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Abdalla A, Cohn JA, Simhan J. Unraveling the Complexities of Uretero-Enteric Strictures: A Modern Review. Curr Urol Rep 2024; 25:287-297. [PMID: 39138815 DOI: 10.1007/s11934-024-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. RECENT FINDINGS In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.
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Affiliation(s)
- A Abdalla
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - Joshua A Cohn
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Simhan
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
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Fu S, Shi H, Fan Z, Li J, Luan T, Dong H, Wang J, Chen S, Zhang J, Wang J, Ding M, Wang H. Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety. Int J Surg 2024; 110:01279778-990000000-00948. [PMID: 38260944 PMCID: PMC11020008 DOI: 10.1097/js9.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. METHODS The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. RESULTS Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: -555.52; 95% CI, -681.64 to -429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: -2.05; 95% CI, -2.93 to -1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades CONCLUSION Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.
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Affiliation(s)
- Shi Fu
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - HongJin Shi
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhinan Fan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, Meishan People's Hospital, Meishan, China
| | - Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haonan Dong
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jincheng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuwen Chen
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinsong Zhang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingxia Ding
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Nabavizadeh R, Rodrigues Pessoa R, Dumbrava MG, Packiam VT, Thapa P, Tarrell R, Tollefson MK, Jeffrey Karnes R, Frank I, Khanna A, Shah P, Sharma V, Boorjian SA. Cutaneous Ureterostomy Following Radical Cystectomy for Bladder Cancer: A Contemporary Series. Urology 2023; 181:162-166. [PMID: 37689248 DOI: 10.1016/j.urology.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To report peri-operative outcomes of a contemporary series of bladder cancer patients undergoing radical cystectomy (RC) with cutaneous ureterostomy (CU) urinary diversion at a tertiary referral center. METHODS We retrospectively identified patients who underwent RC with CU at Mayo Clinic between 2016 and 2021. Clinicopathologic and perioperative characteristics were analyzed using standard descriptive statistics. RESULTS A total of 31 patients underwent RC with CU at our institution. Median age was 72years and 21 were male. This was highly comorbid cohort (83% had an American Society of Anesthesiologists [ASA] Physical Status Classification System ≥3; median Charlson Comorbidity index= 8). Median time to flatus, tolerating regular diet, and length of stay were 3 (interquartile range [IQR] 3-3), 3 (IQR 3-4), and 4days (IQR 4-7), respectively. A total of 14 patients experienced a high-grade complication (Clavien-Dindo ≥3) within 30days of surgery, and 8 were readmitted. The most common 30-day complication was sepsis, which affected 13% (4/31) of patients. At 90days postsurgery, the readmission rate was 32% (10/31), most commonly for sepsis. Three patients required reoperation within 90days, including one patient who required CU revision due to stomal ischemia. One patient died within this time frame from causes unrelated to bladder cancer. CONCLUSION In a comorbid, relatively elderly bladder cancer cohort undergoing RC, the use of CU was associated with expeditious surgery and postoperative recovery. CU represents an option for urinary diversion in high-risk patients undergoing RC. Higher rate of postoperative ureteral obstruction can be pre-emptively addressed with chronic stent placement.
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Affiliation(s)
| | | | - Mihai G Dumbrava
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Alix School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
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Chen Z, Deng K, Sun L, Qu L, Chao X, Rao J, Hong C, Zhuo Y, Lin Z, Lai C. 3D laparoscopic treatment of bladder cancer with pelvic multi-organ invasion: a case report and literature review. Front Oncol 2023; 13:1249389. [PMID: 37920155 PMCID: PMC10619152 DOI: 10.3389/fonc.2023.1249389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Radical cystectomy with dissection of pelvic lymph nodes and urethral diversion is the standard surgical treatment for muscle-invasive non-metastatic bladder cancer. In rare cases where patients with bladder cancer without distant metastasis have pelvic multi-organ invasion, the cancer compresses or invades the ureter and, in severe cases, leads to bilateral upper urinary tract obstruction and renal damage. The treatment recommended by guidelines often cannot improve the patients' clinical symptoms immediately, and patients cannot complete the treatment owing to severe side effects, resulting in poor survival benefits. Case presentation A 69-year-old woman with facial edema was treated at the First Affiliated Hospital of Jinan University. The serum creatinine and potassium values were 1244 umol/L and 5.86 mmol/L, respectively. Pelvic magnetic resonance and abdominal computed tomography revealed that the bladder tumor had infiltrated the uterus, anterior vaginal wall, rectum, right ureter, right fallopian tube, and right ovary and metastasized to multiple pelvic lymph nodes. Tumor invasion of the right ureter resulted in severe hydronephrosis of the right kidney and loss of function and obstructive symptoms in the left kidney. Four days later, the patient's creatinine level decreased to 98 u mol/L, the general condition significantly improved, and the patient and family members strongly desired surgical treatment of the tumor. Through a comprehensive preoperative discussion, possible intraoperative and postoperative complications were evaluated. Right nephrectomy, right ureterectomy, total pelvic organ resection, extended pelvic lymph node dissection, and bowel and urinary diversion were conducted under 3D laparoscopy-assisted treatment. The patient was followed-up for 1.5 years and showed good tumor control, self-care, and mental status. Conclusion Minimally invasive surgery is a curative option for patients with bladder cancer with pelvic multi-organ invasion without distant metastasis. Surgeons should strictly control the indications for surgery and warn patients about the occurrence of related post-surgical complications.
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Affiliation(s)
- Zheng Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Kaifeng Deng
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Luping Sun
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Lijun Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Xinhui Chao
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Jingmin Rao
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Caimmei Hong
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Zhichao Lin
- Medical Image Center, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Caiyong Lai
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
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Erdik A, Cimen HI, Kose O, Ates OF, Taydas O, Gul D, Saglam HS. Can pelvic diameter measurement have an effect on surgical outcomes in radical cystectomy? BMC Urol 2023; 23:105. [PMID: 37286956 DOI: 10.1186/s12894-023-01277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of pelvis diameters in determining postoperative outcomes in men who underwent open radical cystectomy + urinary diversion, it is aimed to predict the factors that may affect the operative difficulty and possible surgical outcomes before the operation. METHODS A total of 79 radical cystectomy patients operated in our institution with preoperative computed tomography (CT) were included the study. Pelvic dimensions; symphysis angle (SA), upper conjugate, lower conjugate, pelvic depth, apical depth (AD), interspinous distance (ISD), bone femoral width and soft tissue width were measured by preoperative CT. ISD index were defined as ISD/AD. Postoperative outcomes and indicators of operative difficulty were recorded. Regression analyses were used to predict perioperative and postoperative outcomes. RESULTS Total of 96 complications were observed in 52 of the 79 patients in ninety days (65,8%) with a mean age of 68.25 years. There were significant correlations between SA and body mass index (BMI) with operative time (p = 0.006, p < 0.001; respectively). For estimated blood loss, there were significant correlations between preoperative hematocrit (p = 0,031). Analysis of multivariate logistic regression revealed that higher Charlson comorbidity index (CCI) and BMI were found to be significant predictors for major complications while CCI, pathological T stage and ISD index are prominent predictors for surgical margin positivity. CONCLUSIONS Pelvic dimensions are not significant with minor or major complications. However, operative time may be associated with SA. Also, narrow and deep pelvis may increase the risk of positive surgical margins.
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Affiliation(s)
- Anil Erdik
- Department of Urology, Sadıka Sabancı Hospital, 54050, Sakarya, Turkey.
| | - Haci Ibrahim Cimen
- Department of Urology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
| | - Osman Kose
- Department of Urology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
| | - Omer Faruk Ates
- Department of Radiology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
| | - Onur Taydas
- Department of Radiology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
| | - Deniz Gul
- Department of Urology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
| | - Hasan Salih Saglam
- Department of Urology, Sakarya University, School of Medicine, 54100, Sakarya, Turkey
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we think we do? A systematic review. Actas Urol Esp 2023; 47:195-210. [PMID: 36427800 DOI: 10.1016/j.acuroe.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023]
Abstract
Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk.
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Affiliation(s)
- A Domínguez García
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - J Muñoz Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Prats López
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Almirall Daly
- Servicio de Nefrología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Centeno Álvarez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - L de Verdonces Roman
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Pla Terradellas
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - X Serra Aracil
- Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
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Boehm D, Rosenfeld J, Ji E, Lee Z. A Review of Bowel-based Urinary Diversions for the Colorectal Surgeon. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Acidosis metabólica tras cistectomía radical con derivación urinaria ileal. ¿Sabemos tanto como creemos? Revisión sistemática. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Asimakopoulos AD, Gubbiotti M, Agrò EF, Morini E, Giommoni V, Piechaud T, Gaston R, Annino F. "Bordeaux Neobladder": First Evaluation of the Urodynamic Outcomes. EUR UROL SUPPL 2023; 47:102-109. [PMID: 36578286 PMCID: PMC9791315 DOI: 10.1016/j.euros.2022.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background The intracorporeal orthotopic modified-Y "Bordeaux" neobladder (iYNB) was first described in 2016. No urodynamic evaluation of this neobladder has yet been performed. Objective To present the urodynamic features of the iYNB and incontinence-specific health-related quality of life (HRQoL) outcomes. Design setting and participants We prospectively assessed 26 patients operated between September 2018 and November 2020. Surgical procedure Robotic radical cystectomy for malignant disease of the bladder and iYNB, performed by a single surgeon, were used. Measurements Three months after surgery and in November 2021, consenting patients underwent clinical evaluation and multichannel urodynamic study (UDS). The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day- and nighttime, and clinically defined as the use of zero pads. A descriptive statistical analysis was performed. Results and limitations The mean age at surgery was 65.4 yr. The mean follow-up period was 27 mo (12-38). The mean time for the neobladder reconstruction was 192 min (110-340). The mean maximum capacity was 431 cm3 (range 200-553). The mean postvoid residual was 101.6 ml (0-310), and the rate of clean intermittent catheterization was 17.6%. With the exception of a significant reduction in the volume of the first sensation of bladder fullness, no other statistically significant changes in the UDS parameters of both the storage and the voiding phase were observed over time. Day- and nighttime continence rates were 58.8% and 23.5%, respectively. The mean postoperative I-QoL score was 103.3 (89-110). Limitations include the small number of patients and short follow-up. Conclusions The UDS evaluation of iYNB demonstrates that both the volumetric and the pressure characteristics are acceptable and may enhance quality of life. Prospective studies with larger numbers of patients and longer follow-up are needed to further evaluate the iYNB. Patient summary The "Bordeaux" neobladder provides acceptable urodynamic outcomes. It is associated with high levels of health-related quality of life and good rates of continence in patients.
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Affiliation(s)
- Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, Arezzo, Italy
| | - Marilena Gubbiotti
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, Arezzo, Italy
| | - Enrico Finazzi Agrò
- Urology Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Elena Morini
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, Arezzo, Italy
| | - Valentina Giommoni
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, Arezzo, Italy
| | | | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Filippo Annino
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, Arezzo, Italy
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Huang C, Assel M, Beech BB, Benfante NE, Sjoberg DD, Touijer A, Coleman JA, Dalbagni G, Herr HW, Donat SM, Laudone VP, Vickers AJ, Bochner BH, Goh AC. Uretero-enteric stricture outcomes: secondary analysis of a randomised controlled trial comparing open versus robot-assisted radical cystectomy. BJU Int 2022; 130:809-814. [PMID: 35694836 PMCID: PMC10454986 DOI: 10.1111/bju.15825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse the risk of uretero-enteric anastomotic stricture in patients randomised to open (ORC) or robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion. PATIENTS AND METHODS We included 118 patients randomised to RARC (n = 60) or ORC (n = 58) at a single, high-volume institution from March 2010 to April 2013. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher's exact test. RESULTS In all, 58 and 60 patients were randomised to RARC and ORC, respectively. We identified five strictures, all in the ORC group. In patients with ≥1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% confidence interval 1.5%, 17%). Of the five strictures, three were managed endoscopically while two required open revision. There was no evidence that perioperative Grade 3-5 complications were associated with development of a stricture (P = 1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (P = 0.15). CONCLUSIONS In this study at a high-volume centre, RARC with extracorporeal urinary diversion achieved excellent ureteric anastomotic outcomes. Purported increased risk of stricture is not a reason to avoid RARC. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed.
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Affiliation(s)
- Chun Huang
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Division of Urology, Department of Surgery, University of Saskatchewan, Moose Jaw, SK, Canada
| | - Melissa Assel
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin B Beech
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adam Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guido Dalbagni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sherri Machele Donat
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vincent P Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Zheng B, Liu Z, Wang H, Wang J, Zhang P, Zhang D. Comparative study on the clinical effect of preparing neobladder with different lengths of ileum. Front Oncol 2022; 12:972676. [PMID: 36324595 PMCID: PMC9618620 DOI: 10.3389/fonc.2022.972676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/28/2022] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To investigate the relationship between orthotopic U-shaped ileal neobladder volume and bladder function. To investigate the correlation between the volume of the radical cystectomy and the U-shaped ileal neobladder in situ and the function of the bladder. METHODS The clinical data of patients undergoing in orthotopic U-shaped neobladder in our hospital were retrospectively analyzed. They were divided into two groups according to the length of the retained ileum. Group 1: The length of the ileum was 25-35cm (including 35cm), and the second group: the length of the ileum was 35-45cm. The basic information, cushion usage, urodynamic examination and complications of the two groups were obtained. RESULTS A total of 88 patients were included in the study, including 33 in the first group and 55 in the second group. There was no statistical difference in general data, lymph node collection, lymph node positive rate, positive margin rate, postoperative pathological stage, pathological grade, pathological type, intraoperative blood loss, blood transfusion, postoperative hospital stay, and complications between the two groups of patients. significance. Although the usage of urine pads in group 1 was more than that in group 2 in the short term after operation (P<0.05), it started from the third year after operation. Patients in group 1 used less cushion than group 2 (P<0.05). Urodynamic examination was performed on the patients, and the bladder function of group 1 maintained satisfactory time longer than that of group 2. The total number of deaths in the two groups was 12 and 23, respectively. The 5-year overall survival (OS) rate of group 1 was 53.60%, and the 5-year overall survival rate of group 2 was 52.9%. CONCLUSIONS A new bladder formed by cutting the ileum with a length of 25-35 cm (including 35cm) has a longer time to maintain good bladder function than cutting the ileum with a length of 35-45 cm to produce a new bladder.
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Affiliation(s)
| | | | | | | | - Pu Zhang
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Dahong Zhang
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
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12
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Grobet-Jeandin E, Benamran D, Pinar U, Beirnaert J, Parra J, Vaessen C, Seisen T, Rouprêt M, Phé V. Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study. World J Urol 2022; 40:2535-2541. [PMID: 35994092 DOI: 10.1007/s00345-022-04126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. METHODS In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6 months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. RESULTS Fourteen male patients were included (median age: 64 years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495 ml [IQR 410-606] and median compliance was 35.5 ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30 ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. CONCLUSION RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland.,Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland.,Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Ugo Pinar
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeanne Beirnaert
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.,Service d'Urologie, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Jérôme Parra
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Christophe Vaessen
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Seisen
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Oncology, Assistance Publique-Hôpitaux de Paris, AP-HP Sorbonne Université, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France.
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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Comparative performance of the different orthotopic urinary diversions. Curr Opin Urol 2022; 32:554-560. [DOI: 10.1097/mou.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Volz Y, Eismann L, Pfitzinger P, Westhofen T, Ebner B, Jokisch JF, Buchner A, Schulz G, Schlenker B, Karl A, Stief CG, Kretschmer A. Long-term health-related quality of life (HRQOL) after radical cystectomy and urinary diversion - A propensity score-matched analysis. Clin Genitourin Cancer 2022; 20:e283-e290. [DOI: 10.1016/j.clgc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/12/2022]
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16
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Minimally Invasive Robotic-Assisted Cystolithotomy in a Complicated Urinary Diversion: A Feasible and Safe Approach. Case Rep Urol 2021; 2021:8345092. [PMID: 34950523 PMCID: PMC8692026 DOI: 10.1155/2021/8345092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.
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17
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Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture. Langenbecks Arch Surg 2021; 407:1233-1240. [PMID: 34940890 PMCID: PMC9151556 DOI: 10.1007/s00423-021-02413-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
Abstract
Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.
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Nouhaud FX, Coughlin G. Advantages of an Intracorporeal W-shaped Neobladder. EUR UROL SUPPL 2021; 35:14-15. [PMID: 34870244 PMCID: PMC8627955 DOI: 10.1016/j.euros.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Geoff Coughlin
- Wesley Urology Clinic, The Wesley Hospital, Auchenflower, Australia
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Chen Z, He P, Zhou X, Li P, Li Q, Zheng J, Li X, Zhou Z. Preliminary Functional Outcome Following Robotic Intracorporeal Orthotopic Ileal Neobladder Suspension with Round Ligaments in Women with Bladder Cancer. Eur Urol 2021; 82:295-302. [PMID: 34862097 DOI: 10.1016/j.eururo.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic urinary retention (CUR) is a frequent complication after orthotopic neobladder (ONB) reconstruction in women. To decrease CUR, several open surgical modifications to provide back support to the ONB have been established on the basis of pelvic anatomical differences between females and males. OBJECTIVE To illustrate our technique for robotic intracorporeal reconfiguration of ONB as integrated into our open surgical approach to provide back support to the ONB with round ligaments in women. DESIGN, SETTING, AND PARTICIPANTS From November 2017 to April 2021, 28 patients underwent robotic intracorporeal ONB with a minimum of 6 mo of follow-up at a single centre. SURGICAL PROCEDURE We performed robotic radical cystectomy, pelvic lymphadenectomy, and a complete intracorporeal ONB suspended with round ligaments (rONB). Our surgical procedure is demonstrated in the accompanying video. MEASUREMENTS Demographics and clinical and pathological data were collected. Perioperative and 90-d complications and 6-mo functional outcomes were compared for the rONB group (n = 12) and the patients receiving a traditional ONB (tONB; n = 16). RESULTS AND LIMITATIONS The median total operative time was 305 min (interquartile range [IQR] 270-370) for tONB and 303 min (IQR 287-330) for rONB. The median estimated blood loss was 325 ml (IQR 200-700) for tONB and 350 ml (IQR 262-600) for rONB. Some 50% of the tONB group and 41.7% of the rONB group experienced low-grade complications. A total of 12.5% tONB and 8.3% rONB patients experienced high-grade complications with neobladder-vaginal fistula. The cumulative risk of CUR was 37.5% in the tONB group and 16.7% in the rONB group. This study is limited by the small sample size and the short follow-up period. CONCLUSIONS We established a feasible surgical technique for a robotic intracorporeal ONB configuration suspended with round ligaments. This may prevent the occurrence of emptying dysfunction in women. PATIENT SUMMARY We describe our stepwise technique for creating a new bladder within the body that is suspended with round ligaments. Patients undergoing removal of the bladder for bladder cancer may benefit from this technique in terms of better urinary function and the advantages of a robotic surgical approach.
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Affiliation(s)
- Zhiwen Chen
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Peng He
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaozhou Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Peng Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qianwei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ji Zheng
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xuemei Li
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhansong Zhou
- Department of Urology, Urology Institute of PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
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Lee CU, Lee JH, Lee DH, Song W. Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder. J Clin Med 2021; 10:jcm10225372. [PMID: 34830652 PMCID: PMC8624446 DOI: 10.3390/jcm10225372] [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: 09/18/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was to study the effect of stentless UIA on uretero-intestinal anastomosis stricture (UIAS), and the secondary objective was to evaluate the association between stentless UIA and other complications, including paralytic ileus, febrile urinary tract infection (UTI), and urine leakage. Kaplan–Meier survival analysis was used to estimate UIAS-free survival, and Cox proportional hazard models were applied to identify factors associated with the risk of UIAS. Results: Among 403 patients with 790 renal units, UIAS was identified in 39 (9.7%) patients and 53 (6.7%) renal units. Forty-four (83.0%) patients with UIAS were diagnosed within 6 months. The 1- and 2-year overall UIAS-free rates were 93.9% and 92.7%, respectively. Paralytic ileus was identified in 105 (26.1%) patients and resolved with supportive treatment. Febrile UTI occurred in 57 patients (14.1%). However, there was no leak of the UIA. Conclusions: Stentless UIA during RC with an ileal orthotopic neobladder is a feasible and safe surgical option. Further prospective randomized trials are required to determine the clinical usefulness of stentless UIA during RC.
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Affiliation(s)
- Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (C.U.L.); (J.H.L.)
| | - Jong Hoon Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (C.U.L.); (J.H.L.)
| | - Dong Hyeon Lee
- Department of Urology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul 07985, Korea;
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (C.U.L.); (J.H.L.)
- Correspondence: ; Tel.: +82-2-3410-3559
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Thakare N, Lamb BW, Biers S. Orthotopic bladder substitution: Surgical aspects and optimization of outcomes. BJUI COMPASS 2021; 2:359-369. [PMID: 35474698 PMCID: PMC8988640 DOI: 10.1002/bco2.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Orthotopic bladder substitution (OBS) is a management option for urinary diversion in men and women undergoing cystectomy. The aim of the procedure is to provide a functional continent urinary reservoir of adequate capacity, compliance and low pressure. We have provided a narrative review of the existing literature and highlighted areas where improvement and standardization can be recommended. Methods Literature search included database search for publications from January 1970 to November 2020, using keywords including OBS, bladder reconstruction, neobladder, radical cystectomy, robotic cystectomy, intracorporeal neobladder, surgical technique, patient selection and outcomes. Results Due to various factors including indications, operative technique and risk of complications, OBS is an enormous undertaking and commitment for patients, surgeons and health professionals involved in the care pathway. The main considerations for patient selection, the technical elements of the procedure and the rationale behind these are discussed. Previously considered to be a choice for a select few, the inclusion criteria have expanded over the last decade. Similarly, surgical techniques including the choice and configuration of bowel segments, construction of anastomosis and nerve or organ sparing procedures have evolved over the years. Minimally invasive laparoscopic and robotic assisted surgery has added further perspectives to the existing literature on OBS. Understanding the principles of operative techniques and assessing the best evidence to influence patient management is crucial as it has a major impact on clinical outcomes. Peri- and post-operative care, focused on the prevention of complications and morbidity, affects long-term functional and oncological outcomes, which ultimately dictates the quality of life. Conclusions This concise overview of OBS literature highlights the importance of pre-operative, peri-operative, and post-operative aspects with regards to the optimization of patient care. To achieve the best results, meticulous attention should be paid in all these areas, surgical and multi-disciplinary. Patient education and counseling, with shared decision making are central to the success of the procedure.
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Affiliation(s)
- N. Thakare
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
| | - B. W. Lamb
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - S. Biers
- Department of UrologyCambridge University Hospitals NHS Foundation TrustAddenbrooke’s HospitalCambridgeUK
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
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Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience. Curr Oncol 2021; 28:4109-4117. [PMID: 34677266 PMCID: PMC8534632 DOI: 10.3390/curroncol28050348] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.
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Clinical indications for necessary and discretionary hospital readmissions after radical cystectomy. Urol Oncol 2021; 40:164.e1-164.e7. [PMID: 34629281 DOI: 10.1016/j.urolonc.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND To assess predictors, indicators and medical necessity of readmissions after neoadjuvant chemotherapy and radical cystectomy in order to identify opportunities for reducing readmission rates. METHODS Records for patients treated with cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy between 2007 and 2017 were reviewed for 90-day complications and readmission. Readmissions were classified as necessary vs. discretionary based on independent clinician review. The association between postoperative complications and necessary or discretionary readmission were examined with adjusted regression models. RESULTS Among a total of 250 patients, 76 patients (30.4%) were readmitted within 90 days of surgery (19 discretionary and 57 necessary). Age, insurance coverage, and comorbidity were similar between readmitted and non-readmitted patients. Readmission was more likely after neobladder than ileal conduit (39% vs. 23%, P = 0.02). Major (grade ≥ 3) complications within 90-day of surgery including index admission and post-discharge period were significantly more common among re-admitted patients compared to patients who were not readmitted (40% in necessary, 21% in discretionary, 3% in none, P < 0.001). Median length of stay on readmission was twice as long in necessary cases compared to discretionary cases (5 vs. 2.5 days, P < 0.001). Gastrointestinal and infectious complications were associated with discretionary readmission in adjusted analyses, while infectious, renal/genitourinary and thromboembolic complications were associated with necessary readmission. CONCLUSIONS Twenty-five percent of readmissions were categorized as discretionary and were driven primarily by low-grade gastrointestinal complications, marginal oral intake and failure to thrive, suggesting that better coordinated post-discharge supportive care could help avoid a substantial proportion of readmissions.
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Djordjevic D, Dragicevic S, Vukovic M. Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate. Arch Ital Urol Androl 2021; 93:262-267. [PMID: 34839626 DOI: 10.4081/aiua.2021.3.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. MATERIALS AND METHODS A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. RESULTS Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). CONCLUSION Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.
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Affiliation(s)
| | | | - Marko Vukovic
- Urology clinic, Clinical centre of Montenegro, Podgorica.
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Borghi C, Manservigi M, Milandri ES, Ippolito C, Greco P, Dell'Atti L. The impact of orthotopic reconstruction on female sexuality and quality of life after radical cystectomy for non-malignant bladder conditions. Arch Ital Urol Androl 2021; 93:255-261. [PMID: 34839630 DOI: 10.4081/aiua.2021.3.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To review the literature on the impact on female quality of life and sexual function of orthotopic reconstruction after radical cystectomy for non-malignant bladder conditions. Radical cystectomy is commonly required to treat malignant conditions but may also be considered for the treatment of non-malignant diseases. These heterogeneous group of disorders includes interstitial cystitis, painful bladder syndrome, neurogenic bladder, haemorrhagic/ radiation cystitis, endometriosis and refractory genitourinary fistula. Treatment begins with non-invasive medical therapies but, in non-responder cases, a surgical solution should be considered. Such invasive techniques include urinary diversion and reconstructive procedures that have an impact on healthrelated quality of life, physical, social, and mental status. MATERIALS AND METHODS This narrative review research was done using the PubMed database up until 2020, July. All papers referring to cystectomy for benign indication were considered. RESULTS In comparison to other reconstructive options, orthotopic neobladder allows the restoration of a normal self-image and consequently it is the most suitable procedure when a surgical reconstruction is necessary for non-malignant conditions. However, women can face many disorders that impact on everyday life, such as voiding dysfunction or sexual activity problems. CONCLUSIONS Scant data is available about quality of life, sexual life and self-perception in women treated by cystectomy for benign conditions and most literature is dedicated to those indicators in cancer patients. More research is needed to understand the tolerability and the quality of life results of the female population affected by benign conditions undergoing this kind of surgical approach.
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Affiliation(s)
- Chiara Borghi
- Department of Surgical Sciences, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Sant'Anna, University of Ferrara, Cona (Ferrara).
| | - Margherita Manservigi
- Department of Surgical Sciences, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Sant'Anna, University of Ferrara, Cona (Ferrara).
| | - Elena Sofia Milandri
- Department of Surgical Sciences, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Sant'Anna, University of Ferrara, Cona (Ferrara).
| | - Carmelo Ippolito
- Department of Surgical Sciences, Section of Urology, Azienda Ospedaliero-Universitaria Sant'Anna, University of Ferrara, Cona (Ferrara).
| | - Pantaleo Greco
- Department of Surgical Sciences, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Sant'Anna, University of Ferrara, Cona (Ferrara).
| | - Lucio Dell'Atti
- Division of Urology, Department of Clinical, Special and Dental Sciences, University Hospital "Ospedali Riuniti" School of Medicine, Marche Polytechnic University, Ancona.
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Zhao Q, Yang F, Hao H, Li X, Wu L, Li X, Xing N. Surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders. Transl Androl Urol 2021; 10:2970-2981. [PMID: 34430400 PMCID: PMC8350254 DOI: 10.21037/tau-21-251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background In recent years, the construction of orthotopic neobladder has become the focus of research. Our study is aim to illustrate and evaluate surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders (IONB). Methods We retrospectively reviewed of 64 patients who underwent laparoscopic radical cystectomy (LRC) + Xing’s neobladder (n=41), Institute of Urology Peking University neobladder (IUPUB) (n=23) at two tertiary referral centers. Then demographic characteristics, operation outcomes were analyzed. In addition, postoperative complication rates, oncologic outcomes, continence, and neobladders’ function were further evaluated. Results All LRC + IONB were carried out in 64 patients successfully. Pathological results show that 63 were urothelial carcinoma and 1 was adenocarcinoma. Time to flatus was 3 [1–6] d in Xing’s neobladder group while 3 [2–5] d in IUPUB group (P=0.049). In terms of overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS), there is no statistical difference between the two groups. Overall, grade 1–2 complications were 36%, grade 3–4 complications were 1.6% on the 30th day, and 15.6%, 1.6% respectively on the 90th day. On the whole, daytime and night continence were 96.4%, 83.6% respectively one year after operation. Conclusions The two types of modified IONB are safe and feasible. The technical improvements significantly simplify the procedure and decrease the difficulty of the surgery, probably shorten the operative time and reduce blood loss. Furthermore, they take the advantage of less late complications and comparative good functional outcomes without affecting the prognosis of oncology. In addition, Xing’s neobladder is more beneficial to the recovery of postoperative gastrointestinal function.
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Affiliation(s)
- Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liyuan Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peng YL, Ning K, Wu ZS, Li ZY, Deng MH, Xiong LB, Yu CP, Zhang ZL, Liu ZW, Lu HM, Zhou FJ. Ureteral stents cannot decrease the incidence of ureteroileal anastomotic stricture and leakage: A systematic review and meta-analysis. Int J Surg 2021; 93:106058. [PMID: 34416355 DOI: 10.1016/j.ijsu.2021.106058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ileal conduit and ileal orthotopic neobladder were the most popular methods for urinary diversion following radical cystectomy. Stenting the anastomosis of ileo-ureter or ureter-neobladder was a common practice. However, it is still controversial if ureteral stents could prevent complications such as ureteroileal anastomosis stricture (UIAS) and ureteroileal anastomosis leakage (UIAL) after ureteral anastomosis. OBJECTIVES This study aims to investigate the role of the ureteral stent in preventing UIAS and UIAL. DATA SOURCES We systematically searched the related studies in PubMed, Embase, and Cochrane Library up to June 2020. STUDY ELIGIBILITY CRITERIA Cohort studies that identified the use of stent and the incidence of UIAS or UIAL were recorded. DATA SYNTHESIS Comparative meta-analysis was conducted on four cohort studies for comparison of UIAS and UIAL between the stented and nonstented groups. Besides, eleven studies which reported the events of UIAS and UIAL were used for meta-analysis of single proportion. RESULTS A total of 11 studies were qualified for analysis. Comparative meta-analysis identified that the incidence of UIAS was higher in the stented group than that in the nonstented group, but this did not reach a significant difference (odds ratio [OR]: 1.64; 95% confidence interval [CI]: 0.88-3.05; P = 0.12). Besides, there was no difference in the incidences of UIAL between the stented and the nonstented groups. On meta-analysis of single proportion, the incidence of UIAS was 7% (95% CI: 3%-10%) in the stented group and 3% (95% CI: 1%-6%) in the nonstented group. The UIAL rate was 1% (95% CI, 0%-4%) in stented patients and 2% (95% CI, 1%-4%) in nonstented patients. CONCLUSION Stenting the ureteroileal anastomosis resulted in a higher incidence of UIAS. There is no evidence to support ureteral stents could prevent the occurrence of UIAL after urinary diversion.
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Affiliation(s)
- Yu-Lu Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Kang Ning
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ze-Shen Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Yong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Min-Hua Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Long-Bin Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Chun-Ping Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Ling Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hui-Ming Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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Variables affecting quality of life after Radical cystectomy and neobladder substitution: Egyptian National Cancer Institute experience. Prog Urol 2021; 32:410-418. [PMID: 34312079 DOI: 10.1016/j.purol.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To evaluate the functional outcomes and quality of life beyond 1 year, in patients treated with radical cystectomy and orthotopic diversion for invasive bladder cancer. To investigate various potential contributing factors on patient's quality of life after radical cystectomy and urinary diversion via orthotopic neobladder. MATERIALS AND METHODS This retrospective study was conducted at the National Cancer Institute (NCI), Cairo; including a total of 97 patients who underwent radical cystectomy and orthotopic diversion. Functional and sexual outcome and patient QoL were assessed by ICIQ-SF, IIEF-5 and QLQ-C30 questionnaires. Potential association of patient QoL with pre-and intraoperative variables was studied. RESULTS Our results show that preoperative ECOG performance status 0 (P=0.0001), and nerve sparing surgery (P=0.001), were associated with high QoL and functional outcomes. On the contrary, ECOG performance status 2, preoperative comorbidities as ischemic heart diseases (P=0.01), recurrence (0.041), adjuvant chemotherapy (P=0.017) and radiotherapy (P=0.001) were associated with low QoL on univariate analysis. However, only ECOG performance status 2 (P<0.0001), incontinence (P<0.0001), non-nerve sparing surgery (P=0.001) and ureteric stricture (P=0.001) were independent predictors of worse QoL on multivariate analysis. CONCLUSION Orthotopic bladder is associated with increased morbidity. Attention should be given to preoprative patient characteristics at the time of patient selection, and intraoperative quality of functional preservation. LEVEL OF EVIDENCE 3.
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Tyson M, Andrews P, Cheney S, Humphreys M. Single Incision Robotic Cystectomy and Hybrid Orthotopic Neobladder Reconstruction: A Step by Step Description. Urology 2021; 156:285-288. [PMID: 34274390 DOI: 10.1016/j.urology.2021.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a new technique for single incision robotic cystectomy and Studer-type ileal neobladder using the single-port (SP) da Vinci SP robotic platform. METHODS In April 2021, a 71 year-old patient underwent a single incision robotic cystectomy and orthotopic Studer-type ileal neobladder using the single-port da Vinci SP robotic platform for cT2, cN0 urothelial carcinoma of the bladder. He was not a candidate for neoadjuvant cisplatin-based combination chemotherapy and declined participation in a clinical trial. RESULTS Total operative time was 554 minutes and estimated blood loss was 250 cc. He was discharged on postoperative day six without developing any Clavien complications. He underwent adjuvant chemotherapy for node-positive disease and follow-up through June 2021 was notable for the absence of any significant complications or readmissions. We provide a comprehensive discussion of the required instrumentation, a description of the technique with illustrations, and discuss the advantages and disadvantages of this technology as it pertains to cystectomy and urinary diversion. CONCLUSION We make no claim regarding the superiority of this technique over others, only that it is technically feasible and that the approach holds promise.
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Affiliation(s)
- Mark Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ.
| | - Paul Andrews
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | - Scott Cheney
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
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Laukhtina E, Mori K, D Andrea D, Moschini M, Abufaraj M, Soria F, Mari A, Krajewski W, Albisinni S, Teoh JYC, Quhal F, Sari Motlagh R, Mostafaei H, Katayama S, Grossmann NС, Rajwa P, Enikeev D, Zimmermann K, Fajkovic H, Glybochko P, Shariat SF, Pradere B. Incidence, risk factors and outcomes of urethral recurrence after radical cystectomy for bladder cancer: A systematic review and meta-analysis. Urol Oncol 2021; 39:806-815. [PMID: 34266740 DOI: 10.1016/j.urolonc.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 01/11/2023]
Abstract
We aimed to conduct a systematic review and meta-analysis assessing the incidence and risk factors of urethral recurrence (UR) as well as summarizing data on survival outcomes in patients with UR after radical cystectomy (RC) for bladder cancer. The MEDLINE and EMBASE databases were searched in February 2021 for studies of patients with UR after RC. Incidence and risk factors of UR were the primary endpoints. The secondary endpoint was survival outcomes in patients who experienced UR. Twenty-one studies, comprising 9,435 patients, were included in the quantitative synthesis. Orthotopic neobladder (ONB) diversion was associated with a decreased probability of UR compared to non-ONB (pooled OR: 0.44, 95% CI: 0.31-0.61, P < 0.001) and male patients had a significantly higher risk of UR compared to female patients (pooled OR: 3.16, 95% CI: 1.83-5.47, P < 0.001). Among risk factors, prostatic urethral or prostatic stromal involvement (pooled HR: 5.44, 95% CI: 3.58-8.26, P < 0.001; pooled HR: 5.90, 95% CI: 1.82-19.17, P = 0.003, respectively) and tumor multifocality (pooled HR: 2.97, 95% CI: 2.05-4.29, P < 0.001) were associated with worse urethral recurrence-free survival. Neither tumor stage (P = 0.63) nor CIS (P = 0.72) were associated with worse urethral recurrence-free survival. Patients with UR had a 5-year CSS that varied from 47% to 63% and an OS - from 40% to 74%; UR did not appear to be related to worse survival outcomes. Male patients treated with non-ONB diversion as well as patients with prostatic involvement and tumor multifocality seem to be at the highest risk of UR after RC. Risk-adjusted standardized surveillance protocols should be developed into clinical practice after RC.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - David D Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology and Division of Experimental Oncology, Urological Research Institute, Milano, Italy
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Simone Albisinni
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nico С Grossmann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Functional Results, Complications Associated with the Serosa-lined Tunnel, and Quality of Life with a Cross-folded Ileal Reservoir Combined with an Afferent Tubular Isoperistaltic Segment for Heterotopic Continent Urinary Diversion: An Observational Long-term Cohort Analysis. Eur Urol Focus 2021; 7:869-876. [DOI: 10.1016/j.euf.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022]
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Jaipuria J, Karimi AM, Singh A, Thapa BB, Gupta S, Sadasukhi N, Venkatasubramaniyan M, Pathak P, Kasaraneni P, Khanna A, Narayan TA, Sharma G, Rawal S. Pitcher pot neourethral modification of ileal orthotopic neobladder achieves satisfactory long‐term functional and quality of life outcomes with low clean intermittent self‐catheterization rate. BJUI COMPASS 2021; 2:292-299. [PMID: 35475302 PMCID: PMC8988529 DOI: 10.1002/bco2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To describe a decade of our experience with a neo‐urethral modification of ileal orthotopic neobladder (pitcher pot ONB). Multiple investigators have reported similar modifications. However, long‐term longitudinal functional and quality of life (QOL) outcomes are lacking. Methods Prospectively maintained hospital registry for 238 ONB patients comprising a mix of open and robotic surgery cohorts from 2007 to 2017, and minimum of 2 years of follow‐up was retrospectively queried. QOL was evaluated using Bladder Cancer Index (BCI). Longitudinal trends of QOL domain parameters were analysed. List of perioperative variables that have a biologically plausible association with continence, potency, and post‐operative BCI QOL sexual, urinary, and bowel domain scores was drawn. Variables included surgery type, Body Mass Index (BMI), T and N stage, neurovascular bundle (NVB) sparing, age, and related pre‐operative BCI QOL domain score. Prognostic associations were analysed using multivariable Cox proportional hazard models and multilevel mixed‐effects modeling. Results The study comprised 80 and 158 patients who underwent open and robotic sandwich technique cohorts, respectively. Open surgery was associated with significantly higher “any” complication (40% vs 27%, P‐value .050) and “major” complication rate (15% vs 11%, P‐value .048). All patients developed a bladder capacity >400 cc with negligible post‐void residual urine, and all but one patient achieved spontaneous voiding by the end of study period (<1% clean intermittent self‐catheterization [CISC] rate). By 15 months, QOL for all three domains had recovered to reach a plateau. About 45% of patients achieved potency, and the median time to achieve day and night time continence was 9 and 12 months respectively. Lower age and NVBs spared during surgery were found to be significantly associated with the earlier achievement of potency, day and night time continence, as well as better urinary and sexual summary QOL scores. Conclusions Pitcher pot neobladder achieves satisfactory long‐term functional and QOL outcomes with negligible CISC rate. Results were superior with incremental nerves spared during surgery.
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Affiliation(s)
- Jiten Jaipuria
- Amity Centre for Cancer Epidemiology & Cancer Research Amity Institute of Biotechnology Amity University Uttar Pradesh Noida India
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ahmad Mamoon Karimi
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Amitabh Singh
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Bikash Bikram Thapa
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Shashikant Gupta
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Nripesh Sadasukhi
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | | | - Preeti Pathak
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Priyatham Kasaraneni
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Ashish Khanna
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Tushar Aditya Narayan
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
| | - Girish Sharma
- Centre for Medical Biotechnology, Coordinator Amity Centre for Cancer Epidemiology & Cancer Research Amity Institute of Biotechnology Amity University Uttar Pradesh Noida India
| | - Sudhir Rawal
- Department of Surgical Oncology Uro‐oncology Division Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
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Lampel A, Schultz-Lampel D. [Urinary diversion after uro-oncologic interventions in women: the right procedure for the right patient]. Aktuelle Urol 2021; 52:268-275. [PMID: 33906240 DOI: 10.1055/a-1377-2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Bladder carcinoma is a relatively rare tumour in women. The even rarer constellation of an invasive carcinoma or a high-risk situation when cystectomy is indicated requires adequate urinary diversion.The individual underlying circumstances of tumour and patient and the experience and preferences of the surgeon determine the choice of urinary diversion.A variety of alternatives are available for bladder replacement. The first decision to be made is between incontinent or continent urinary diversion. There is no general solution that fits all patients, but an individual solution must be found based on adequate information. Options include incontinent drainage with an ostomy, e. g. ureterocutaneostomy or ileum conduit, and the much more complex techniques of the continent variants of orthotopic or heterotopic replacement.Experience with continent diversion is significantly limited in women compared with men. In particular, the orthotopic connection to the urethra reveals gender-specific differences.All in all, clear inclusion or exclusion criteria for the different techniques have to be respected. Especially in cases when quality of life or body image play a crucial role, it is difficult to decide which type of urinary diversion is appropriate. This requires extensive experience on the part of the surgeon regarding the various options of surgical methods as well as knowledge and control of consecutive complications.
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Affiliation(s)
- Alexander Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
| | - Daniela Schultz-Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
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Asanad K, Nazemi A, Ghodoussipour S, Ladi-Seyedian S, Nassiri N, Wayne K, Schuckman A, Djaladat H, Daneshmand S. Evaluation of Bowel Function Following Radical Cystectomy and Urinary Diversion Using Two Validated Questionnaires: What Are the Effects on Quality of Life? Urology 2021; 156:279-284. [PMID: 34058241 DOI: 10.1016/j.urology.2021.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess both short- and long-term constipation symptoms and their impact on quality of life in patients who underwent radical cystectomy (RC) with three different types of urinary diversion: orthotopic neobladder (ONB), continent cutaneous diversion (CCD), and ileal conduit (IC). MATERIALS AND METHODS The validated Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires were administered to all patients at follow-up greater than 30 days from surgery. Clinical and pathological characteristics were prospectively recorded in an institutional review board approved bladder cancer database. Using multivariable linear regression analyses, we determined significant predictors of improved constipation symptoms and quality of life scores. RESULTS A total of 198 patients completed 255 PAC-SYM and PAC-QOL questionnaires with a median follow-up time of 1.7 years (IQR: 0.7 - 3.0 years). ONB, CCD, and IC were performed in 78%, 5.5%, and 16.5% of patients, respectively. Higher bowel function scores (i.e. worse symptoms) were noted at 3 months post-operatively, while these scores significantly improved over time for PAC-SYM total score (P = .004), abdominal subscore (P = .001), and rectal subscore (P = .018). On multivariable analysis, we found that patients <70 years old (B -2.1, P = .004), with follow-up >1 year (B -4.8, P = .001), and who received an IC (B -2.4, P = .02) had significantly lower PAC-SYM scores. CONCLUSION Patients have few constipation symptoms and are overall satisfied with their bowel function at long-term follow-up after RC. While patients with IC have significantly fewer constipation symptoms compared to those with ONB or CCD, all patients had significant improvement one year after the surgery.
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Affiliation(s)
- Kian Asanad
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Azadeh Nazemi
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Sanam Ladi-Seyedian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Nima Nassiri
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Kevin Wayne
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Anne Schuckman
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Hooman Djaladat
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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Khan A, Vuppalapati JK, Sarath LR, Mujeeburahiman M, D'souza N. Functional outcome of robotic-assisted intracorporeal versus extracorporeal neobladder following radical cystectomy: Initial experience. Urol Ann 2021; 13:9-13. [PMID: 33897157 PMCID: PMC8052906 DOI: 10.4103/ua.ua_132_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/19/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: Worldwide, the seventh most commonly diagnosed cancer in the male population is Bladder cancer (BC), while it drops to eleventh when both genders are considered. Radical cystectomy is the surgical treatment of choice for patients with all muscle-invasive and some nonmuscle invasive BCs. An orthotopic continent diversion (neobladder) is preferred whenever possible to achieve a better postoperative quality of life. We attempt to study the functional outcomes of intracorporeal neobladder (ICNB) versus extracorporeal neobladder (ECNB) (ICNB vs. ECNB). Materials and Methods: Forty patients who underwent robot-assisted radical cystectomy with neobladder in our institute during the period of March 2016–March 2018 were included in the study. An orthotopic neobladder (Studer method) was created in all our patients. Our main outcomes of interest were peak flow rates, residual urine, attainment of continence, and Pdet at qmax of the neobladder. Results: The mean age of patients in our study group was 54 ± 6 years. The mean body mass index was 23 ± 2 kg/m2. The mean follow-up period was 24 ± 5 months. Twenty patients underwent ICNB and 20 patients underwent ECNB. The urodynamic assessment was done 1-year postprocedure. The same parameters applied to an intact bladder are used, and results analyzed by comparing it with other studies. Common in the initial postoperative period was incontinence which reduced substantially over time. After 1-year, 75% of patients did not require pads in the daytime, and a meager, <10% used more than one pad per day. There was no difference in outcome between both the groups, which was statistically significant. Conclusion: Both ICNB and ECNB groups achieved urodynamically proven values of adequate bladder capacity and compliance. Daytime continence was excellent, and night time continence was good in both groups. Furthermore, there was no significant difference between both the groups as regards to urodynamic parameters. However, continence is attained little earlier in the ICNB group. There is no perceived superiority of ICNB over ECNB.
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Affiliation(s)
- Altaf Khan
- Department of Urology, Yenepoya Medical College, Mangaluru, India
| | | | | | - M Mujeeburahiman
- Department of Urology, Yenepoya Medical College, Mangaluru, India
| | - Nischith D'souza
- Department of Urology, Yenepoya Medical College, Mangaluru, India
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Djordjevic D, Vukovic M. Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients. Int Braz J Urol 2021; 47:426-435. [PMID: 33146976 PMCID: PMC7857759 DOI: 10.1590/s1677-5538.ibju.2020.0415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. MATERIALS AND METHODS Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. RESULTS Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. CONCLUSIONS The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.
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Affiliation(s)
- Dejan Djordjevic
- Department of Urology, Clinic Urology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Marko Vukovic
- Department of Urology, Clinic Urology, Clinical Centre of Serbia, Belgrade, Serbia.,Department of Urology, Clinic Urology, Clinical Centre of Montenegro, Podgorica, Montenegro
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Butea-Bocu MC, Müller G, Brock O, Otto U. [Metabolic acidosis in neobladder patients : Risk factors and treatment options]. Urologe A 2021; 60:617-623. [PMID: 33884463 DOI: 10.1007/s00120-021-01523-7] [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: 03/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In cystectomy patients who underwent neobladder creation, the intestinal mucosa of the neobladder is in constant contact with urine, which may result in chronic metabolic acidosis (CMA) due to specific absorption capabilities of the intestinal mucosa. Despite being a prevalent comorbidity, the risk factors for CMA and its diagnostic parameters are poorly understood. OBJECTIVES This review examines the risk factors associated with the development of CMA and their prevalence in patients with a neobladder. MATERIALS AND METHODS We conducted a systematic literature search using the PubMed database to detect studies about the topics CMA and neobladder that were published between 2000 and 2020. The prevalence and risk factors for CMA in neobladder patients were assessed by reviewing 23 studies. RESULTS Acidosis is most prevalent during the first year after surgery (25-70%). Risk factors are renal failure, high continence, old age and diabetes mellitus. CONCLUSIONS The prevalence of CMA is at its highest during the early postoperative period for neobladder patients, so for this time period, weekly diagnostic investigations are recommended according to the German S3-guidelines for the "Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinomsent für Neoblasepatienten". Blood gas tests should not only be used to analyze the pH value but also to detect and counteract acid-base imbalance issues in time. The recommended normalization of serum bicarbonate levels with oral bicarbonate follows patient-specific therapy strategies.
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Affiliation(s)
- Marius Cristian Butea-Bocu
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland.
| | - Guido Müller
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
| | - Oliver Brock
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
| | - Ullrich Otto
- Urologisches Kompetenzzentrum für die Rehabilitation - UKR, Kliniken Hartenstein, Dr.-Herbert-Kienle-Str. 6, 34537, Bad Wildungen, Deutschland
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Bröder S, Jäger W, Thüroff JW, Stein R. Orthotopic MAINZ pouch bladder substitution - long-term follow-up. Cent European J Urol 2021; 74:235-240. [PMID: 34336244 PMCID: PMC8318017 DOI: 10.5173/ceju.2021.0275.r2] [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: 09/29/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. MATERIAL AND METHODS Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-end (Wallace) and the right ureter by an end-to side technique (Nesbit). Surgical and medical follow-up reports were evaluated and a recent follow-up was obtained by a questionnaire. RESULTS Median follow-up in 183 patients was 72 months (1-336). A total of 74 patients (38%) died during the follow-up. A surgical intervention was required in 26 out of 193 patients with early complications while 45 out of 183 patients had late and 17 patients had both, early and late complications. Ureteral stenosis was found in 13% of submucosal implanted ureters, 13% with the Wallace technique, and 3.6% with the Nesbit technique. In total, 66 patients responded to the questions concerning long-term continence (minimal follow-up >2 years). Overall, 84.8% were completely continent, 1.6%, reported grade I and 9.8% grade II stress incontinence. CONCLUSIONS The long-term continence and complication rates are comparable to those of other types of orthotopic bladder substitution. Orthotopic MAINZ pouch procedure can be considered as one of the options for orthoptic diversion, which stands the test of time.
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Affiliation(s)
- Saskia Bröder
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Joachim W. Thüroff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Khalilullah SA, Tranggono U, Hendri AZ, Danarto R. Comparing the outcome of ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a retrospective cohort study. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC.
Methods
This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications.
Results
Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups.
Conclusions
Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.
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Obrecht F, Youssef NA, Burkhardt O, Schregel C, Randazzo M, Padevit C, Wiklund P, John H. Robot-assisted radical cystectomy and intracorporeal orthotopic neobladder: 1-year functional outcomes. Asian J Androl 2021; 22:145-148. [PMID: 31929193 PMCID: PMC7155788 DOI: 10.4103/aja.aja_125_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Fabian Obrecht
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Nadim Abo Youssef
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Orlando Burkhardt
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Christoph Schregel
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Marco Randazzo
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Christian Padevit
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
| | - Peter Wiklund
- Department of Urology, Karolinska Institutet, Stockholm SE-14186, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10025, USA
| | - Hubert John
- Department of Urology, Cantonal Hospital Winterthur, Winterthur CH-8400, Switzerland
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Faraj KS, Rose KM, Navaratnam AK, Abdul-Muhsin HM, Eversman S, Singh V, Tyson MD. Effect of intracorporeal urinary diversion on the incidence of benign ureteroenteric stricture after cystectomy. Int J Urol 2021; 28:593-597. [PMID: 33594730 DOI: 10.1111/iju.14521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare ureteroenteric stricture rates after radical cystectomy in patients who undergo an intracorporeal urinary diversion versus other surgical approaches. METHODS We retrospectively reviewed health records of all patients who underwent cystectomy with urinary diversion at Mayo Clinic Hospital (Phoenix, AZ, USA) from 1 January 2007 through 1 January 2018. Ureteroenteric stricture was identified by surveillance imaging. Patients were stratified by surgical approach: open radical cystectomy, robot-assisted radical cystectomy with extracorporeal urinary diversion and robot-assisted radical cystectomy-intracorporeal urinary diversion. A Cox proportional hazards model was fitted that included independent predictors of stricture development. RESULTS Of the 573 cystectomies assessed, 236 (41.2%) were carried out robotically. In the robot-assisted radical cystectomy cohort, 39 patients (16.5%) underwent intracorporeal urinary diversion. The median follow-up period was 55, 70 and 71 months for the open radical cystectomy, robot-assisted radical cystectomy-extracorporeal urinary diversion and robot-assisted radical cystectomy-intracorporeal urinary diversion groups, respectively. Subgroup stricture rates were as follows: open radical cystectomy, 8.0%; robot-assisted radical cystectomy-extracorporeal urinary diversion, 9.6%; and robot-assisted radical cystectomy-intracorporeal urinary diversion, 2.6% (P = 0.33). The median time to stricture was 5 months (interquartile range 3.3-11.5 months). In the bivariable analysis, factors that were associated with the development of ureteroenteric stricture were postoperative urinary leak (hazard ratio 3.177, 95% confidence interval 1.129-8.935; P = 0.03) and body mass index (hazard ratio 1.078, 95% confidence interval 1.027-1.132; P = 0.002). On multivariable logistic regression analysis, intracorporeal urinary diversion approach was not associated with the development of ureteroenteric stricture (hazard ratio 0.272, 95% confidence interval 0.036-2.066; P = 0.21). CONCLUSIONS Ureteroenteric stricture is a complication that typically occurs within the first postoperative year. Although our results did not support major differences in outcomes between intracorporeal urinary diversion and extracorporeal urinary diversion, the small sample size did not exclude the possibility of a type 2 statistical error.
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Affiliation(s)
- Kassem S Faraj
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Kyle M Rose
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | | | | - Sarah Eversman
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Vijay Singh
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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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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Chan EP, Nair SM, Hetou K, Stephenson E, Power NE, Izawa J, Chin JLK. Longitudinal experience with Studer neobladders: Outcomes and complications. Can Urol Assoc J 2021; 15:E386-E392. [PMID: 33410740 DOI: 10.5489/cuaj.6893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aims to assess the longer-term functional, anatomical, and metabolic outcomes of patients who underwent Studer neobladder (SNB) urinary diversion. METHODS A retrospective review of patients who underwent SNB at a single center from 1995-2017 (n=116) was performed. Demographics, comorbidities, pathological data, and longer-term functional, anatomical, and metabolic outcomes were collected from hospital records. The primary outcome was voiding function of patients at most recent followup. Secondary outcomes included postoperative complications, renal function, nephrolithiasis, infections, and metabolic outcomes. RESULTS Excluding those with incomplete followup data, 72 patients with a minimum followup of one year were included for analysis. Median followup was 70±11 months, with 52.8% of patients having ≥5 years of followup. Clean intermittent catheterization (CIC) was used by 22.2% of patient at most recent followup, which was mostly necessitated by bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding. Patients experienced more daytime and nighttime urinary incontinence in the early postoperative setting, which improved over time. Generally, renal function declined over time; poorer long-term renal function was predicted by hydronephrosis within one year (p=0.002). CONCLUSIONS Longer-term followup of SNB reveals significant but manageable complications. Gradual decline in renal function was common. Strict adherence to bladder emptying protocols (e.g., timed voiding or CIC) may reduce incidence of renal deterioration, metabolic disorders, and urinary dysfunction. Early onset (<1 year) of hydronephrosis may indicate a need for intervention to preserve long-term renal function.
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Affiliation(s)
- Ernest Pang Chan
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Shiva Madhwan Nair
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Khalil Hetou
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada.,Department of Urology, Klinikum Bremen Mitte, Bremen, Germany
| | - Emily Stephenson
- Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Nicholas E Power
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Jonathan Izawa
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Joseph L K Chin
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
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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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45
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Khawaja A, Dar Y, Suhail M, Sofi K, Muzaffar P, Parra S, Malik S, Bhat A, Wani M. Feasibility and safety of retrograde radical cystectomy under combined spinal and epidural anesthesia in high-risk and elderly patients. A single surgeon experience. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_156_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Haywood S, Donahue TF, Bochner BH. Management of Common Complications After Radical Cystectomy, Lymph Node Dissection, and Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liaw CW, Bamberger J, Gupta K, Gupta M. Endoscopic Creation of a Neochimneycystotomy: A Case Report of a Ureteroileal Chimney Stricture. J Endourol Case Rep 2020; 6:163-165. [PMID: 33102717 DOI: 10.1089/cren.2019.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are many nonmalignant complications after urinary reconstruction. Anastomotic strictures and redundancy of an ileal chimney are such. A patient with both issues might necessitate an open surgical approach; yet endoscopic techniques are more attractive for these older frail patients. Case Presentation: A 61-year-old woman with a history of bladder cancer who underwent radical cystectomy and neobladder creation now develops left hydronephrosis and a redundant ileal chimney with severe metabolic acidosis. She underwent endoscopic creation of a neochimneycystotomy. Conclusion: The refinement of endoscopic techniques moves the field of surgery away from open surgery, which is beneficial for patients. This endoscopic technique treated the anastomotic stricture as well as redundant ileal chimney in a novel way that has not been reported previously in the literature.
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Affiliation(s)
- Christine W Liaw
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Bamberger
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kasmira Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Predictors of Benign Ureteroenteric Anastomotic Strictures After Radical Cystectomy and Urinary Diversion. Urology 2020; 144:225-229. [DOI: 10.1016/j.urology.2018.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022]
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49
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Vassantachart A, Daneshmand S, Cai J, Miranda G, Ghodoussipour S, Schuckman AK, Djaladat H, Ballas L. Feasibility and Outcomes of Orthotopic Ileal Neobladder Reconstruction Following Pelvic Irradiation. Urology 2020; 148:198-202. [PMID: 32979377 DOI: 10.1016/j.urology.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the complications and oncologic outcomes of orthotopic ileal neobladder reconstruction (ONB) following pelvic radiotherapy (RT) compared to patients with no prior pelvic RT. METHODS Our institutional database was queried for all patients with pT0-4bN0-3M0 urothelial carcinoma of the bladder who underwent radical cystectomy with curative intent and ONB between 1990 and 2018. We then queried this cohort for patients who had prior pelvic RT (>3900 cGy) and compared baseline characteristics, perioperative complications, and recurrence free survival between patients with and without prior pelvic RT. RESULTS One thousand eight hundred and forty-six patients matched our inclusion criteria; 34 had prior pelvic RT with a median dose of 6280 cGy. Prior RT targeted the bladder, prostate, and cervix in 27, 6, and 1 patient, respectively. Median time from RT to cystectomy was 15.5 months. Patients with prior RT had a longer time from diagnosis to cystectomy, more frequently had ≥5 TURBT and neoadjuvant chemo, and less frequently had multifocal disease. Perioperative complications including operative time, estimated blood loss, days hospitalized, as well as 30- and 90-day complication rates, were not statistically different. There was no statistical difference in recurrence free survival between the 2 groups (P = .48). CONCLUSION ONB in highly selected patients with prior pelvic RT is feasible with statistically similar perioperative complication rates compared to ONB without prior RT.
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Affiliation(s)
| | - Siamak Daneshmand
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jie Cai
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Gus Miranda
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Anne K Schuckman
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Hooman Djaladat
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Leslie Ballas
- Department of Radiation Oncology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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Yee CH, Yuen-Chun J, Chan ESY. Current evidence for robotic surgery in radical cystectomy. Turk J Urol 2020; 47:S1-S8. [PMID: 32976090 DOI: 10.5152/tud.2020.20355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Robotic-assisted radical cystectomy (RARC) has been gaining momentum as an alternative to its conventional open radical cystectomy (ORC) for the management of invasive bladder cancer. Although RARC, in general, demonstrated less blood loss and shorter hospital stay than ORC, whether there is any significant difference in the overall complication rate still requires further investigation. Thus, both RARC and ORC share a similar oncology outcome, with comparable positive surgical margin rates, disease-free survival, and overall survival. Techniques of intracorporeal urinary diversion (ICUD) have not yet been standardized. ICUD may result in a lower risk of ureteroileal anastomotic stricture than extracorporeal urinary diversion (ECUD). However, ECUD is still a valid and commonly practiced option according to the available data. In general, RARC has been demonstrated to provide promising results. Long-term data and functional outcome after RARC and ICUD are needed to further validate the role of RARC in the management of bladder cancer.
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Affiliation(s)
- Chi Hang Yee
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Yuen-Chun
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Eddie Shu-Yin Chan
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
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