Experience in 100 Patients with an Ileal Low Pressure Bladder Substitute Combined with an Afferent Tubular Isoperistaltic Segment

Abstract

Between April 1985 and April 1993, 100 consecutive men underwent lower urinary tract reconstruction after cystectomy. An ileal low pressure reservoir using the Goodwin cup-patch principle was combined with an afferent ileal tubular segment. The early complication rate was 11%, including 2 postoperative deaths due to septicemia. After a median followup of 27 months (range 3 to 96) 14 patients required surgery for late complications (intestinal obstruction, urethral stricture or tumor recurrence, hernia or ureteral stenosis). A total of 32 patients died of metastatic bladder cancer and 7 died of other causes. The functional capacity of the bladder substitute was increased to the desired 450 to 500 ml. after 3 to 12 months, which was paralleled by improving urinary continence. After 1 year 92% of the patients were continent by day and after 2 years 80% were continent at night. Upper tract surveillance with excretory urography, renal ultrasound and serum creatinine estimation has shown 4 left ureteral strictures but not significant upper tract deterioration or ureteral recurrence. Significant reflux was not observed during video urodynamics unless the reservoir was overfilled. During voiding, by outlet relaxation and straining if necessary, the intra-abdominal pressure increase with straining acted equally on the reservoir and ureters. Therefore, unlike voiding with a normal bladder, no isolated intravesical pressure increase occurred and, thus, there was no reflux from the reservoir. The combination of an ileal low pressure reservoir with an afferent isoperistaltic ileal segment and an open end-to-side ureteroileal anastomosis allows for radical cancer surgery with resection of the ureters where they cross the iliac vessels and minimizes the risk of ureteral stenosis. The unidirectional peristalsis of the ureters and the afferent tubular ileal segment seem to protect the upper urinary tract sufficiently. The surgical technique is straightforward and allows for later conversion to an ileal conduit if necessary. The functional results of the bladder substitute are comparable to other similar reservoir techniques, provided that the patients are carefully selected, well rehabilitated and meticulously followed.

FGFR3 Expression in Primary Invasive Bladder Cancers and Matched Lymph Node Metastases

“…13,14 The surgical specimens were processed as described previously. 14 Tumors were staged according to the 7th Union…”

Measurements using the alkaline comet assay predict bladder cancer cell radiosensitivity

“…Patients with organ-confined, muscle-invasive tumours, (T2/3/4a) who are deemed fit, are considered for potentially curative treatment in the form of radical surgery (cystectomy) or radiotherapy. Radical cystectomy (removal of the bladder and urinary diversion) is associated with significant morbidity and a mortality rate of B2% (Skinner et al, 1988;Studer et al, 1995). Furthermore, the necessary creation of an abdominal wall stoma (ileal conduit) may impact on quality of life, and erectile dysfunction is virtually universal.…”

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

“…The issues of urethral recurrence and urethral preservation have become particularly critical since the advent of orthotopic continent urinary diversion. Hautman et al 16 have reported a 2% urethral recurrence rate in more than 200 patients and Studer et al 17 have described a 6% rate in 100 patients who underwent radical cystectomy and ileal neobladder construction. Two of these six patients were treated by urethrotomy, while the remaining four were treated conservatively.…”