrence usually did not affect neobladder function. The rate of outlet obstruction by local recurrence was 2%, that of gross hematuria 1%, and of entero-reservoir fistulas 1-2%. Daytime continence at 12 months was 92%, while nighttime continence was lower around 80%. Transient or permanent urinary retention was seen in 11-12% of male patients. In both series, long-term upper urinary tract safety was good. The risk of stenoses of the uretero-intestinal anastomosis with consecutive loss of renal function decreased with the introduction of non-refluxing implantation techniques. The rate of long-term metabolic complications remains low when adequate substitution with sodium bicarbonate is guaranteed in patients with impaired renal function. Patient selection and meticulous postoperative follow-up contributed to achieve good long-term results after cystectomy and orthotopic ileal neobladder substitution of the two large series of patients from the Universities of Ulm and Bern.
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Affiliation(s)
- Richard E Hautmann
- Department of Urology, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
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Hautmann RE, Schumacher M, Gschwend JE, Studer UE, Volkmer BG. Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 2006. [DOI: 10.1007/s00345-006-0077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Falagas ME, Vergidis PI. Urinary Tract Infections in Patients With Urinary Diversion. Am J Kidney Dis 2005; 46:1030-7. [PMID: 16310568 DOI: 10.1053/j.ajkd.2005.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Accepted: 09/07/2005] [Indexed: 11/11/2022]
Abstract
Several surgical techniques have been used to provide urinary diversion after radical cystectomy. The noncontinent type of urinary diversion (using an intestinal conduit) and the continent urinary diversion (ureterosigmoidostomy or construction of an intestinal pouch that serves as a deposit of urine) were used commonly in the past, leading to a cumulative considerable number of patients encountered in clinical practice. The orthotopic urinary diversion (neobladder) has been used widely during the last years. The incidence and characteristics of urinary tract infection in patients with different types of urinary diversion are reviewed. Clinicians should be aware that urinary tract infection is a frequent cause of fever in patients with urinary diversion because it occurs in a significant proportion. In addition, symptoms from the lower urinary tract may not be prominent in this population.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences, Department of Medicine, Henry Dunant Hospital, Athens, Greece.
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Porter MP, Wei JT, Penson DF. Quality of Life Issues in Bladder Cancer Patients Following Cystectomy and Urinary Diversion. Urol Clin North Am 2005; 32:207-16. [PMID: 15862618 DOI: 10.1016/j.ucl.2005.01.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
HRQOL outcomes in bladder cancer patients undergoing cystectomy and urinary diversion are an important component in the critical assessment of bladder cancer treatment. To date, understanding of HRQOL in these patients remains poor. Although it is known that there are common factors that most likely affect HRQOL for all patients, it is unclear whether factors unique to a specific type of diversion impact HRQOL in a way that makes one type of diversion superior to another. Factors such as stoma maintenance, catheter use, urinary incontinence, body image, and sexual side effects are potentially different for each major type of diversion and most likely impact HRQOL, but a consistent advantage of one type of diversion over another has yet to be demonstrated. With slight changes in the approach to studying HRQOL outcomes, this question could be answered. Prospective study designs, appropriate adjustment for confounding factors, diverse patient populations, and the use of validated and disease-specific instruments would greatly enhance understanding of HRQOL in patients undergoing cystectomy for bladder cancer. By understanding these issues more completely, patients could be counseled not only about their predicted surgical risks and survival but also about the impact their disease will have on their longer-term quality of survival. Patients will then be able to make a more fully informed decision on the most appropriate form of therapy for this serious life-altering disease.
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Affiliation(s)
- Michael P Porter
- Department of Urology, University of Washington, H220 Health Sciences Center, Box 357183, Seattle, WA 98195-7183, USA
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Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol 2005; 173:1318-22. [PMID: 15758789 DOI: 10.1097/01.ju.0000149080.82697.65] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Continent forms of urinary diversion have become a gold standard of urinary tract reconstruction after radical cystectomy, based mostly on the premise of improved quality of life. It is unclear whether the existing body of literature supports this assumption. MATERIALS AND METHODS We performed a systematic review to determine if differences exist in health related quality of life (HRQOL) outcomes among different types of urinary diversion after radical cystectomy. A MEDLINE search was performed inclusive of the dates 1966 to January 2004. Inclusion criteria included adult patients, patients with bladder cancer, comparative studies, original research, primary study outcome related to quality of life, and use of a quality of life instrument to measure outcomes. Only studies comparing neobladder, continent reservoir, or conduit diversion were included. RESULTS Of 378 initial articles 15 studies met all inclusion criteria. None of the studies were randomized trials. Only 1 study was prospective. Of 15 studies 10 (67%) used some type of previously validated HRQOL instrument, 10 (67%) used some form of ad hoc instrument, 11 (73%) used bladder cancer disease specific instruments, while 9 (60%) used general instruments. Only 1 of the bladder cancer specific instruments had been previously validated. Common limitations included unvalidated HRQOL instruments, use of general HRQOL instruments only, lack of baseline data, cross- sectional analysis, and retrospective study design. CONCLUSIONS To date, the current body of published literature is insufficient to conclude that 1 form of urinary diversion is superior to another based on HRQOL outcomes. Future studies should attempt to incorporate prospective data collection, longer term followup and validated disease specific HRQOL instruments.
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Affiliation(s)
- Michael P Porter
- Department of Urology, University of Washington, Seattle 98195-7183, USA.
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