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Piramide F, Turri F, Amparore D, Fallara G, De Groote R, Knipper S, Wuernschimmel C, Bravi CA, Lambert E, Di Maida F, Liakos N, Pellegrino F, Andras I, Mastrorosa A, Tillu N, Mastroianni R, Paciotti M, Wenzel M, Bianchi R, di Trapani E, Moschovas MC, Gandaglia G, Moschini M, D'Hondt F, Rocco B, Fiori C, Galfano A, Minervini A, Simone G, Briganti A, De Cobelli O, Gaston R, Montorsi F, Breda A, Wiklund P, Porpiglia F, Mottrie A, Larcher A, Dell'Oglio P. Atlas of Intracorporeal Orthotopic Neobladder Techniques After Robot-assisted Radical Cystectomy and Systematic Review of Clinical Outcomes. Eur Urol 2024; 85:348-360. [PMID: 38044179 DOI: 10.1016/j.eururo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. OBJECTIVE To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. DESIGN, SETTING, AND PARTICIPANTS We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. SURGICAL PROCEDURE Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. MEASUREMENTS Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. RESULTS AND LIMITATIONS Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. CONCLUSIONS Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. PATIENT SUMMARY Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others.
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Affiliation(s)
- Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Fallara
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Sophie Knipper
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Edward Lambert
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Nikolaos Liakos
- Department of Urology, Medical Faculty and Medical Centre of the University of Freiburg, Freiburg, Germany
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandro Mastrorosa
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France; Urology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Neeraja Tillu
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco Paciotti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Bernando Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autònoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Rich JM, Cumarasamy S, Ranti D, Lavallee E, Attalla K, Sfakianos JP, Waingankar N, Wiklund PN, Mehrazin R. Contemporary outcomes of patients undergoing robotic-assisted radical cystectomy: A comparative analysis between intracorporeal ileal conduit and neobladder urinary diversions. Asian J Urol 2023; 10:446-452. [PMID: 38024428 PMCID: PMC10659981 DOI: 10.1016/j.ajur.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (IC) and neobladder (NB) urinary diversion. Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai, New York, NY, USA were indexed. Baseline demographics, clinical characteristics, perioperative, and oncologic outcomes were analyzed. Survival was estimated with Kaplan-Meier plots. Results Of 261 patients (206 [78.9%] male), 190 (72.8%) received IC while 71 (27.2%) received NB diversion. Median age was greater in the IC group (71 [interquartile range, IQR 65-78] years vs. 64 [IQR 59-67] years, p<0.001) and BMI was 26.6 (IQR 23.2-30.4) kg/m2. IC group was more likely to have prior abdominal or pelvic radiation (15.8% vs. 2.8%, p=0.014). American Association of Anesthesiologists scores were comparable between groups. The IC group had a higher proportion of patients with pathological tumor stage 2 (pT2) tumors (34 [17.9%] vs. 10 [14.1%], p=0.008) and pathological node stages pN2-N3 (28 [14.7%] vs. 3 [4.2%], p<0.001). The IC group had less median operative time (272 [IQR 246-306] min vs. 341 [IQR 303-378] min, p<0.001) and estimated blood loss (250 [150-500] mL vs. 325 [200-575] mL, p=0.002). Thirty- and 90-day complication rates were 44.4% and 50.2%, respectively, and comparable between groups. Clavien-Dindo grades 3-5 complications occurred in 27 (10.3%) and 34 (13.0%) patients within 30 and 90 days, respectively, with comparable rates between groups. Median follow-up was 324 (IQR 167-552) days, and comparable between groups. Kaplan-Meier estimate for overall survival at 24 months was 89% for the IC cohort and 93% for the NB cohort (hazard ratio 1.23, 95% confidence interval 1.05-2.42, p=0.02). Kaplan-Meier estimate for recurrence-free survival at 24 months was 74% for IC and 87% for NB (hazard ratio 1.81, 95% confidence interval 0.82-4.04, p=0.10). Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage, increased nodal involvement, similar complications outcomes, decreased overall survival, and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.
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Affiliation(s)
- Jordan M. Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Ranti
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Etienne Lavallee
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P. Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter N. Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Xu S, Wang XN, Wang ZJ, Zhang TW, Zhang YH, Cao YC, Jiao W. Migrated Hem-o-Lok clips in the neobladder with giant stone formation: a case report. BMC Urol 2023; 23:52. [PMID: 36997995 PMCID: PMC10061752 DOI: 10.1186/s12894-023-01223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Neobladder urolithiasis is a rare but important delaying complication of orthotopic urinary diversion. We report a case of Hem-o-Lok (HOLC) migration into the neobladder with giant stone formation after orthotopic neobladder cystectomy. CASE REPORT We report a case of a 57-year-old man with frequent urination and occasional discharge of stones 3 years after a laparoscopic orthotopic neobladder cystectomy. Computed tomography revealed a large round 3.5 cm calculus. An endoscopic neocystolitholapaxy was performed, and a Hem-o-Lok was found in the center of the stone. CONCLUSION We described the case presentation, treatment and analysis of etiology of stone formation to avoid such complication.
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Affiliation(s)
- Shang Xu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Xin-Ning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Zi-Jie Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Tian-Wei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Yu-Hao Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Yuan-Chao Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Wei Jiao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
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Xu P, Chen C, Chen B, Bi E, Du W, Jiang N, Liu Z, Lan H, Cao M, Liu Y, Huang J, Shen H, Liu C, Liu C, Xu A. Long-term Follow-up of Detaenial Sigmoid Neobladder Reconstruction for Paediatric Patients with Bladder and Prostate Rhabdomyosarcoma: Technique and Results from a Single High-volume Centre. Eur Urol 2022; 82:543-550. [PMID: 36050131 DOI: 10.1016/j.eururo.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma. Approximately 15-20% of RMS cases arise from the bladder and prostate (B/P). The optimal treatment strategy for B/P RMS remains unclear. OBJECTIVE To retrospectively evaluate the applicability of our procedure performed to treat paediatric patients with B/P RMS. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective analysis from a single tertiary referral hospital. From August 2003 to March 2021, 62 children pathologically diagnosed with B/P RMS underwent radical cystectomy and orthotopic detaenial sigmoid neobladder reconstruction in our centre. SURGICAL PROCEDURE Surgical procedures included laparoscopic radical cystectomy and detaenial sigmoid neobladder reconstruction, which is demonstrated in the accompanying video. MEASUREMENTS Demographic, clinical, and follow-up data were collected. Perioperative and long-term oncological and functional outcomes were reported. A logistic regression analysis was also performed. RESULTS AND LIMITATIONS All surgeries, including three intracorporeal laparoscopic surgeries, were completed successfully. Of the 62 patients, 54 were alive without evidence of disease recurrence or metastasis at the last follow-up. Five of the 14 >12-yr-old boys reported that they experienced erections. Two female patients >12 yr old reported that they menstruated. However, this was a retrospective study conducted at a single centre with limited surgeon experience. CONCLUSIONS Our results confirmed the safety and feasibility of primary orthotopic sigmoid neobladder reconstruction after radical cystectomy for paediatric patients with B/P RMS. Good outcomes in terms of oncological control and functional recovery were achieved. The high histocompatibility and tissue adaptability of children are inspiring. PATIENT SUMMARY We describe our stepwise technique of radical cystectomy and detaenial sigmoid neobladder reconstruction for paediatric patients with bladder and prostate rhabdomyosarcoma. With this technique, we were able to achieve good functional recovery without compromising cancer control and significantly increasing complications.
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Affiliation(s)
- Peng Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxiao Chen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Binshen Chen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Enguang Bi
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Biochemistry and Molecular Biology, School of Basic Medical Science, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, Guangzhou, China
| | - Wei Du
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ning Jiang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hekui Lan
- Department of Paediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Manming Cao
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yazhen Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jingwen Huang
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Haiyan Shen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Cunrong Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Abai Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Lavallée E, Dovey Z, Pathak P, Dey L, Renström Koskela L, Hosseini A, Waingankar N, Mehrazin R, Sfakianos J, Hosseini A, Wiklund P. Functional and Oncological Outcomes of Female Pelvic Organ-preserving Robot-assisted Radical Cystectomy. EUR UROL SUPPL 2022; 36:34-40. [PMID: 35005650 DOI: 10.1016/j.euros.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background For females undergoing cystectomy and urinary diversion, decreases in sexual and urinary functions can have a significant impact on quality of life. Pelvic organ-preserving (POP) radical cystectomy (RC) has been proposed as an approach to improve postoperative functional outcomes. Objective To evaluate postoperative functional outcomes of a robotic approach for female POP RC with intracorporeal urinary diversion. Design setting and participants This was a multicenter retrospective study evaluating sexual, urinary, and oncological outcomes for sexually active females undergoing POP robot-assisted RC for ≤T2 bladder cancer. Exclusion criteria included multifocal, trigonal, or locally advanced tumors. Surgical procedure We describe a step-by-step technique for POP robot-assisted RC with intracorporeal urinary diversion. Measurements The primary outcome of the study was evaluation of sexual and urinary functions following surgery. Oncological outcomes were evaluated as a secondary endpoint. Results and limitations Our study included 23 females who underwent POP robot-assisted RC between 2008 and 2020 with intracorporeal neobladder (87%) or ileal conduit (13%) reconstruction. The median follow-up was 20 mo. A postoperative sexual function questionnaire was completed by 15 patients (65%). Of those, 13 (87%) resumed sexual activity at a median of 6 mo after surgery. Of the patients with a neobladder, 14 (70%) achieved daytime continence and 16 (80%) achieved nighttime continence. Cancer-specific and overall survival were both 91%. The results are limited by their retrospective nature. Conclusions POP robot-assisted RC with orthotopic neobladder allows a majority of female patients to return to sexual activity after surgery. This approach should be considered for selected sexually active women. Patient summary We evaluated 23 women with bladder cancer who underwent surgical removal of the bladder with preservation of their reproductive organs. Following this surgery, a majority of patients resumed sexual activity. For selected patients, this technique can be performed without compromising cancer control.
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Checcucci E, Manfredi M, Sica M, Amparore D, De Cillis S, Volpi G, Granato S, Carbonaro B, Piramide F, Meziere J, Verri P, Piana A, Poggio M, Cossu M, Fiori C, Porpiglia F. Robot-assisted-radical-cystectomy with total intracorporeal Y neobladder: Analysis of postoperative complications and functional outcomes with urodynamics findings. Eur J Surg Oncol 2021; 48:694-702. [PMID: 34949495 DOI: 10.1016/j.ejso.2021.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe our robotic Y intracorporeal neobladder (ICNB) technique and to report its post-operative complications and urodynamics (UD) findings. SUBJECTS and Methods: In this prospective study we enrolled patients affected by MIBC (T1-T4N0-N1M0) from 01/2017 to 06/2021 at our Centers. All the patients underwent robotic radical cystectomy (RARC) with Y-ICNB reconfiguration. Early and late complications were collected and classified according to Clavien-Dindo. Continence and potency at 1, 3, 6 and 12 months were evaluated. At the 3rd month of follow-up patients underwent UD. Finally, in a retrospective match paired analysis the functional outcomes of Y RARC patients were compared with a cohort of open Y radical cystectomy. RESULTS 45 patients were enrolled. Overall 30-day complications were observed in 25 (55,5%) patients and 30 to 90-days complications in 4 (8,9%). 9 patients (20%) had Clavien ≥3 complications. UDs revealed median neobladder capacity of 268 cc, with a median compliance of 13 ml/cm H20; the voiding phase showed a voiding volume and a post void residual (PVR) of 154 cc and 105 cc respectively. At 12 months of follow-up 4.4%, 15.5% and 4.4% of the patients experienced urge, stress and mix urinary incontinence respectively. The comparison between Y RARC and Y open RC revealed a higher neobladder capacity with open approach (p = 0.049) with subsequent better findings during the voiding phase in terms of maximum flow (p = 0.002), voiding volume (p = 0.001) and PVR (p = 0.01). Focusing on continence recovery, a slight trend in favor of RARC was shown without reaching the statistical significance. CONCLUSIONS Robotic Y-ICNB is feasible and safe as shown by the low rate of postoperative complications. Satisfying UD functional outcomes are achievable, both during filling and voiding phase.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy.
| | - Matteo Manfredi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Gabriele Volpi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Beatrice Carbonaro
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Juliette Meziere
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Massimiliano Poggio
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Marco Cossu
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Bergamaschi L, Gerardi MA, Zaffaroni M, Augugliaro M, Vigorito S, Rondi E, Della Vigna P, Varano G, Fumagalli Romario U, Biffi R, Picardi EEE, Ferrari A, Jereczek-Fossa BA. Neobladder and ablative pelvic radiotherapy: still a taboo? Tumori 2021; 107:NP108-NP113. [PMID: 34235994 DOI: 10.1177/03008916211031295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The presence of a neobladder constitutes a limitation for the radiation oncologist, as there is no clear evidence about its tolerance to radiotherapy (RT). The limited literature only concerns the conventional postoperative treatment in patients with bladder cancer after cystectomy. Here we report a case of a patient with neobladder who underwent a stereotactic RT for a pelvic recurrence of disease, with response to treatment and no toxicity to the neobladder. This case represents a promising example of the chance to perform RT with ablative intent, using advanced techniques, even on lesions close to the neobladder.
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Affiliation(s)
- Luca Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Rondi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Interventional Radiology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Varano
- Interventional Radiology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Roberto Biffi
- Department of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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9
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Choi SY, Lim B, Chi BH, Kim JH, Lee W, You D, Kim CS. Hybrid ileal pouch with concomitant anti-refluxing and refluxing ureteroileal anastomosis. BMC Urol 2021; 21:92. [PMID: 34116662 PMCID: PMC8194180 DOI: 10.1186/s12894-021-00828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We report our preliminary experience of using a hybrid ileal pouch, assessing oncologic outcomes, complications, voiding, and renal function. METHODS The study included 25 patients with bladder cancer treated with radical cystectomy with a hybrid ileal pouch with concomitant anti-refluxing and refluxing anastomosis, performed by a single surgeon. The patients were divided into two groups (first and last cases) according to the surgery date. Postoperative complications, separate renal function by renal scan, voiding function by uroflowmetry with residual urine, and oncologic outcomes were assessed. RESULTS The surgery duration was shorter in the last cases than the first cases. The voiding volume increased with time. There were 23 cases of grade 3 complication in 12 patients and one case of grade 4 complication (sepsis). In the first cases, ureterovesical stenosis occurred in five cases, whereas in the last cases, there were no cases of stenosis. In separate renal function, there was no difference between the left and right side or between the first and last cases. CONCLUSIONS The hybrid ileal pouch showed acceptable oncologic and functional outcomes and complications; therefore, it can be used according to the appropriate surgical situation with a relatively short bowel segment during neobladder construction.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.,Biomedical Research Institute, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Byung Hoon Chi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Jung Hoon Kim
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - Wonchul Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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10
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Minervini A, Di Maida F, Tasso G, Mari A, Bossa R, Sforza S, Grosso AA, Tellini R, Vittori G, Siena G, Tuccio A, Masieri L, Carini M. Robot assisted radical cystectomy with Florence robotic intracorporeal neobladder (FloRIN): Analysis of survival and functional outcomes after first 100 consecutive patients upon accomplishment of phase 3 IDEAL framework. Eur J Surg Oncol 2021:S0748-7983(21)00483-2. [PMID: 34023169 DOI: 10.1016/j.ejso.2021.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Aim of the study was to evaluate the Florence intracorporeal neobladder (FloRIN) oncological and functional outcomes at the end of assessment phase (phase 3) IDEAL-Guidelines. MATERIALS AND METHODS This single-institution prospective series included consecutive patients treated with robot-assisted radical cystectomy (RARC) and FloRIN reconfiguration technique from February 2016 to June 2020. Functional features were evaluated six months after surgery. Patients were grouped into four quartiles according to time of radical cystectomy and impact of learning curve improvement was evaluated. RESULTS One-hundred FloRIN were completed with a median console time of 373 (IQR: 312-415) minutes. Two cases were converted to open surgery. No intraoperative complications occurred. At pathological examination, 30% of patients were staged as pT ≤ 1 and 47% as pT ≥ 3. Transitional cell carcinoma was present in 87% of cases. Carcinoma in situ (CIS) and nodal involvement were observed in 38% and 29% of patients, respectively. At a median follow-up time of 17 (IQR: 7-28) months, 20 clinically relevant events (Clavien-Dindo≥3) occurred. Operative time significantly decreased throughout the series (median minutes 435; 395; 365 and 330 in the four quartiles, respectively; p < 0.001). Similarly, early Clavien-Dindo≥3 postoperative complications rate significantly decreased across the series (number of events: 1; 4; 0; 0; p = 0.03). Overall, 75% and 65% of patients achieved day-time and nigh-time continence, respectively. Twenty-seven patients experienced disease recurrence. Cancer-specific and overall survival were equal to 80%. CONCLUSIONS RARC with FloRIN reconfiguration showed worthy functional and survival outcomes, with learning curve improvement significantly influencing operative time and early complications rate across series.
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11
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Sarrió Sanz P, Sánchez Caballero L, Pérez Tomás C, Nakdali Kassab B, Gómez Garberí M, Martínez Cayuelas L, Ortiz Gorraiz MÁ. [Metabolic alterations and stones in patients with orthotopic ileal diversions. Case description.]. ARCH ESP UROL 2021; 74:351-354. [PMID: 33818432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bacterial presence, anatomic anomalies and metabolic alterations increase the risk of stone formation in patients with neobladders. These patients sometimes require medical or surgical procedures. The aim of the current work is to analyze those alterations and medical treatment associated to it. METHODS: A case of a 66 yo male who had undergone a cystectomy with neobladder 3 years ago. Currently present with a staghorn stone on the right kidney. Past medical history of stone formation as well as double J calcification. RESULTS: The combination of medical and surgical treatment for stone was performed. Medical therapy will allow prevention of new stones. CONCLUSIONS: Metabolic and chronic infections in patients with neobladders treated should decreased the new stone formation in patients with neobladders.
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Affiliation(s)
- Pau Sarrió Sanz
- Servicio de Urología. Hospital Universitario San Juan de Alicante. España
| | | | - Carla Pérez Tomás
- Servicio de Urología. Hospital Universitario San Juan de Alicante. España
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12
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Abstract
OBJECTIVE To provide a narrative overview of contemporary surgical management of muscle-invasive bladder cancer with focus on radical cystectomy and urinary tract reconstruction. DATA SOURCES International guidelines and a search for articles in PubMed, Medline, and Cochrane Database for single and collaborative studies on surgical management of muscle-invasive bladder cancer. CONCLUSION Patients diagnosed with muscle invasive bladder cancer often have complex treatment and care needs. For those who undergo radical cystectomy as the curative treatment, there is a considerable risk of general complications after major surgery and short- and long-term complications specific to reconstruction of the urinary tract after radical cystectomy. Contemporary care focuses on perioperative optimization to lower rates of major complications, enhanced recovery protocols, and focus on rehabilitation and cancer survivorship. IMPLICATIONS FOR NURSING PRACTICE Nurses are integral members of the multidisciplinary team around patients undergoing surgery for muscle-invasive bladder cancer, and are in a position to coordinate pathways for these patients who often have complex care needs because of preexisting comorbidity and limited personal resources that impede recovery after major surgery and cancer survivorship.
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Affiliation(s)
- Ulla Nordström Joensen
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sophia Liff Maibom
- Department of Urology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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13
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Xu P, Chen B, Xu A, Yuan D, Zhang Y, Liu C. Initial Experience with Intracorporeal Laparoscopic Radical Cystectomy and Detaenial Sigmoid Neobladder Reconstruction. Eur Urol 2021; 79:545-51. [PMID: 33203548 DOI: 10.1016/j.eururo.2020.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intracorporeal urinary diversion is considered to be effective in improving intestinal function recovery and reducing the occurrence of early complications after radical cystectomy. Almost all neobladders constructed via intracorporeal laparoscopy have used the ileum. OBJECTIVE To present our intracorporeal detaenial sigmoid neobladder technique that replicates open surgery principles and to present oncological and functional outcomes and complication rates. DESIGN, SETTING, AND PARTICIPANTS This is a case series from a single tertiary referral hospital from September 11, 2018 to April 19, 2019, including 12 selected patients with pathologically confirmed muscle-invasive or refractory non-muscle-invasive bladder cancer. SURGICAL PROCEDURE Laparoscopic radical cystectomy including pelvic lymph-node dissection and intracorporeal detaenial sigmoid neobladder, which is demonstrated in the accompanying video. MEASUREMENTS Demographic, clinical, and pathological data were collected. Perioperative outcomes and 1-yr oncological and functional outcomes are reported. RESULTS AND LIMITATIONS All surgeries were successful without severe complications or conversion to open surgery. The mean operative time (± standard deviation) was 414.6 ± 52.2 min, with 33.8 ± 6.80 min for neobladder construction. Surgical margins and lymph nodes were all negative for metastasis. All patients were encouraged to do ambulation exercise 1 d after surgery, and oral liquid intake was resumed between days 2 and 4. However, because this was a retrospective study in a single centre with very few cases, it is difficult to reach a definitive conclusion. CONCLUSIONS Intracorporeal detaenial sigmoid neobladder is technically feasible with no need for additional medical equipment. Encouraging outcomes were observed during short-term follow-up. This approach could represent another alternative choice for patients undergoing laparoscopic radical cystectomy. Longer-term follow-up data are needed to evaluate oncological and functional outcomes. PATIENT SUMMARY We describe our stepwise technique for intracorporeal detaenial sigmoid neobladder while replicating established open surgery principles. In addition to retaining the advantages of a neobladder, better postoperative recovery is achieved.
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14
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Rocco B, Luciani LG, Collins J, Sanchez-Salas R, Adding C, Mattevi D, Hosseini A, Wiklund P. Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step. J Robot Surg 2021; 15:355-61. [PMID: 32602023 DOI: 10.1007/s11701-020-01108-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
A posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified posterior Rocco's repair involving the Denonvillier's fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck was performed. The steps are shown in a video at https://doi.org/10.1089/vid.2019.0029 . The primary outcome was urinary continence; the secondary outcomes were urinary leakage, intermittent catheterization, and complications related to the reconstructive steps. Eleven male patients with a median age and BMI of 67 years and 24, respectively, underwent RARC with PR associated to the neovesico-urethral anastomosis. Overall and posterior reconstruction time were 300' (195-320) and 6' (4-7), respectively. The daytime and nighttime continence rates were 100% and 44% at 12 months, respectively; the median pad weight was 3.5 g and 108 g at daytime and nighttime, respectively. One urinary leakage from the urethrovesical anastomosis was treated conservatively. Two patients perform intermittent catheterization. The posterior reconstruction during RARC is safe and feasible, providing good continence rates. It supported a careful suturing of the anastomosis as well as an uncomplicated catheter placement.
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15
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Maltagliati M, Milandri R, Bocchialini T, Graziotti P, Guarneri A, Naselli A. Validation of the effectiveness of a modified Studer orthotopic neobladder in a single center after 3 years of its application. Urologia 2020; 87:167-169. [PMID: 32567527 DOI: 10.1177/0391560320930115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVE In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively. MATERIALS AND METHODS In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the EAU guidelines. RESULTS We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4-1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease. CONCLUSION The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.
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Affiliation(s)
- Matteo Maltagliati
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Milandri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Bocchialini
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierpaolo Graziotti
- Department of Urology, San Giuseppe Hospital, Multimedica Group, Milan, Italy
| | - Andrea Guarneri
- Department of Urology, San Giuseppe Hospital, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Department of Urology, San Giuseppe Hospital, Multimedica Group, Milan, Italy
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Theodoridou E, Lolis ED, Vogiatzis N, Daskalakis K. Trauma laparotomy for the usual reasons, but for unusual causes. Trauma Case Rep 2020; 28:100318. [PMID: 32509955 PMCID: PMC7264757 DOI: 10.1016/j.tcr.2020.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
The impact of synchronous diseases or conditions on operative management of Trauma patients is not well established. In trauma patients, secondary diagnoses may complicate the treatment strategy and lead to changes in management and potentially outcomes. We present 5 unusual trauma cases and we discuss the difficulties and the outcomes we experienced in managing these patients.
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Affiliation(s)
- Eleni Theodoridou
- Department of General Surgery, General Hospital of Rethymno, Crete, Greece
| | - Evangelos D Lolis
- Department of General Surgery, General Hospital of Rethymno, Crete, Greece
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17
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Gaston R, Ramírez P. Intracorporeal neobladder. ARCH ESP UROL 2019; 72:309-317. [PMID: 30945658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE It is well known that RARC with intracorporeal diversion is being increasingly performed worldwide. In this article, we review the current situation of the intracorporeal neobladder. METHODS We discuss the principles of intracorporeal orhotopic diversion, focusing on the most relevant: The Karolinska-modified Studer neobladder, the University of Southern California-modified Studer neobladder. The pyramid pouch and the modified Y-shaped orthotopic neobladder. We also compare functional and perioperative outcomes from our series and the available studies regarding RARC and intracorporeal orthotopic diversion. RESULTS: Review of existing literature suggests that RARC with totally intracorporeal neobladder, in some cases, has improved operative, postoperative, and functional outcomes, becoming a safe and feasible alternative to ORC. CONCLUSIONS The results from the intraorporeal neobladders series appear to be promising, but high-quality randomized controlled trials comparing to ICUD to ECUD should be performed in order to define the advantages and disadvantages of totally intracorporeal urinary diversion and its future role in the treatment of invasive bladder cancer.
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18
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Wishahi M, Ismail MA, Elganzoury H, Elkholy A, Nour HH, Zayed AS, Eldahshan S. Genital-Sparing Cystectomy versus Standard Urethral-Sparing Cystectomy Followed with Orthotopic Neobladder in Women with Bladder Cancer: Incidence and Causes of Hypercontinence with an Ultrastructure Study of Urethral Smooth Muscles. Open Access Maced J Med Sci 2019; 7:978-981. [PMID: 30976344 PMCID: PMC6454182 DOI: 10.3889/oamjms.2019.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Bladder cancer in women is an indication for radical cystectomy (RC) when the tumour is confined muscle-invasive bladder cancer (MIBC) of T2 N0M0, or high risk progressive non-muscle invasive bladder cancer (NMIBC). Radical cystectomy is either genital-sparing cystectomy (GSC) or standard urethra-sparing cystectomy (USC) that is followed with orthotopic ileal neobladder (ONB). Post-operative chronic retention “Hypercontinence” had been reported in different series following URS or GSC and ONB. In long-term follow-up, we evaluated the functional outcome of women who developed hypercontinence after USC or GSC and ONB. AIM: An ultrastructure study of female urethral smooth muscle was done to elucidate the underlying causes of hypercontinence. MATERIAL AND METHODS: Retrospective study was conducted on 71 women who underwent RC and ONB, 45women had undergone USC, and 26 women had GSC, follow-up ranged from 5 to 15 years. Ultrastructure studies were done on 5 urethral biopsy specimens from 5 women who had hypercontinence, and 4 biopsies were from a normal control. RESULTS: Follow-up showed that women who had undergone USC and ONB, 28.88% developed hypercontinence, where in the series of GSC and ONB three women out of 26 developed hypercontinence (7.80%). Three women who had hypercontinence following USC and ONB, they developed stones in the ileal pouch. Ultrastructure study of urethral smooth muscles in women who had hypercontinence showed organized collagen fibrils, absent myelin sheath, and non-detected lymphatic vessels. Normal urethra showed collagen fibrils within the interstitial matrix, preserved myelin sheath of nerve fibres, the presence of lymphatic vessels in the matrix. CONCLUSION: The present study shoes that GSC with ONB leads to the minimal incidence of hypercontinence (7.80%), while standard USC lead to higher incidence (28.88%). Ultrastructure changes of the female urethra who had hypercontinence were fibrotic changes, loss of myelin sheath and minimal vascularity, their findings explains the underlying cause of hypercontinence and support the technique of GSC rather than the standard USC.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Mohamed A Ismail
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Hossam Elganzoury
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Amr Elkholy
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed S Zayed
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Samir Eldahshan
- Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt
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Schulz GB, Grimm T, Buchner A, Jokisch F, Kretschmer A, Casuscelli J, Ziegelmüller B, Stief CG, Karl A. Surgical High-risk Patients With ASA ≥ 3 Undergoing Radical Cystectomy: Morbidity, Mortality, and Predictors for Major Complications in a High-volume Tertiary Center. Clin Genitourin Cancer 2018; 16:e1141-e1149. [PMID: 30174234 DOI: 10.1016/j.clgc.2018.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate major complications and risk factors for adverse clinical outcome in surgical high-risk (American Society of Anesthesiologists [ASA] 3-4) patients undergoing radical cystectomy (RC) in a high-volume setting. PATIENTS AND METHODS A total of 1206 patients underwent RC between 2004 and 2017 in our institution and were included. We assessed complications graded by the Clavien-Dindo-Classification system (CDC) in addition to the 90-day mortality rate and stratified results by the ASA classification. In a multivariate analysis, risk factors for high-grade complications (CDC ≥ 3) were tested. Additionally, outcome parameters were compared between 2004 to 2010 and 2010 to 2017. RESULTS Patients with ASA ≥ 3 presented with more locally advanced tumors pT ≥ 3 (52.1% vs. 42.4%; P = .002) and positive lymphatic spread N1 (27.2% vs. 23.5%; P = .001) compared with patients with ASA ≤ 2. High-grade complications were significantly (P < .001) more prevalent in patients with ASA ≥ 3 compared with patients with ASA ≤ 2: CDC3 (14.6% vs. 9.4%), CDC4 (10.2% vs. 5.4%), and CDC5 (2.5% vs. 1.0%). The 90-day mortality rate (7.6% vs. 3.2%; P = .002) and perioperative reinterventions (23.5% vs. 13.1%; P < .001) were elevated in patients with ASA ≥ 3. ASA (odds ratio [OR], 2.701, 95% confidence interval [CI], 1.089-6.703; P = .032), previous abdominal operations (OR, 1.683; 95% CI, 1.188-2.384; P = .003), and body mass index ≥ 30 (OR, 1.533; 95% CI, 1.021-2.304; P = .039) proved to function as independent predictors for major complications. CDC ≥ 3 complications (31.7% vs. 24.3%; P = .029) and 90-day mortality (10.4% vs. 5.6%; P = .018) were significantly lower in the second half of the study period. CONCLUSIONS Mortality and morbidity in surgical high-risk patients with ASA 3 to 4 undergoing RC is about twice as high compared with patients with ASA 1 to 2. ASA, previous abdominal operations, and elevated body mass index independently predict adverse clinical outcome in patients with ASA 3 to 4. Our results may help to weigh the surgical risk of RC in multimorbid patients.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Voskuilen CS, Fransen van de Putte EE, Pérez-Reggeti JI, van Werkhoven E, Mertens LS, van Rhijn BWG, Saad M, Bex A, Cathelineau X, van der Poel HG, Horenblas S, Sanchez-Salas R, Meijer RP. Prostate sparing cystectomy for bladder cancer: A two-center study. Eur J Surg Oncol 2018; 44:1446-1452. [PMID: 29929902 DOI: 10.1016/j.ejso.2018.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess long-term functional and oncologic outcomes of prostate sparing cystectomy (PSC) as a sexuality-preserving alternative to radical cystectomy in a selected group of bladder cancer (BC) patients. MATERIALS AND METHODS Between 1995 and 2014, 185 BC patients underwent PSC according to one of two standardized procedures at two centers. All patients had received extensive evaluation to rule out prostate cancer and BC at the bladder neck and prostatic urethra (PU), including prostate specific antigen blood analysis, transrectal ultrasound and/or prostate biopsies, PU biopsies and/or PU frozen section analysis. All patients received an orthotopic ileal neobladder. Overall survival (OS) was assessed by Kaplan-Meier estimates. Cumulative incidence of cancer specific mortality, any recurrence and loco-regional recurrence were calculated using competing-risk methods. Finally, functional outcomes (voiding, continence and erectile function) were evaluated. RESULTS 185 patients (cTa-3N0M0) with a mean age of 57 years (SD: 9) were included. Median follow-up was 7.5 years (IQR: 5.6-10.8). Five-year OS was 71% and 5-year cumulative incidence of recurrence was 31%. Twenty patients (10.8%) had a loco-regional recurrence, two recurrences were in the PU. During follow-up, prostate cancer was detected in six patients (3.2%). Erectile function was preserved in 86.1% of patients, complete daytime and nighttime continence in 95.6% and 70.2%, respectively. CONCLUSION This two-center study shows that in men with BC in whom the prostate and PU were proven free of malignancy, PSC would represent a valid treatment option with excellent functional outcome. Oncologic outcomes were comparable to what is known from radical cystoprostatectomy series.
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Affiliation(s)
- Charlotte S Voskuilen
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands.
| | | | | | - Erik van Werkhoven
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Biostatistics, Amsterdam, The Netherlands
| | - Laura S Mertens
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands
| | - Mohamed Saad
- Institut Mutualiste Montsouris, Dept. of Urology, Paris, France
| | - Axel Bex
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands
| | | | - Henk G van der Poel
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands
| | - Simon Horenblas
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands
| | | | - Richard P Meijer
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands; University Medical Center Utrecht Cancer Center, Dept. of Urology, Utrecht, The Netherlands
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Moeen AM, Safwat AS, Gadelmoula MM, Moeen SM, Behnsawy HM, Shahat AA, Gadelkareem RA, Hameed DA, Hammouda HM. Does the site of the orthotopic neobladder outlet matter? A prospective randomized comparative study. Eur J Surg Oncol 2018; 44:847-852. [PMID: 29429598 DOI: 10.1016/j.ejso.2018.01.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. METHODS From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. RESULTS There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). CONCLUSION The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.
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Affiliation(s)
- Ahmed M Moeen
- Department of Urology, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | | | - Seham M Moeen
- Department of Anesthesiology and Intensive Care, Assiut University, Assiut, Egypt
| | | | | | | | - Diaa A Hameed
- Department of Urology, Assiut University, Assiut, Egypt
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Simone G, Tuderti G, Misuraca L, Anceschi U, Ferriero M, Minisola F, Guaglianone S, Gallucci M. Perioperative and mid-term oncologic outcomes of robotic assisted radical cystectomy with totally intracorporeal neobladder: Results of a propensity score matched comparison with open cohort from a single-centre series. Eur J Surg Oncol 2018; 44:1432-1438. [PMID: 29699838 DOI: 10.1016/j.ejso.2018.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/29/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
AIM In this study, we compared perioperative and oncologic outcomes of patients treated with either open or robot-assisted radical cystectomy and intracorporeal neobladder at a tertiary care center. METHODS The institutional prospective bladder cancer database was queried for "cystectomy with curative intent" and "neobladder". All patients underwent robot-assisted radical cystectomy and intracorporeal neobladder or open radical cystectomy and orthotopic neobladder for high-grade non-muscle invasive bladder cancer or muscle invasive bladder cancer with a follow-up length ≥2 years were included. A 1:1 propensity score matching analysis was used. Kaplan-Meier method was performed to compare oncologic outcomes of selected cohorts. Survival rates were computed at 1,2,3 and 4 years after surgery and the log rank test was applied to assess statistical significance between the matched groups. RESULTS Overall, 363 patients (299 open and 64 robotic) were included. Open radical cystectomy patients were more frequently male (p = 0.08), with higher pT stages (p = 0.003), lower incidence of urothelial histologies (p = 0.05) and lesser adoption of neoadjuvant chemotherapy (<0.001). After applying the propensity score matching, 64 robot-assisted radical cystectomy patients were matched with 46 open radical cystectomy cases (all p ≥ 0.22). Open cohort showed a higher rate of perioperative overall complications (91.3% vs 42.2%, p 0.001). At Kaplan-Meier analysis robotic and open cohorts displayed comparable disease-free survival (log-rank p = 0.746), cancer-specific survival (p = 0.753) and overall-survival rates (p = 0.909). CONCLUSIONS Robot-assisted radical cystectomy and intracorporeal neobladder provides comparable oncologic outcomes of open radical cystectomy and orthotopic neobladder at intermediate term survival analysis.
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Affiliation(s)
- Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Gabriele Tuderti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Francesco Minisola
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Michele Gallucci
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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23
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Ramachandra MN, Somani BK. Challenges of Retrograde Ureteroscopy in Patients with Urinary Diversion: Outcomes and Lessons Learnt from a Systematic Review of Literature. Urol Int 2018; 101:249-255. [PMID: 29614503 DOI: 10.1159/000488325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/09/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Retrograde ureteroscopy (URS) can be safely and successfully performed in patients who have had previous urinary diversion (UD). With broadening indications and advances in technology, URS can be used in complex cases. In this review article, we have summarized the relevant published literature regarding the outcomes and challenges encountered during retrograde URS in patients with UD. MATERIALS AND METHODS We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on retrograde URS from inception to September 2017. A literature search was conducted through MEDLINE, EMBASE, CINAHL, and Cochrane library for all English language articles. RESULTS Our literature search identified 6 retrospective studies. In total, 125 patients with a mean age of 67 years (range 28-90 years) underwent retrograde URS (190 procedures) after UD for diagnostic and therapeutic purposes. The main indications included upper urinary tract filling defects (due to either intrinsic pathology or extrinsic compression), strictures due to ureteral thickening, stone disease, and surveillance for suspected malignancy. The success rate and complications across the studies varied from 56 to 80% and 0 to 44% respectively, with most complications being Clavien I in nature. CONCLUSION Retrograde URS can be technically challenging due to ureteric cannulation, strictures, and anatomical variations. However, there is very little evidence currently available on this topic with data based on retrospective case series. In experienced hands, it seems to be relatively successful with a low risk of major complications.
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Abstract
Approximately 1 in 5 new cases of clinically localized bladder cancer is muscle invasive and requires the patient to choose from 1 of 2 prevailing options for treatment: radical cystectomy or radiation to the bladder. However, these treatments are associated with detrimental effects on patient well-being and quality of life, particularly with respect to functional independence, urinary and sexual function, social and emotional health, body image, and psychosocial stress. Compared with the literature on other malignancies like breast or prostate cancer, high-quality studies evaluating the effects of bladder cancer treatment on quality of life are lacking.
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Affiliation(s)
- Mark D Tyson
- Department of Urology, Mayo Clinic Arizona, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA
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25
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Abstract
Orthotopic neobladder is a viable option for women undergoing cystectomy for bladder cancer, with excellent oncologic outcomes and a low incidence of urethral recurrence. Careful patient selection is important, as is developing a clear understanding by the patient and her family in what to expect with an orthotopic diversion. Surgical technique is also important in optimizing functional outcomes, such as continence, sexual function, and decreased rate of vaginal fistula formation, and urinary retention.
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Affiliation(s)
- Dimitar V Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford University Hospital and Clinics, 300 Pasteur Drive, Room S287, Stanford, CA 94304, USA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford University Hospital and Clinics, 300 Pasteur Drive, Room S287, Stanford, CA 94304, USA.
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Abstract
It has been known that urinary diversions juxtaposing the urinary and intestinal tracts lead to increased incidence of secondary malignancies. Although tumorigenesis in ureterosigmoidostomies follows the typical course from adenomas to adenocarcinomas, secondary malignancies arising from isolated intestinal diversions are much more heterogeneous. Research over the last half century has unveiled patterns of incidence and progression, while also uncovering possible mechanisms driving the neoplastic changes. In this review, we summarize the current understanding of these unique tumors, with the hope that the knowledge gained may shed light on the etiologies of other cancers arising from the urinary and intestinal tracts.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
| | - Janet E Baack Kukreja
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA.
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Sakhri L, Pinsolle J, Moro-Sibilot D, Pluchart H. Unusually prolonged pemetrexed cytotoxicity in a patient with a lung adenocarcinoma: a case report. J Med Case Rep 2017; 11:262. [PMID: 28915906 PMCID: PMC5603063 DOI: 10.1186/s13256-017-1436-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/27/2017] [Indexed: 01/05/2023] Open
Abstract
Background We describe a case of pemetrexed toxicities related to reabsorption by an ileal neobladder, which caused prolonged hematotoxicity and nephrotoxicity. Case presentation A 59-year-old white man was diagnosed with metastatic wild-type adenocarcinoma of the upper lobe of his right lung. After a first cycle of cisplatin and pemetrexed, he had unusually prolonged aplasia and acute kidney injury. The prolonged aplasia was caused by pemetrexed reabsorption by the ileal mucosa of the neobladder as pemetrexed was eliminated renally in an active form and is partly lipophilic. Conclusions Pemetrexed may be reabsorbed by the ileal mucosa of the neobladder because of its hydrophobic structure and renal excretion in its active form. Acute urinary retention may maintain this phenomenon. Published data excluded a potential role for cisplatin in this toxicity; furthermore, we could not assess pemetrexed concentrations in the blood or urine as these assay techniques are not validated. Thus, care is needed when giving chemotherapy to patients with a neobladder.
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Affiliation(s)
- Linda Sakhri
- Institut de Cancérologie Daniel Hollard, Groupe Hospitalier Mutualiste, 124 rue d'Alembert, 38000, Grenoble, France.
| | - Julian Pinsolle
- UM Oncologie Thoracique, Clinique de pneumologie, Pôle Thorax et vaisseaux, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
| | - Denis Moro-Sibilot
- UM Oncologie Thoracique, Clinique de pneumologie, Pôle Thorax et vaisseaux, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
| | - Hélène Pluchart
- UM Pharmacie Clinique, Pôle Pharmacie, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
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Cerruto MA, D'Elia C, Siracusano S, Porcaro AB, Cacciamani G, De Marchi D, Niero M, Lonardi C, Iafrate M, Bassi P, Belgrano E, Imbimbo C, Racioppi M, Talamini R, Ciciliato S, Toffoli L, Rizzo M, Visalli F, Verze P, Artibani W. Is Health-Related Quality of Life after Radical Cystectomy Using Validated Questionnaires Really Better in Patients with Ileal Orthotopic Neobladder Compared to Ileal Conduit: A Meta-Analysis of Retrospective Comparative Studies. Curr Urol 2017; 10:57-68. [PMID: 28785189 DOI: 10.1159/000447153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/11/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires. MATERIALS AND METHODS Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement. RESULTS The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized. CONCLUSION This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.
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Affiliation(s)
| | | | | | | | | | | | - Mauro Niero
- TESIS Department, University of Verona, Verona
| | | | | | | | | | - Ciro Imbimbo
- Urology Department, University of Naples, Naples
| | - Marco Racioppi
- Urology Department, Catholic University Policlinico Gemelli, Rome
| | - Renato Talamini
- Unit of Epidemiology and Biostatistics, IRCCS-CRO, Aviano, Italy
| | | | | | | | | | - Paolo Verze
- Urology Department, University of Naples, Naples
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Kanashiro A, Gaya JM, Palou J, Gausa L, Villavicencio H. Robot-assisted radical cystoprostatectomy: Analysis of the complications and oncological and functional aspects. Actas Urol Esp 2017; 41:267-273. [PMID: 27769597 DOI: 10.1016/j.acuro.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. MATERIALS AND METHODS From 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumours and on 30 due to high-risk nonmuscle-invasive tumours. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. RESULTS The mean blood loss was 300mL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3-33). Pathology revealed 16 pT0, 15 pTis,-pT1-pTa and 44 muscle-invasive tumours, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1-2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. CONCLUSIONS Robot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications.
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Affiliation(s)
- A Kanashiro
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J M Gaya
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
| | - L Gausa
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - H Villavicencio
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
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30
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Dal Moro F. "Vesica Patavina" (lat.). J Robot Surg 2017; 11:289-290. [PMID: 28361406 DOI: 10.1007/s11701-017-0696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/19/2017] [Indexed: 11/30/2022]
Abstract
After the initial simulation, we started performing Ves.Pa. on human patients. We can confirm that the technique is more rapid than others, and easy to perform with a totally intracorporeal robotic approach.
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Affiliation(s)
- Fabrizio Dal Moro
- Department of Surgical, Oncological and Gastroenterological Sciences-Urology, University of Padova, Via Giustiniani 2, 35126, Padova, Italy.
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31
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Bangash HK, McCombie SP, Bangash OK, Hayne D. Neobladder Obstruction: A Non-ischemic Cause for Hepatic Portal Venous Gas: Case Report. Urol Case Rep 2017; 12:31-33. [PMID: 28316934 PMCID: PMC5345954 DOI: 10.1016/j.eucr.2017.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022] Open
Abstract
Hepatic portal venous gas (HPVG) is a rare ominous radiological sign usually indicative of mesenteric ischemia. Increased detection of HPVG has been associated with a growing number of non-ischemic causes. A 64-year-old gentleman following radical cystectomy and neobladder formation developed clinical signs suggestive of bowel obstruction. HPVG was demonstrated on abdominal imaging. Urgent laparotomy revealed no evidence of ischemia. We hypothesize an obstructed neobladder permitted gas to enter the mesenteric circulation. The patient made a complete recovery with supportive management.
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Affiliation(s)
| | | | - Omar K Bangash
- School of Surgery, University of Western Australia, Perth, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Perth, Australia; School of Surgery, University of Western Australia, Perth, Australia
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Abstract
Radical cystectomy remains the gold standard treatment for organ-confined high-grade recurrent or muscle-invasive bladder cancer. Orthotopic neobladder urinary diversion following cystectomy represents an option for patients wishing for continent urinary diversion. Female patients who undergo radical cystectomy with orthotopic bladder substitution are at risk for developing both common and neobladder-specific disorders of the pelvic floor, including urinary incontinence, hypercontinence, vaginal prolapse, and neobladder-vaginal fistula. Each of these sequelae can have significant impact on the patient's quality of life. Due to the increased frequency of orthotopic neobladder creation in women, subspecialty urologists are more likely to confront such pelvic floor disorders in bladder cancer survivors. This review presents the most current information on the treatment of pelvic floor disorders after orthotopic bladder substitution.
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Hoogenkamp HR, Pot MW, Hafmans TG, Tiemessen DM, Sun Y, Oosterwijk E, Feitz WF, Daamen WF, van Kuppevelt TH. Scaffolds for whole organ tissue engineering: Construction and in vitro evaluation of a seamless, spherical and hollow collagen bladder construct with appendices. Acta Biomater 2016; 43:112-121. [PMID: 27424084 DOI: 10.1016/j.actbio.2016.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The field of regenerative medicine has developed promising techniques to improve current neobladder strategies used for radical cystectomies or congenital anomalies. Scaffolds made from molecularly defined biomaterials are instrumental in the regeneration of tissues, but are generally confined to small flat patches and do not comprise the whole organ. We have developed a simple, one-step casting method to produce a seamless large hollow collagen-based scaffold, mimicking the shape of the whole bladder, and with integrated anastomotic sites for ureters and urethra. The hollow bladder scaffold is highly standardized, with uniform wall thickness and a unidirectional pore structure to facilitate cell infiltration in vivo. Human and porcine bladder urothelial and smooth muscle cells were able to attach to the scaffold and maintained their phenotype in vitro. The closed luminal side and the porous outside of the scaffold facilitated the formation of an urothelial lining and infiltration of smooth muscle cells, respectively. The cells aligned according to the provided scaffold template. The technology used is highly adjustable (shape, size, materials) and may be used as a starting point for research to an off-the-shelf medical device suitable for neobladders. STATEMENT OF SIGNIFICANCE In this study, we describe the development of a simple, one-step casting method to produce a seamless large hollow collagen-based scaffold mimicking the shape of the whole bladder with integrated anastomotic sites for ureters and urethra. The hollow bladder scaffold is highly standardized with uniform wall thickness and a unidirectional pore structure to facilitate cell infiltration in vivo. The closed luminal surface and the porous exterior of the scaffold facilitated the formation of a urothelial lining and infiltration of smooth muscle cells, respectively. The applied technology is highly adjustable (shape, size, materials) and can be the starting point for research to an off-the-shelf medical device suitable for neobladders.
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Kawamoto B, Honda M, Iwamoto H, Morizane S, Hikita K, Takenaka A. Urothelial Carcinoma Recurrence at an Ileal Orthotopic Neobladder and Unilateral Lower Ureter After Surgery. Urol Case Rep 2016; 9:27-9. [PMID: 27656417 PMCID: PMC5030330 DOI: 10.1016/j.eucr.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/30/2016] [Accepted: 08/12/2016] [Indexed: 11/28/2022] Open
Abstract
The recurrence of urothelial carcinoma in an orthotopic neobladder is rare. We report the case of a 61-year-old man with a muscle-invasive bladder tumor that was treated using radical cystectomy and the creation of a Studer's orthotopic neobladder. However, nine years after the cystectomy, we detected a mass at the left ureteroileal anastomosis. We successfully performed Studer's neobladder resection, urethrectomy, and left nephroureterectomy to remove the entire mass. Pathological examination revealed urothelial carcinoma with adenocarcinoma in the neobladder and adenocarcinomatous metastasis in the mesenteric lymph node.
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Affiliation(s)
- Bunya Kawamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Abstract
Radical cystectomy and urinary diversion are a challenge for patients. Requirements for the successful participation of the patient are sufficient urinary diversion management and recuperation/recovery as the result of urological rehabilitation. A social medical assessment reviews the individual oncological prognosis and the rehabilitation results to determine the return to work.
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Affiliation(s)
- D-H Zermann
- Fachklinik für Urologie, Uroonkologie und Nephrologie, Rehabilitationszentrum Vogtland-Klinik Bad Elster, Forststraße 3, 08645, Bad Elster, Deutschland. .,Deutsche Akademie für Kurortwissenschaften und Rehabilitationsmedizin e. V., Bad Elster, Deutschland.
| | - W Vahlensieck
- Fachklinik für Urologie, Kurpark-Klinik, Bad Nauheim, Deutschland
| | - W Hoffmann
- Klinik Park-Therme, Badenweiler, Deutschland
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Kubota H, Takahashi S, Monzawa S, Yuasa N, Endo T, Miura T, Yuen K, Yamashita M. Pictorial review of orthotopic neobladder reconstruction: indication, normal postsurgical anatomy, and complications. Abdom Radiol (NY) 2016; 41:356-67. [PMID: 26867922 DOI: 10.1007/s00261-015-0576-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radical cystectomy with urinary diversion is a common urological procedure performed for the treatment of bladder cancer. Numerous surgical procedures have been developed for urinary diversion. Over the past decade, orthotopic neobladder reconstruction has been used frequently for urinary diversion because of its advantageousness in providing patients with a good quality of life compared with other urinary diversion technique. Knowledge of the indication, surgical procedure, and postsurgical anatomy of orthotopic neobladder reconstruction is essential. While the technique has many advantages, multiple postsurgical complications may occur after reconstruction, including urine leakage, bowel obstruction and fluid collection (lymphocele, urinoma, hematoma, and abscess), neobladder rupture, vesicoureteral reflux, hydronephrosis, urinary tract infection, urinary calculi, abdominal incisional hernia, bowel obstruction, intraneobladder tumor, and tumor recurrence. Radiological imaging including multiple modalities such as intravenous urography, cystography, CT, and MRI plays an important role in the postoperative evaluation of patients with orthotopic neobladder reconstruction and is an accurate method for evaluating complications. In addition, knowledge of appearances on multimodal imaging helps clinicians to select the modality required to achieve an accurate diagnosis of each complication and avoid misdiagnosis.
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Tao S, Long Z, Zhang XJ, Chen SS, Zhu D, Shi XJ, Tan WL. Ileal versus sigmoid neobladder as bladder substitute after radical cystectomy for bladder cancer: A meta-analysis. Int J Surg 2016; 27:39-45. [PMID: 26804352 DOI: 10.1016/j.ijsu.2016.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/10/2016] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate and compare the functional outcomes of ileal and sigmoid neobladders in patients underwent radical cystectomy. METHODS Relevant studies were identified by searching PubMed, Embase, and Cochrane Library. The studies comparing the functional outcomes of sigmoid neobladder (SN) and ileal neobladder (IN) in patients underwent radical cystectomy were included. RESULTS A total of 12 cohort studies were included in this meta-analysis. From our analysis, more early complications were observed in SN group than in IN group (RR = 1.37, 95% CI: 1.03-1.81). Both daytime and nighttime continence rates were significantly better in IN group than in SN group (RR = 0.87, 95%CI: 0.81-0.94) (RR = 0.73, 95%CI: 0.60-0.90). More patients could spontaneous voiding in SN group than in IN group (RR = 1.12, 95%CI: 1.00-1.26). According to the urodynamic study, ileal neobladder exhibited bigger capacity (WMD = -84.93, 95%CI: -160.36 to -9.50), lower pressure at capacity (WMD = 11.18, 95%CI: 4.29-18.06), better compliance (WMD = -25.55, 95%CI: -32.45 to -18.64), and greater post-void residual volume(WMD = -23.48, 95%CI: -36.75 to -10.21); There was no significant difference in the max voiding flow rate or void volume between the two groups (WMD = -1.00, 95%CI: -3.73-1.73) (WMD = -27.00, 95%CI: 70.05-16.06). No significant difference was found in the serum creatinine between the two groups (WMD = -0.05, 95%CI: -0.12-0.03). CONCLUSIONS Ileal neobladder seems able to provide more favorable patient's satisfaction, while sigmoid neobladder may provide a better chance of spontaneous voiding. This meta-analysis may provide some useful evidences for urological surgeons to choose the ideal bladder substitute for patients underwent radical cystectomy.
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Affiliation(s)
- Sha Tao
- Department of Urology, People's Hosptial of Xuancheng City, Xuancheng, An hui, China
| | - Zhaolin Long
- Department of Urology, Shunde First People's Hospital Affiliated to Southern Medical University, Guangdong, China
| | - Xin-Ji Zhang
- Department of Urology, Shunde First People's Hospital Affiliated to Southern Medical University, Guangdong, China
| | - San-San Chen
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dajian Zhu
- Department of Urology, Shunde First People's Hospital Affiliated to Southern Medical University, Guangdong, China
| | - Xiao-Jun Shi
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wan-Long Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Gil-Sousa D, Oliveira-Reis D, Cavadas V, Oliveira M, Soares J, Fraga A. Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis. Urol Case Rep 2015; 3:74-6. [PMID: 26793507 DOI: 10.1016/j.eucr.2015.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 12/01/2022] Open
Abstract
Studer's neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studer's orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.
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39
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Kalra R, Reyad A, Gordon D, Verna D, Youssef Y. Case Report: A Neocystostomy Perforation Presenting as a Gallstone. Urol Case Rep 2015; 3:146-8. [PMID: 26793533 DOI: 10.1016/j.eucr.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/26/2015] [Indexed: 11/22/2022] Open
Abstract
An 83-year-old man, with a surgical history of radical cystectomy with simultaneous construction of a neobladder 13 years ago, presented clinically and radiologically as acute cholecystitis. Upon emergent exploratory laparotomy for his acute deterioration, a perforated neobladder was identified with its spilled stones in the gallbladder fossa, mimicking acute cholecystitis. This is the first case report of this presentation. Neobladder perforations should be considered in any patient who has undergone orthotopic bladder substitution, no matter how long it has been since the original reconstruction.
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40
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Morganstern BA, Greenblatt LB, Yaskiv O, Steckel J. Tubulovillous Adenoma in a Urethral Neobladder Anastomosis. Urol Case Rep 2016; 3:209-10. [PMID: 26793555 PMCID: PMC4714311 DOI: 10.1016/j.eucr.2015.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
We present a case of a tubulovillous adenoma arising in a neobladder that was managed by cystoscopic resection. A 64 year-old male underwent a cystectomy with creation of an ileocolic neobladder urinary diversion for T2 urothelial carcinoma of the bladder. Nine years following his surgery, the patient noted several episodes of gross hematuria. Cystoscopic evaluation revealed the rare occurrence of a 3 cm tubulovillous adenoma with high-grade dysplasia at the neck of the neobladder.
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Affiliation(s)
- Bradley A Morganstern
- The Arthur Smith Institute for Urology, 450 Lakeville Road, Suite M41, New Hyde Park, NY 11042, USA
| | - Logan B Greenblatt
- The Arthur Smith Institute for Urology, 450 Lakeville Road, Suite M41, New Hyde Park, NY 11042, USA
| | - Oksana Yaskiv
- Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System, 6 Ohio Drive, Suite 202, Lake Success, NY 11042, USA
| | - Joph Steckel
- The Arthur Smith Institute for Urology, 450 Lakeville Road, Suite M41, New Hyde Park, NY 11042, USA
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41
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Mateo E, García-Tello A, Ramón de Fata F, Romero I, Núñez-Mora C, Angulo JC. A comparative study between open and laparoscopic approach in radical cystectomy with orthotopic ileal neobladder. Actas Urol Esp 2015; 39:92-7. [PMID: 25015318 DOI: 10.1016/j.acuro.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Probably, laparoscopic radical cystectomy with ileal neobladder and neovesicourethral anastomosis is one of the most complex procedures in minimally invasive surgery. MATERIAL AND METHODS Prospective study carried out in 72 patients surgically treated for invasive bladder neoplasia between January 2008 and October 2013. Patients were undergone to radical cystectomy with ileal neobladder (open approach in 33 patients and laparoscopic approach in 39). The study assessed comparatively surgical outcomes, continence rate and postoperative complications. RESULTS Mean age was 63.5±9 years (64.3 open vs. 62.7 laparoscopic, P=.46) mean surgery time 323.6±78.7 minutes (321.3 vs. 326.5, P=.77), average hospital stay 14.8 days±8,1 (16.2 vs. 13.6, P=.2), transfusion rate 40.3% (66.7% vs. 17.9%, P<.0001) and complications rate 47.2% (63.6% vs. 33.3%, P=.01). Major complications were reported in 29.1% of cases (39.4% open vs. 20,5% laparoscopic, P=.07). With a mean follow-up rate of 42.5±19.2 months (range 15-70), 50 (69.4%) patients remain alive and free of disease. Continence was evaluated in these patients: total continence rate was 38% (50% vs. 27%, P=.09) and diurnal continence rate 58% (70.8% vs. 46.1%, P=.07). Self-catheterization rate was 8% (4.2% vs. 11.5%, P=.67). Total incontinence rate was 34% (25% vs. 42.3%, P=.19). CONCLUSION According to our experience, transfusion rate, number and severity of complications are lower in laparoscopic cystectomy with ileal neobladder. No statistically significant impact on operative time and on hospital stay was observed. In patients undergone to laparoscopic approach, continence rate is lower but not statistically significant.
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42
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Stewart D, Inouye BM, Goldstein SD, Shah BB, Massanyi EZ, DiCarlo H, Kern AJ, Tourchi A, Baradaran N, Gearhart JP. Pediatric surgical complications of major genitourinary reconstruction in the exstrophy-epispadias complex. J Pediatr Surg 2015; 50:167-70. [PMID: 25598117 DOI: 10.1016/j.jpedsurg.2014.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Urinary continence is the goal of exstrophy-epispadias complex (EEC) reconstruction. Patients may require a continent urinary diversion (CUD) if they are a poor candidate for bladder neck reconstruction or are receiving an augmentation cystoplasty (AC) or neobladder (NB). This study was designed to identify the incidence of surgical complications among various bowel segments typically used for CUD. METHODS A prospectively kept database of 1078 patients with EEC at a tertiary referral center from 1980 to 2012 was reviewed for major genitourinary reconstruction. Patient demographics, surgical indications, perioperative complications, and outcomes were recorded. RESULTS Among reviewed EEC patients, 134 underwent CUD (81 male, 53 female). Concomitant AC was performed in 106 patients and NB in 11. Median follow up time after initial diversion was 5 years. The most common CUD bowel segments were appendix and ileum. The most common surgical complications after CUD were small bowel obstruction, post-operative ileus, and intraabdominal abscess. There was a significantly increased risk in the occurrence of pelvic or abdominal abscess when colon was used as a conduit compared to all other bowel segments (OR=16.7, 95% CI: 1.16-239) and following NB creation compared to AC (OR=39.4, 95% CI: 3.66-423). At postoperative follow-up, 98% of patients were continent of urine via their stoma. CONCLUSION We report the largest series to date examining CUD in the EEC population. The increased risk of abdominal and pelvic abscesses in patients who receive a colon CUD and undergo NB compared to AC indicates that while surgical complications following major genitourinary reconstruction are rare, they do occur. Practitioners must be wary of potential complications that are best managed by a multi-disciplinary team approach.
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Affiliation(s)
- Dylan Stewart
- The Johns Hopkins University School of Medicine, Division of Pediatric Surgery, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Baltimore, MD 21287
| | - Brian M Inouye
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Seth D Goldstein
- The Johns Hopkins University School of Medicine, Division of Pediatric Surgery, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Baltimore, MD 21287
| | - Bhavik B Shah
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Eric Z Massanyi
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Heather DiCarlo
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Adam J Kern
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Ali Tourchi
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Nima Baradaran
- Medical University of South Carolina, Department of Urology, 171 Ashley Ave, Charleston, SC 29425
| | - John P Gearhart
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
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Cano Megías M, Muñoz Delgado EG. Bone and metabolic complications of urinary diversions. ACTA ACUST UNITED AC 2014; 62:100-5. [PMID: 25481805 DOI: 10.1016/j.endonu.2014.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
Hyperchloremic metabolic acidosis is a complication of urinary diversion using ileum or colon. Its prevalence ranges from 25% and 46% depending on the procedure used and renal function of the patient. It is a consequence of intestinal fluid and electrolyte exchange between intestinal mucosa and urine. The main mechanism is absorption of ammonium and chloride from urine. Long-term chronic metabolic acidosis in these patients may lead to impaired bone metabolism and osteomalacia. Regular monitoring of pH, chlorine, bicarbonate, and calcium-phosphorus metabolism is therefore essential for early diagnosis and treatment.
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Affiliation(s)
- Marta Cano Megías
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - Eva Golmayo Muñoz Delgado
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Collins JW, Sooriakumaran P, Sanchez-Salas R, Ahonen R, Nyberg T, Wiklund NP, Hosseini A. Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience. Indian J Urol 2014; 30:307-13. [PMID: 25097318 PMCID: PMC4120219 DOI: 10.4103/0970-1591.134251] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation. Materials and Methods: Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates. Results: The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women. Conclusions: Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.
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Affiliation(s)
- Justin W Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - P Sooriakumaran
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden ; Department of Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Sanchez-Salas
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - R Ahonen
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - T Nyberg
- Department of Oncology and Pathology, Section of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - N P Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - A Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
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45
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Miyake H, Furukawa J, Sakai I, Muramaki M, Yamashita M, Inoue TA, Fujisawa M. Orthotopic sigmoid vs. ileal neobladders in Japanese patients: a comparative assessment of complications, functional outcomes, and quality of life. Urol Oncol 2011; 31:1155-60. [PMID: 22153716 DOI: 10.1016/j.urolonc.2011.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/02/2011] [Accepted: 11/03/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the clinical outcomes of sigmoid and ileal neobladders (NBs) created following radical cystectomy. MATERIALS AND METHODS This study included 90 and 144 Japanese patients undergoing radical cystectomy and orthotopic NB reconstruction with a sigmoid and ileal segment, respectively. Postoperative clinical outcomes between the sigmoid and ileal NB groups (SNBG and INBG) were compared. RESULTS In this series, 110 early and 51 late complications occurred in 71 and 41 patients, respectively; however, there was no significant difference in the incidence of complications between SNBG and INBG. At 1 year postoperatively, there were no significant differences in the proportion of spontaneous voiders and the continence status between these 2 groups; however, despite the lack of significant differences in the maximal flow rate and voided volume, the post-void residual in SNBG was significantly smaller than that in INBG. Voiding functional outcomes at 5 years postoperatively were also obtained from 28 and 49 in SNBG and INBG, respectively. Although there were no significant changes in the functional outcomes in SNBG, the proportion of spontaneous voiders and post-void residual in INBG at 5 years postoperatively were significantly poorer than those at 1 year postoperatively. Furthermore, the postoperative health-related quality of life assessed by a Short-Form 36 survey did not show any significant differences in all 8 scores between these 2 groups. CONCLUSIONS Both types of NB reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function, particularly that on long-term follow-up, in SNBG appeared to be more favorable than that in INBG.
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Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
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