Cystectomy and orthotopic ileal neobladder in a male patient 12�years after kidney transplantation; good preservation of the renal function

Summary Renal transplant recipients with high‐risk bladder cancer following cystectomy need a urinary diversion preserving the renal function and possibly maintaining body image, while still offering the best oncological outcome. The aim of this report is to describe our experience of radical cystectomy and orthotopic ileal neobladder with Studer technique in this population, and to review the literature. We performed radical cystectomy and Studer ileal neobladder in four male patients (median age 67 years) after median time of 9.5 years following renal transplantation. Pathology revealed pT1HGN+ transitional cell carcinoma in one case, pT1HGN0 in two and pT3aHGN0 in one. Two patients presenting aggressive disease (N+ and pT3a) died of tumour progression after 20 and 14 months, respectively, while the other two are alive after 56 and 36 months of follow‐up with no evidence of disease, stable serum creatinine (2.29 and 1.6 mg/dl) and mild metabolic acidosis. Day and night‐time urinary continence were satisfactory in all patients. Good functional outcomes have been reported in the 20 cases of ileal orthotopic neobladder with different techniques published so far and the global experience of 24 cases with a median follow‐up of 39 months documents a cancer specific survival of 62.5%.

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“…Radical cystectomy and Studer orthotopic ileal neobladder were performed as previously described ( Fig. 1) [4].…”

Section: Discussionmentioning

confidence: 99%

Orthotopic bladder substitute in renal transplant recipients: experience with Studer technique and literature review

Manassero¹,

Paola²,

Mogorovich³

et al. 2011

Transplant International

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Long-term results of standard procedures in urology: the ileal neobladder

et al. 2006

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Over the past 20 years orthotopic urinary reconstruction with the techniques developed at Ulm and Bern has become a widely accepted form of urinary diversion. So far, both centers together have performed more than 1,300 orthotopic bladder substitutions with an overall rate of neobladder formation in 58% of all cystectomized patients. Today, the absolute contraindications for this procedure are urinary stress incontinence, damaged rhabdosphincter, severely impaired renal and liver function, severe intestinal diseases or an oncologic situation requiring urethrectomy. In patients treated for transitional cell carcinoma of the bladder, the rate of urethral recurrence in both centers was 1.5 and 5%, respectively, and the rate of upper urinary tract recurrence was 2-3%. Local tumor recurrence usually did not affect neobladder function. The rate of outlet obstruction by local recurrence was 2%, that of gross hematuria 1%, and of entero-reservoir fistulas 1-2%. Daytime continence at 12 months was 92%, while nighttime continence was lower around 80%. Transient or permanent urinary retention was seen in 11-12% of male patients. In both series, long-term upper urinary tract safety was good. The risk of stenoses of the uretero-intestinal anastomosis with consecutive loss of renal function decreased with the introduction of non-refluxing implantation techniques. The rate of long-term metabolic complications remains low when adequate substitution with sodium bicarbonate is guaranteed in patients with impaired renal function. Patient selection and meticulous postoperative follow-up contributed to achieve good long-term results after cystectomy and orthotopic ileal neobladder substitution of the two large series of patients from the Universities of Ulm and Bern.

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Cystectomy and orthotopic ileal neobladder in a male patient 12�years after kidney transplantation; good preservation of the renal function

Cited by 2 publications

References 13 publications

Orthotopic bladder substitute in renal transplant recipients: experience with Studer technique and literature review

Orthotopic bladder substitute in renal transplant recipients: experience with Studer technique and literature review

Long-term results of standard procedures in urology: the ileal neobladder

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