Is Orthotopic Bladder Replacement the New Gold Standard? Evidence From a Systematic Review

Nabi, Ghulam; Yong, Sze Ming; Ong, E.; Grant, Adrian; N’Dow, James

doi:10.1097/01.ju.0000162021.24730.4f

Cited by 35 publications

(9 citation statements)

References 49 publications

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“…Orthotopic neobladder replacement using intestinal segments has recently become the most preferred method of urinary diversion in appropriately selected patients [1][2][3][4][5]. At our institutions, neobladder creation following radical cystectomy using ileum or sigmoid colon has been mainly performed [14][15][16], and based on this experience, we have investigated differences in several characteristics between these two types of neobladder [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, incontinent urinary diversions have been mainly performed due to the relatively low morbidity accompanying these procedures, while improved operative techniques and additional surgical experience have facilitated the acceptance of various types of continent urinary diversions [2]. Among these methods, orthotopic bladder replacement using a bowel segment has become the most favored from of continent urinary diversion because of its superior characteristics, such as acceptable voiding function, positive body image and improved quality of life [3][4][5]. However, there has been growing recognition of possible complications associated with orthotopic neobladder creation [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Among these methods, orthotopic bladder replacement using a bowel segment has become the most favored from of continent urinary diversion because of its superior characteristics, such as acceptable voiding function, positive body image and improved quality of life [3][4][5]. However, there has been growing recognition of possible complications associated with orthotopic neobladder creation [2][3][4][5]. One such postoperative problem is the frequent development of chronic asymptomatic bacteriuria, whose pathogenesis has not been well characterized [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Elevated urinary cytokine levels in patients undergoing ileal neobladder replacement compared with sigmoid neobladder replacement

et al. 2007

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Elevated urinary cytokine levels in patients undergoing ileal neobladder replacement compared with sigmoid neobladder replacement

et al. 2007

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“…Numerous review articles [9][10][11][12][13][14][15][16][17][18][19][20][21] on this topic have been published during the recent time period.…”

Section: Quality Of Lifementioning

confidence: 99%

Quality of life after therapy for muscle-invasive bladder cancer

Henningsohn

2006

Current Opinion in Urology

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“…To date, methodology has been limited [7][8][9]13 and results have been mixed. [14][15][16][17][18][19][20] While general health-related quality of life appears to be similar in both, 21 specific issues concerning body image, problematic urine leakage and decreased sexual functioning have been inconsistent, although more commonly reported following ileal conduit diversion.…”

mentioning

confidence: 99%

Determining when to recommend continent urinary diversion

Gilbert

Montie

2013

CUAJ

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For many bladder cancer patients diagnosed with muscle-invasive disease and in cases of high-risk progressive noninvasive disease, cystectomy is an effective treatment, offering diseasespecific survival of about 87%.1 Bladder cancer survivors, however, face a multitude of health-related consequences following cystectomy. These are mostly related to urinary diversion and reconstruction. While improvements in perioperative care have decreased the surgical morbidity following cystectomy, 2 the complications and functional consequences associated with urinary diversion remain problematic. As a result, the functional and healthrelated quality of life issues following cystectomy are substantial for this group of cancer survivors.The impact of urinary diversion has long been recognized as a major shortcoming of cystectomy and has prompted interest in limiting the adverse functional effects associated with surgical removal of the bladder. Several forms of continent urinary diversion have been developed and refined with the objective of decreasing the burdens associated with diversion. 3,4 In addition, the options and recommended use of continent diversion have expanded during the past decade, and currently, proponents of continent diversion estimate that 80% of men and greater than 65% of women with invasive bladder cancer are candidates for orthotopic continent urinary diversion.5 Most cystectomy patients, however, do not receive continent reconstruction. 6Although the reasons are not entirely clear, significant baseline infirmity and comorbidity, technical complexity, risk of complications 7 and uncertainty regarding a health-related quality of life benefit have likely limited widespread adoption of continent reconstruction.Although the optimal type of urinary reconstruction has not been firmly established, 7-9 continent diversion offers potential advantages through maintenance of anatomic voiding, approximation of normal functional voiding and preservation of preoperative body image. Previous work has shown that complications following this type of diversion are modifiable and that cancer control and survival are independent of the type of urinary diversion used.3,10,11 Experienced groups have reported improvement in short-and long-term complications 3 as well as satisfactory urinary continence in up to 95% of patients following continent urinary diversion.12 While these results are likely not generalizable and may overestimate the health-related quality of life benefit of continent orthotopic urinary diversion, they do underscore the potential benefit of continent diversion when used in the right setting.Still, comparisons of functional outcomes and health-related quality of life in bladder cancer survivors managed with continent and incontinent urinary diversion have been difficult to interpret. To date, methodology has been limited [7][8][9]13 and results have been mixed.14-20 While general health-related quality of life appears to be similar in both, 21 specific issues concerning body image, problematic urine lea...

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Is Orthotopic Bladder Replacement the New Gold Standard? Evidence From a Systematic Review

Cited by 35 publications

References 49 publications

Elevated urinary cytokine levels in patients undergoing ileal neobladder replacement compared with sigmoid neobladder replacement

Elevated urinary cytokine levels in patients undergoing ileal neobladder replacement compared with sigmoid neobladder replacement

Quality of life after therapy for muscle-invasive bladder cancer

Determining when to recommend continent urinary diversion

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