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Asimakopoulos AD, Finazzi Agrò E, Piechaud T, Gakis G, Gaston R, Rosato E. Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis. Cancers (Basel) 2024; 16:1253. [PMID: 38610933 PMCID: PMC11010941 DOI: 10.3390/cancers16071253] [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: 02/02/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. OBJECTIVE To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. METHODS A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001-December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. RESULTS AND CONCLUSION Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9-433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5-25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7-89.1%) and 61.7% (95% CI: 51.9-71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.
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Affiliation(s)
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, 00133 Rome, Italy; (E.F.A.); (E.R.)
| | - Thierry Piechaud
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France; (T.P.); (R.G.)
| | - Georgios Gakis
- University Clinic and Polyclinic of Urology, University Hospital of Halle (Saale), D-06120 Halle, Germany;
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France; (T.P.); (R.G.)
| | - Eleonora Rosato
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, 00133 Rome, Italy; (E.F.A.); (E.R.)
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Salihagic IK, Hrkac A, Ovcaricek S, Bokarica P, Gilja I. Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up. Technol Health Care 2024; 32:951-962. [PMID: 37661899 DOI: 10.3233/thc-230339] [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] [Indexed: 09/05/2023]
Abstract
BACKGROUND Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). CONCLUSION Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.
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Affiliation(s)
| | - Adelina Hrkac
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Slaven Ovcaricek
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Pero Bokarica
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ivan Gilja
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
- Department of Urology, University Hospital Mostar, Mostar, Bosnia and Herzegovina
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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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Nesbitt AL, Yuhico MP, Khan M, Pridgeon SW. Guideline proposal for the conservative management of a ruptured neobladder. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415819865707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Level of evidence: 4
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Affiliation(s)
| | | | - Munad Khan
- Department of Urology, Cairns Hospital, Australia
| | - Simon W Pridgeon
- Department of Urology, Cairns Hospital, Australia
- Northern Urology, Australia
- College of Medicine and Dentistry, James Cook University, Australia
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Han JH, Yuk HD, Choi JW, Ku JH. NBCA-Lipiodol Mixture Embolization of Persistent Urine Leakage After Orthotopic Neobladder Formation: Techniques and Outcomes. Front Surg 2022; 9:844588. [PMID: 35574556 PMCID: PMC9091345 DOI: 10.3389/fsurg.2022.844588] [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: 12/28/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo show the effective and successful technical approach of percutaneous embolization for persistent urine leakage that occurred after orthotopic neobladder formation.Materials and MethodsWe retrospectively reviewed patients who underwent percutaneous embolization of N-butyl cyanoacrylate (NBCA) and lipiodol mixture after orthotopic neobladder formation at the Seoul National University Hospital (Seoul, Korea) from 1 January 2018 to 31 December 2020.ResultsAmong total of 182 patients of neobladder formation, five patients (four males and one female) were enrolled in this study, and their median age was 61.0 years (interquartile range (IQR): 42.5–69.5 years). All the patients showed persistent urine leakage at the neobladder-urethral anastomosis site and percutaneous drainage was primarily performed. The median time to perform percutaneous embolization was 40 days (IQR: 31.5–71.5 days) postoperatively. Elective two-staged embolization was performed in three cases for large diameter with a large fluid-filled cavity, while re-embolization was needed for delayed recurrence of urine leakage in two cases. Complete resolution of urine leakage was seen in all the cases and the median time to leakage closure was 55 days (IQR: 27.5–82.5 days). The median follow-up period after leakage closure was 26 months (IQR: 15.5–36.4 months), and embolization material-related bladder stone was a noticeable complication (two cases) during follow-up, which was removed endoscopically within 1 year after embolization. All patients' quality of life (EQ-5D-5L score) was well-maintained during the entire period.ConclusionsPersistent urine leakage after neobladder formation can be effectively managed with percutaneous embolization of “dumbbell technique” by reinforcing the closure of leakage tract from inner opening to the outer opening even for large diameter (>1 cm).
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Affiliation(s)
- Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Ja Hyeon Ku
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Andersen CS, Thoft Jensen B, Nielsen Holck E, Kingo PS, Jensen JB. Prospective versus retrospective recordings of comorbidities and complications in bladder cancer patients undergoing radical cystectomy - a randomized controlled trial. Scand J Urol 2021; 56:6-11. [PMID: 34658306 DOI: 10.1080/21681805.2021.1987978] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients undergoing radical cystectomy are predominantly elderly with many comorbidities and high risk of complications. Studies on comorbidity and complications following cancer surgery are often based on data collected retrospectively from records. However, prospective registration is often considered a more valid source of information. Therefore, it is relevant to investigate if the amount and severity of complications and comorbidities is valid when using retrospective registration compared to a more meticulous prospective registration. OBJECTIVE To investigate the difference in registered comorbidities and complications between prospective and retrospective data collection in patients with bladder cancer undergoing radical cystectomy. METHOD Seventy-three bladder cancer patients undergoing radical cystectomy were randomized to receive prospective or retrospective collection of data regarding comorbidities and complications. Data in the prospective arm was collected daily during hospitalization, 14-days after discharge and 90-days postoperatively. In the retrospective arm, medical records were reviewed retrospectively at 90-days. Comorbidities were compared using the Charlson Comorbidity Index (CCI) and complications were reported as overall, minor and major dependent on Clavien Dindo Classification (CDC). The primary endpoint was the difference in overall complication rate. RESULTS No statistically significant difference in CCI was observed with median [IQR] 2[0;3] and 1[0;2] (p = 0.21). No statistically significant difference was found regarding all, minor (CDC I-II) or major (CDC III-V) complications at all three time points. CONCLUSION No statistically significant difference in comorbidity and complications between retrospectively and prospectively collected data was observed. We find that retrospective collected data is reliable when strict reporting guidelines are used in this single-centre study.
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García-Rojo E, Medina-Polo J, Miranda-Utrera N, Abad-López P, Gonzalez-Padilla D, González-Díaz A, Arrébola-Pajares A, Guerrero-Ramos F, Tejido-Sánchez Á, Rodríguez-Antolín A. Evaluation of health care-associated infections following radical cystectomy. Actas Urol Esp 2021; 45:124-131. [PMID: 32948346 DOI: 10.1016/j.acuro.2020.06.004] [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: 04/23/2020] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and higher costs. The aim of this work is to evaluate health care-associated infections (HAIs) in these patients, as well as associated microorganisms, antibiotic resistance profiles and risk factors. MATERIAL AND METHODS Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed. RESULTS 122 patients. Mean age 67 (SD:18,42). Mean hospital stay 23.5 days (18.42). HAIs rate of 45%, with predominant urinary tract infections (43%) and surgical wound infections (31%). Positive cultures in 78.6% of cases. Increased isolation of Enterococcus (18%) and Escherichia coli (13%). Forty-three percent of microorganisms were resistant to amoxicillin/ampicillin, 23% to beta-lactamases and 36% to quinolones. Empirical treatment was adequate in 87.5%. Hospital stay is increased (17 days, p< 0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p< 0.001) and in orthotopic vs. ileal conduit diversion (p = 0.04) CONCLUSIONS: We found a high rate of HAIs in our radical cystectomy series, with predominant urinary tract and surgical wound infections. E.coli and Enterococcus spp. are the most frequently isolated microorganisms, with high rates of resistance to some commonly used antibiotics.
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Singh UP, Jena R, Madhavan K, Kumar N, Sureka SK, Srivastava A. Radical cystectomy and W-shaped ileal orthotopic neobladder reconstruction with serosa-lined tunneled ureteroileal anastomoses: A critical analysis of the short-term voiding patterns and urodynamic and functional outcomes. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:121-128. [PMID: 31000917 PMCID: PMC6458799 DOI: 10.4103/iju.iju_356_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction We present the short-term voiding patterns and functional and urodynamic outcomes of W-shaped ileal orthotopic neobladder (ONB) following radical cystectomy (RC). Materials and Methods Forty-one patients who underwent RC and W-shaped ONB creation between July 2015 and January 2018 were enrolled. Data were analyzed in terms of voiding patterns, urodynamic findings, and functional outcomes at 6 months after surgery. Pouch-related quality of life (QoL) was assessed using European Organization for Research and Treatment of Cancer (EORTC) Generic (QLQ C30), Bladder Cancer-Specific Instruments (QLQ BM30), and IONB-Patient-Reported Outcome (IONB-PRO). Results The mean length of follow-up was 19.4 months. At first follow-up, three patients had developed acidosis and rising serum creatinine, and one of them required temporary hemodialysis. One patient developed urethral-pouch anastomotic stricture, which required bladder neck incision. Balloon dilatation was performed for ureteroileal anastomotic stricture and mesh repair for incisional hernia was required in one patient each. Upper tract changes were observed in two patients. During the first and second follow-up, maximum flow rate, voided volume, and postvoid residual urine were 12 ± 4.7 mL/s, 212 ± 120 mL, and 72 + 81 mL and 14.7 ± 5.3 mL/s, 254 ± 168 mL, and 123.7 ± 42.5 mL, respectively. The mean pouch capacity and compliance were 436 ± 103.5 mL and 50.6 ± 17.8 mL/cm H2O. No patient required clean intermittent catheterization for bladder emptying. In EORTC QLQ-C30 questionnaire, the "Cognitive" domain had the highest and "global QoL" domain had the lowest level of functional scores. "Nausea and vomiting and abdominal bloating and flatulence" domain had the lowest level and "financial difficulties and urinary symptoms" had the highest level of symptomatology in EORTC QLQ questionnaire. The IONB-PRO questionnaire showed the highest level of functioning in "relation life" and the lowest level in "emotional life" domain. Conclusion The Ghoneim pouch has a low complication rate with near-normal voiding patterns with an acceptable QoL impairment.
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Affiliation(s)
- Uday Pratap Singh
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Jena
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumar Madhavan
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Naveen Kumar
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Kumar Sureka
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Elmussareh M, Simonsen PC, Young M, Kingo PS, Jakobsen JK, Jensen JB. Correlation between organ-specific co-morbidities and complications in bladder cancer patients undergoing radical cystectomy. Scand J Urol 2019; 52:395-400. [PMID: 30624138 DOI: 10.1080/21681805.2018.1531921] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the association between patients' organ-specific co-morbidities and post-operative complications following radical cystectomy for bladder cancer. PATIENTS AND METHODS All patients who underwent radical cystectomy at Aarhus University Hospital during the period from January 2006 to February 2014 were included retrospectively. A total of 40 comorbidities and 59 complications were registered meticulously. Univariate and multivariate analyses were used to detect associations between the individual comorbidities and specific post-operative complications. RESULTS Ninety-two per cent (575/625) of patients experienced one or more complications following radical cystectomy. Clavien-Dindo grade 3-5 complications were observed in 40.8% of patients, and 6.2% had severe complications (Clavien-Dindo grade 4-5). The mortality rate was 2.2%. High BM, previous myocardial infarction and chronic obstructive pulmonary disease were noted to be associated with moderate-to-severe post-operative complications (Clavien-Dindo grade 3-5), while diabetes and lymphoproliferative disorders were significantly associated with severe complications (Clavien-Dindo grade 4-5). CONCLUSION This study demonstrates that overall complications to radical cystectomy are high (92%). The associations between specific comorbidities and complications need to be further investigated in order to evaluate whether pre-operative assessment can be more optimally used in a prevention strategy tailored to the individual patient.
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Affiliation(s)
- Muhammad Elmussareh
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Urology , Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | | | - Matthew Young
- b Department of Urology , Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | | | | | - Jørgen Bjerggaard Jensen
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,c Department of Clinical Medicine , Health, Aarhus University , Aarhus , Denmark
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Abstract
Introduction The aim of the study was to determine the most frequent early and late complications in different types of ileal urinary diversions. Patients and methods The study was conducted in a five-year period, on 106 patients who were diagnosed with invasive urinary bladder cancer and who had indication for radical cystectomy with one of the investigated types of urine derivation. They were divided into 2 groups, based on the type of ileal urinary diversions. Results The colonization of bacteria was more prominently present in the ileal conduit urinary diversion group (97%) compared to Ghoneim (25%) and Hautmann (10%) group, Ureteral stenosis was slightly less represented in the conduit group (9.1%). Wound infections were significantly more represented in the conduit (21.2%) than in the Ghoneim group (5%) Nighttime incontinence was present in 20% of patients in both groups or 4 patients in each group. Daytime incontinence in the Ghoneim group was present in 3 patients (15%) and in the Hautmann group 2 patients (10%). Late complications correlate significantly negative with the type of surgery and slightly negative with the grade, and significantly positively with the examined group and T stage, and slightly correlate positively to the N and R stages. Early complications correlate slightly negative with the type of surgery, slightly negative with the grade, and significantly positively with T stage, and slightly positively correlates with the N and R stage. Conclusion The most commonly reported complications in ileal conduit are: prolonged ileus, stoma infection, wound dehiscence and bacterial colonization, followed by peristomal skin complications and complications related only to the stoma, such as stenosis and stoma retraction, and prolaps of ileostoma and ileointestinal stenosis. The ileus rate in orthotopic derivation was significantly lower than that of the ileal conduit group, which led to the conclusion that the neomybladder position does not disturb the anatomic abdominal structure.
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Affiliation(s)
- Alden Prcic
- Bahrain Specialist Hospital, Manama, Bahrain
| | - Edin Begic
- Health Care Centre, Maglaj, Bosnia and Herzegovina
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Kulkarni JN, Agarwal H. Transperitoneal vs. extraperitoneal radical cystectomy for bladder cancer: A retrospective study. Int Braz J Urol 2018; 44:296-303. [PMID: 29219280 PMCID: PMC6050562 DOI: 10.1590/s1677-5538.ibju.2017.0441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Conventional transperitoneal radical cystectomy (TPRC) is the standard approach for muscle invasive bladder cancer. But, the procedure is associated with significant morbidities like urinary leak, ileus, and infection. To reduce these morbidities, the technique of extraperitoneal radical cystectomy (EPRC) was described by us in 1999. We compared these two approaches and the data accrued forms the basis of this report. Materials and Methods All patients who underwent radical cystectomy for bladder cancer by the author (JNK) with follow-up for at least 5 years were included. A total of 338 patients were studied, with 180 patients in EPRC group and 158 in TPRC group. Results There were 3 mortalities within 30 days in TPRC group and one in EPRC group. Early complication rate was 52% and 58% in EPRC and TPRC groups. Urinary leak occurred in 31 (9.2%) patients (13 in EPRC, 18 in TPRC, p=0.19). Gastrointestinal complications like ileus occurred in 9 (5%) patients in EPRC group and in 25 (15.8%) patients in TPRC group, (p<0.001). Wound dehiscence occurred in 29, and 36 patients in EPRC and TPRC groups respectively. The reoperation rate was 6.1% and 12% in EPRC and TPRC groups, (p=0.08). Intestinal obstruction were significantly less in EPRC group (1.7% vs. 7.8% in TPRC group, p=0.002). Uretero-enteric anastomosis stricture was seen in 10 patients (4 in EPRC, 6 in TPRC, p=0.39). Conclusions The EPRC is associated with decrease gastrointestinal complications, ease of management of urinary leaks, and low reoperation rates. Thus EPRC appears safe functionally and oncologically.
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Affiliation(s)
- Jagdeesh N Kulkarni
- Department of Urology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Himanshu Agarwal
- Department of Urology, Bombay Hospital and Medical Research Centre, Mumbai, India
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Krughoff K, Ha S, Crawford D, Wilson S. Evaluation of the Use of Remodelable Pericardial Bolsters during Cystectomy and Diversion to Prevent Enterocutaneous Fistulas. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kevin Krughoff
- Department of Surgery/Division of Urology, University of Colorado Denver, Aurora, Colorado
| | - Sarah Ha
- Department of Surgery/Division of Urology, University of Colorado Denver, Aurora, Colorado
| | - David Crawford
- Department of Surgery/Division of Urology, University of Colorado Denver, Aurora, Colorado
| | - Shandra Wilson
- Department of Surgery/Division of Urology, University of Colorado Denver, Aurora, Colorado
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De Sutter T, Akand M, Albersen M, Everaerts W, Van Cleynenbreugel B, De Ridder D, Goethuys H, Moris L, Milenkovic U, Van Poppel H, Van Der Aa F, Joniau S. The N-shaped orthotopic ileal neobladder: functional outcomes and complication rates in 119 patients. SPRINGERPLUS 2016; 5:646. [PMID: 27330912 PMCID: PMC4870512 DOI: 10.1186/s40064-016-2287-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
Background We report our long-term experience with 119 cases of N-shaped orthotopic ileal neobladder. Methods Between March 1996 and July 2013, a total of 119 patients (102 men, 17 women) underwent cystectomy with creation of an N-shaped orthotopic ileal neobladder. The Clavien–Dindo classification score was used for grading early (<3 months postoperative), late, and pouch-related and non-pouch-related complications. Daytime and nighttime continence were evaluated for male and female patients separately, with patients subdivided in three groups: completely continent, use of ≤1 pad, and use of >1 pad. Results Median follow-up was 75 months (range 3–204). Early complications (15 major, 54 minor) occurred in 39.5 % of 119 patients whereas 53.1 % presented with late complications (56 major, 39 minor; 111 patients evaluated). Urinary infection and outlet obstruction were both the most frequent early and late pouch-related complications; early non-pouch-related complications were mainly infectious and gastrointestinal, and the most common late non-pouch-related problem was wound herniation. At 12 months, 96 and 60 % of the men and 84.6 and 66.7 % of the women respectively achieved daytime and nighttime continence. Conclusion Complication rates of the N-shaped orthotopic ileal neobladder were relatively high, probably because of meticulous recording and follow-up. Daytime continence rates were better than nighttime rates. N-shaped orthotopic ileal neobladder can be a good option for urinary diversion in selected patients who undergo radical cystectomy.
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Affiliation(s)
- Thomas De Sutter
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Murat Akand
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hans Goethuys
- Department of Urology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Stapled orthotopic ileal neobladder after radical cystectomy for bladder cancer: Functional results and complications over a 20-year period. Eur J Surg Oncol 2016; 42:412-8. [DOI: 10.1016/j.ejso.2015.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 11/02/2015] [Accepted: 11/13/2015] [Indexed: 11/24/2022] Open
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Use of urostomy bags in the management of perioperative urine leakage after radical cystectomy. Cancer Nurs 2015; 37:170-4. [PMID: 23357883 DOI: 10.1097/ncc.0b013e318277db29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urine leakage is a common complication in patients with bladder cancer after radical cystectomy and neobladder reconstruction. OBJECTIVE The aim of this study was to evaluate the clinical value of the use of urostomy bags in the management of urine leakage in patients with bladder cancer after radical cystectomy. METHODS Urine leakage during the perioperative period was retrospectively analyzed in 483 patients with bladder cancer who underwent radical cystectomy from 2004 to 2010. Before 2008, all patients with urine leakages were treated by routine dressing changes (group A). After 2008, the leakages were managed with urostomy bags (group B). The perioperative quality of life (EQ-5D) and cost for urine leakage for both groups were compared in this controlled study. RESULTS The average cost in management of preoperative urine leakage was significantly higher in group A than in group B as well as the patients with extravasations of urine or lymphoceles. Patients in group B had an overall better perioperative life quality compared with group A. In particular, the score for pain/discomfort was significantly higher in group A than in group B. CONCLUSIONS The management of perioperative urine leakage with urostomy bags avoided constant body wetness and significantly increased the quality of life and reduced the special costs of urine leakage in patients with bladder cancer after cystectomy. IMPLICATIONS FOR PRACTICE Early use of urostomy bag is a good choice for perioperative urine leakage in patients with bladder cancer after radical cystectomy and neobladder reconstruction.
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Barapatre YR, Agarwal MM, Mavuduru R, Sharma SK, Kumar S, Singh SK, Mandal AK. Short-Term Functional and Urodynamic Outcome of W-ileal Orthotopic Neobladder with Serosa-Lined Tunneled Uretero-Ileal Anastomosis. Low Urin Tract Symptoms 2014; 6:26-34. [PMID: 26663497 DOI: 10.1111/luts.12014] [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: 10/16/2012] [Revised: 12/17/2012] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Functional and urodynamic (UDS) outcomes of W-configured ileal orthotopic neobladder (ONB) with extramural serosa-lined tunnel uretero-ileal anastomosis are presented METHODS Consecutive 17 patients undergoing ONB during December 2009 to March 2011 were enrolled. Of these 15 men (bladder cancer 14, tuberculosis 1) with mean age 52.7 ± 11.3 years completed the follow-up. Pouch-related quality of life (PQOL) was assessed using a published questionnaire. Uroflowmetry, cystometry/cystography and urethral-pressure profilometry were done at two follow-up visits at least 3 months apart. Mean follow up 10 ± 5 months. Mean length of harvested ileum 48 ± 6 cm. RESULTS Overall PQOL were similar at both evaluations (55 ± 11 and 54 ± 15, respectively). During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 ± 4 mL/sec, 246 ± 99 mL and 68 ± 74.9 mL and 10.4 ± 4.6 mL/sec, 234 ± 138 mL and 86 ± 146 mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 ± 244 mL, 50.5 ± 49.1 mL/cmH2 O, 42 ±20 cmH2 O and 22 ± 12 mm, and 468 ± 250 mL, 46.4 ± 47.5 mL/cmH2 O, 52 ± 27cmH2 O and 23 ± 12 mm, respectively. Patients with smaller pouch (r = 0.828; P = 0.0001), longer urethral length (r = -0.392; P = 0.023) and lesser incontinence (r = 0.429; P = 0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P = 0.058), MUCP (P = 0.05) and bothersome incontinence (P = NS) was observed. None of the patients had any obstruction or reflux of the upper tracts. CONCLUSION The index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence.
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Affiliation(s)
- Yogesh R Barapatre
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mayank M Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh K Sharma
- Department of Statistics, Punjab University, Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zhong S, Zhu Z, Wang X, Pan C, Chen S, Shen Z. RETRACTED: Modified U-shaped ileal neobladder after radical cystectomy: Assessment of functional outcomes and complications in Chinese patients. Urol Oncol 2013; 31:1683-8. [DOI: 10.1016/j.urolonc.2012.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
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Kaufman MR. Management of Stress Urinary Incontinence in the Neobladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Paananen I, Ohtonen P, Perttilä I, Jonsson O, Edlund C, Wiklund P, Ljungberg B, Möller-Jensen K, Jonsson E, Månsson W. Functional results after orthotopic bladder substitution: a prospective multicentre study comparing four types of neobladder. Scand J Urol 2013; 48:90-8. [PMID: 23863091 DOI: 10.3109/21681805.2013.799225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate enterocystometry, voiding pattern and urine leakage of four types of orthotopic bladder substitute. MATERIAL AND METHODS At eight urological departments, 78 consecutive men were studied: 66 with an ileal neobladder [30 Studer pouches (S), 24 Hautmann pouches (H) and 12 T-pouches (T)] and 12 with a right colonic [Goldwasser type (G)] neobladder. Enterocystometry, determination of residual urine, micturition protocol and 24 h pad weight test were performed 6 and 12 months postoperatively. RESULTS Colonic neobladders had higher pouch pressure at first desire, normal desire and strong desire than ileal neobladders (except at first and normal desire at 12 months) (p < 0.02) and contraction was present more often at both 6 and 12 months (p < 0.01 and p < 0.01). Compliance was good in all types of pouch. Intermittent self-catheterization was more common in H patients at 6 months (p = 0.033). All patients with colonic neobladders used pads during the day and night. In patients with ileal pouches 32% used pads during the day and 70% during the night at 12 months. Urine leakage was higher in patients with colonic bladders at 6 and 12 months during the day (mean/median of 98/31 ml and 82/16 ml versus 10/0 ml and 4/0 ml, p < 0.001). T-pouches had excellent day-time continence, but nocturnal leakage was high. CONCLUSIONS The Hautmann pouch and the Studer pouch behaved similarly at enterocystometry and clinically, and continence was good in the majority of patients. The low number of patients with the other two types of pouch precludes definitive statements.
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Affiliation(s)
- Ilkka Paananen
- 1 Department of Urology, Oulu University Hospital , Oulu , Finland
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Nam JK, Kim TN, Park SW, Lee SD, Chung MK. The Studer orthotopic neobladder: long-term (more than 10 years) functional outcomes, urodynamic features, and complications. Yonsei Med J 2013; 54:690-5. [PMID: 23549816 PMCID: PMC3635617 DOI: 10.3349/ymj.2013.54.3.690] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/04/2012] [Accepted: 08/13/2012] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Radical cystectomy and urinary diversion are the standard treatment for invasive bladder cancer. We analyzed the long-term (>10 years postoperatively) functional outcomes, complications, and urodynamic findings in a single center series of patients who underwent cystectomy and a Studer ileal neobladder substitution. MATERIALS AND METHODS A retrospective chart review of 108 Studer pouches constructed during 1990 and 2011 was performed. Data were analyzed in terms of long-term (>10 years) outcomes. Complications, incontinence, voiding difficulties, upper urinary tract changes, overall satisfaction, and urodynamic findings of the reservoir were obtained. RESULTS We evaluated 19 out of 50 patients who had lived for over 10 years postoperatively. Another 31 patients were not traced: 7 patients died following recurrence, 15 died due to exacerbation of a comorbidity, and 9 patients were lost to follow-up. Concerning complications, 6 patients had an atrophied kidney, 5 patients had moderate hydronephrosis, 5 patients had chronic recurrence of pylelonephritis, and 2 patients had voiding difficulty because of bladder neck stricture due to clean intermittent catheterization. One patient underwent an operation due to intestinal obstruction. Seven patients had incontinence; all 7 patients showed intermittently at night and 2 patients even in waking hours. Maximum bladder capacity was 484.1±119.2 mL, maximum flow rate was 13.6±9.7 mL/sec, and post-void residual urine volume was 146.8±82.7 mL. CONCLUSION Long-term outcomes with the Studer orthotopic ileal neobladder have an acceptable complication rate and good functional results. However, potential adverse outcomes such as renal deterioration, dysfunctional voiding should also be considered.
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Affiliation(s)
- Jong Kil Nam
- Department of Urology, Research Institute for Convergence of Biochemical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Tae Nam Kim
- Department of Urology, Research Institute for Convergence of Biochemical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Woo Park
- Department of Urology, Research Institute for Convergence of Biochemical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Research Institute for Convergence of Biochemical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Moon Kee Chung
- Department of Urology, Research Institute for Convergence of Biochemical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Abstract
Orthotopic urinary diversion (OUD) is performed in almost half of all radical cystectomies. This review presents an overview of the incidence, pathophysiology, and management of urinary incontinence (UI) after OUD. Daytime and nighttime UI are reported in up to 15% and 45% of cases after OUD, respectively. UI after OUD is more frequent in women. Stress incontinence is the most common reason for daytime urinary leakage, while an absent vesicourethral reflex with reduced external sphincter muscle tone is associated with nighttime UI. Conservative management has limited therapeutic value in UI after OUD. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT® system in mild stress UI. Implantation of the artificial urinary sphincter system AMS 800® is the standard treatment for stress UI after OUD. Very limited data exist regarding results after implantation of newer artificial urinary sphincter systems such as the FlowSecure® and the Zephyr® ZSI 375 after OUD.
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Ballouhey Q, Thoulouzan M, Lunardi P, Bellec L, Huyghe E, Plante P, de Petriconi R, Soulié M. Étude prospective chez 100 patients des résultats de la technique d’anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann. Prog Urol 2012; 22:255-60. [DOI: 10.1016/j.purol.2011.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/29/2011] [Accepted: 11/13/2011] [Indexed: 11/30/2022]
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Modified technique for the creation of an orthotopic neobladder in patients with shortened mesentery: making up the difference between the bladder and the urethral stump. Urology 2011; 78:1430-4. [PMID: 21996104 DOI: 10.1016/j.urology.2011.07.1404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe an ileal neobladder reconstruction technique performed in 5 men who had previous abdominal surgeries and presented with a short mesoileum at the time of bladder replacement. METHODS The patients were 5 men scheduled for a radical cystoprostatectomy with bladder substitution and had a short mesoileum at the time of the surgery. All patients had a history of abdominal surgery. A neobladder was constructed in a "J" shape leaving the most proximal part of the ileum (8-10 cm) tubularized. We created a 3- to 4-cm flap from the surface of the most distal region of the reservoir. This flap was tubularized to lengthen the neobladder onto the urethral stump, resulting in a tension-free anastomosis. All patients underwent a complete clinical laboratory evaluation 12 months after the surgery. RESULTS At 1 year after surgery, all patients were able to void spontaneously. Day and night time continence were 80% and 60%, respectively. Urodynamic evaluation revealed a neobladder with good capacity (mean = 521 ml) and compliance (mean = 27.2 mL/cm H(2)O). Only 1 patient demonstrated a moderate hydronephrosis of the right kidney. CONCLUSION Candidates for orthotopic neobladders who have had previous abdominal surgeries and who have a short mesoileum at the time of the surgery are uncommon. Despite the small number of cases, our technique is noteworthy for having achieved good functional results during the short-term follow-up. This technique is advantageous because it is easy to perform and does not require any other bowel resection or anastomose.
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Liedberg F, Holmberg E, Holmäng S, Ljungberg B, Malmström PU, Månsson W, Nunez L, Wessman C, Wijkström H, Jahnson S. Long-term follow-up after radical cystectomy with emphasis on complications and reoperations: A Swedish population-based survey. ACTA ACUST UNITED AC 2011; 46:14-8. [DOI: 10.3109/00365599.2011.609835] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Erik Holmberg
- Department of Urology,
Sahlgrenska University Hospital Göteborg, Sweden
| | - Sten Holmäng
- Department of Surgical and Perioperative Sciences,
Urology and Andrology, Umeå, Sweden
| | - Börje Ljungberg
- Department of Urology,
Akademiska University Hospital, Uppsala, Sweden
| | | | - Wiking Månsson
- Department of Urology,
Karolinska University Hospital, Stockholm, Sweden
| | - Leyla Nunez
- Oncologic Centre Sahlgrenska University Hospital, Göteborg, Sweden
| | - Catrin Wessman
- Oncologic Centre Sahlgrenska University Hospital, Göteborg, Sweden
| | - Hans Wijkström
- Oncologic Centre Sahlgrenska University Hospital, Göteborg, Sweden
| | - Staffan Jahnson
- Department of Urology,
Linköping University Hospital, Linköping, Sweden
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26
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Neuzillet Y, Yonneau L, Lebret T, Herve JM, Butreau M, Botto H. The Z-shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients. BJU Int 2011; 108:596-602. [DOI: 10.1111/j.1464-410x.2010.10000.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Jentzmik F, Schostak M, Stephan C, Baumunk D, Lingnau A, Weikert S, Lein M, Miller K, Schrader M. Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique. World J Urol 2009; 28:457-63. [DOI: 10.1007/s00345-009-0476-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022] Open
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28
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Liu D, Feng F, Shen Z, Xia W, Zhou W, Wang M, Zhu Y, Wang J, Tang Q. Clinical experience in a modified Roux-Y-shaped sigmoid neobladder: assessment of complications and voiding patterns in 43 patients. BJU Int 2009; 105:533-8. [PMID: 19747352 DOI: 10.1111/j.1464-410x.2009.08773.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the complications and urinary voiding patterns in patients with a new Roux-Y-shaped continent neobladder, using a modified sigmoid pouch. PATIENTS AND METHODS Between June 2003 and July 2008, 43 patients (26 men and 17 women, mean age 69.5 years) underwent a modified Roux-Y-shaped sigmoid continent neobladder reconstruction after radical cystectomy. The surgical procedures involved the construction of a Roux-Y-shaped sigmoid pouch, making an antifeces-refluxing valve into the sigmoid urine reservoir and ureterosigmoidostomy using the Leadbetter method. This pouch method has not been described before. The patients' clinical, biochemical, radiological and urodynamic variables were assessed. RESULTS During the mean (range) follow-up of 24 (6-65) months, there were no deaths related to the procedure. In 16% of the patients, early complications occurred, whereas 12% had late complications. There were no cases with local recurrence and metastasis. Routine electrolyte evaluation revealed a slight metabolic acidosis in six patients (14%). Hypovitaminosis B(12) did not occur in any patients. All patients were continent in the daytime and night-time continence was poor in eight patients (19%). The mean (sd, range) neobladder capacity and residual urine volume was 330 (110, 120-410) mL and 48 (26, 25-80) mL, respectively. Moreover, the maximum urinary flow rate was 9.2-25.3 mL/s. CONCLUSION The modified Roux-Y-shaped sigmoid neobladder replacement provides a new simple surgical procedure with low complication rates. The procedure offers comparatively satisfactory daytime continence with low postvoid residual urine volumes and voiding patterns. This technique is a valid alternative to continent urinary diversion.
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Affiliation(s)
- DingYi Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yao K, Hou GL, Liu ZW, Yu SL, Li YH, Zhou FJ. Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: early results of 8 cases. Urol Oncol 2009; 27:611-6. [PMID: 19372052 DOI: 10.1016/j.urolonc.2009.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/20/2009] [Accepted: 01/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We reviewed our experience with dilation of the upper urinary tract caused by the conglutination of distal ureters after orthotopic neobladder reconstruction using the split-cuff nipple ureteral reimplant technique. MATERIALS AND METHODS From January 2000 to April 2007, 250 consecutive patients underwent radical cystectomy and orthotopic neobladder reconstruction. Ureterointestinal anastomosis was performed using the split-cuff nipple technique in 291 renoureteral units. The patients from a single center were followed up for a mean period of 8 months (range 1-22) after surgery. We incised the conglutination band using a transurethral endoscope. Patient characteristics, endoscopic technique, measurement of serum creatinine levels, and results of ultrasonography, cystoscopy, and excretory urography were collected. RESULTS Hydronephrosis was found in 8 patients (14 renoureteral units) due to the conglutination of the distal ureters to each other (n = 6) or to the neobladder wall (n = 2). After the incision procedure, seven patients had obvious improvement in renal function and hydronephrosis, and their symptoms disappeared. In 1 patient, hydronephrosis developed again because of ureteroenteric stenosis after 7 months and was resolved by open surgical revision. The hydronephrosis had improved greatly in this patient by 5 months after revision. CONCLUSION Conglutination of the distal ureters is a cause of hydronephrosis after orthotopic neobladder reconstruction using the reimplant technique with the split-cuff nipple. Cystoscopy is mandatory in following up patients who have hydronephrosis with the split-cuff nipple ureteral reimplant technique, not only to confirm the diagnosis but to treat the complication by incising the conglutination band. Continued follow-up is required to evaluate the long-term results of this treatment.
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Affiliation(s)
- Kai Yao
- Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, PR China
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Meyer JP, Blick C, Arumainayagam N, Hurley K, Gillatt D, Persad R, Fawcett D. A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients. BJU Int 2009; 103:680-3. [PMID: 19076133 DOI: 10.1111/j.1464-410x.2008.08204.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jon-Paul Meyer
- Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK.
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Voiding Dysfunction After Orthotopic Diversion. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Keszthelyi A, Majoros A, Nyirády P, Mayer P, Bach D, Romics I. Voiding symptoms and urodynamic findings in patients with modified ileal neobladde. Pathol Oncol Res 2008; 15:307-13. [PMID: 18802792 DOI: 10.1007/s12253-008-9099-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
Abstract
The aim of our study was to find the cause of urinary incontinence and voiding dysfunction in patients undergoing radical cystectomy and orthotopic bladder replacement with modified ileal neobladder (Reddy). Twenty-eight incontinent patients (operated on between 1988 and 2004) were involved in our examination. Based on the complaints of the patients, continence status was evaluated and divided into two groups: group I: partially incontinent (only night-time incontinence) n = 11 (39.3%) and group II: totally incontinent (night-time and daytime incontinence) n = 17 (60.7%). Detailed urodynamic examination (enterocystometry and urethral pressure profile) in addition to involuntary neobladder contractions and capacity detection were carried out on all patients. Furthermore resting pressure and maximal voluntary contraction ability of the sphincter were determined and statistically analyzed in both groups. Significant difference was noticed in resting pressure and maximal voluntary contraction ability of the sphincter among the partially incontinent and totally incontinent patients. Frequency, intensity and duration of involuntary neobladder contractions also showed significant differences between the two groups. Incontinence of neobladder depends not only on the destruction of resting and contraction capability of the urethral sphincter, but also on the presence or absence of involuntary contractions in the wall of the neobladder and decreased capacity of the neobladder.
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Nieuwenhuijzen JA, de Vries RR, Bex A, van der Poel HG, Meinhardt W, Antonini N, Horenblas S. Urinary Diversions after Cystectomy: The Association of Clinical Factors, Complications and Functional Results of Four Different Diversions. Eur Urol 2008; 53:834-42; discussion 842-4. [PMID: 17904276 DOI: 10.1016/j.eururo.2007.09.008] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 09/10/2007] [Indexed: 11/21/2022]
Abstract
PURPOSE We present a single institute experience of the four most widely used diversions after cystectomy in 281 patients, with an evaluation of the association between clinical factors, complication rates, functional results, and metabolic complications. MATERIALS AND METHODS Between 1990 and 2005, 281 consecutive cystectomies were performed at our institute. Four different diversions were offered: an ileal conduit according to Bricker (IC; 118 patients), an Indiana pouch (IP; 51 patients), and orthotopic diversions after cystectomy/neobladder (N; 62 patients), or sexuality-preserving cystectomy and neobladder (SPCN; 50 patients). RESULTS Forty-four percent developed early complications: IC 48%, IP 43%, N 42%, and SPCN 38%. High ASA score was the only variable significantly associated with early major complications (ASA 1 vs. 3: HR, 0.32; 95%CI, 0.14-0.72). Late complication rate was 51% with fewer complications in the IC group, IC 39%, IP 63%, N 59%, and SPCN 60% (HR, 0.32; 95%CI, 0.14-0.72), which was explained by fewer uncomplicated urinary tract infections (one third of all late complications) in the IC group. There were no differences in experienced late major complications. We found no significant association between tumour stage, ASA, age, preoperative radiotherapy, gender, and diversion-related complication rates. Complete daytime and nighttime continence, respectively, was achieved in 96% and 73% after IP, 90% and 67% after neobladder, and 96% and 67% after SPCN. Metabolic changes were found in 24% of the patients: 21% after IC, 26% after IP, and 28% after orthotopic diversion (neobladder and SPCN combined); low vitamin B12 was measured in 23%, 15%, and 15% respectively. CONCLUSIONS Cystectomy with any subsequent diversion remains a procedure with considerable morbidity. High ASA score was associated with more early complications. Orthotopic diversions provide good functional results, but at the cost of more late complications compared with ileal conduits. We found no evidence that age, ASA score, positive lymph nodes, extravesical tumour growth, or previous radiotherapy were contraindications per se for any diversion.
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Affiliation(s)
- Jakko A Nieuwenhuijzen
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Ghoneim MA, Osman Y. Uretero-intestinal anastomosis in low-pressure reservoirs: refluxing or antirefluxing? BJU Int 2007; 100:1229-33. [DOI: 10.1111/j.1464-410x.2007.07052.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huang GJ, Stein JP. Open radical cystectomy with lymphadenectomy remains the treatment of choice for invasive bladder cancer. Curr Opin Urol 2007; 17:369-75. [PMID: 17762633 DOI: 10.1097/mou.0b013e3282dc95b5] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Radical cystectomy with an appropriate lymph node dissection and an appropriate form of urinary diversion is the standard treatment for muscle-invasive transitional cell carcinoma of the bladder. Optimal outcomes following radical cystectomy require an extended lymph node dissection, negative surgical margins, and a continent urinary diversion. There has been an increasing number of reports describing initial experiences with laparoscopic radical cystectomy. RECENT FINDINGS Intermediate and long-term oncologic outcomes with laparoscopic radical cystectomy remain undefined, and appropriate lymph node dissections laparoscopically have not been uniformly performed. Furthermore, the long-term functional outcomes associated with laparoscopically performed urinary diversions also remain undefined. There appears to be a recent trend toward performing the urinary diversion portion of the procedure extracorporeally, after laparoscopic removal of the bladder. Some studies suggest a decrease in postoperative analgesic requirements and quicker recovery of bowel function in those undergoing laparoscopic radical cystectomy, but these observations have not been corroborated by others. SUMMARY In the absence of long-term functional and oncologic outcome data, laparoscopic radical cystectomy should be considered an investigative technique, and potential candidates for this operation should be appropriately counseled.
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Affiliation(s)
- George J Huang
- Department of Urology, University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, California 90098, USA
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