Long‐term results of orthotopic neobladder reconstruction after radical cystectomy

Abstract

RESULTSIn all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36-144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH 2 O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twentyfour patients had recurrence of disease, of whom 20 died. CONCLUSIONSOrthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates.

Experience with Various Types of Orthotopic Neobladder in Japanese Men: Long-Term Follow-Up

“…This could be partly explained by the short observation period in this study compared with those in other series. Furthermore, there were no significant differences in the incidences of either early or late complications among patients with different types of NB, which is also consistent with previous studies [1,2,8] . In addition, if complications would be divided into surgical related and not, there were no significant differences in the incidences of each type of complications among patients with different types of NB (data not shown).…”

“…To date, a number of studies have reported the clinical outcomes in patients undergoing reconstruction of intestinal orthotopic NB following radical cystectomy [3][4][5][6][7] ; however, there have been few reports comparing longterm outcomes among patients receiving different types of NB creation [8,17,18] . Since 1983, orthotopic NB reconstruction has been performed in more than 400 patients who were treated with radical cystectomy for invasive bladder cancer at our institutions, suggesting that the outcomes obtained from our data may reliable and comparable with other studies performed in high-volume centers.…”

“…To properly evaluate postoperative outcomes in patients with NB, it would be necessary to pay attention to several issues, such as complications, voiding function, 35 quality of life (QOL) and prognosis [3][4][5][6] ; however, there have been few studies synthetically evaluating the clinical features of orthotopic NB based on long-term outcomes [7][8][9][10] . Since 1983, several types of NB replacement, such as modified Studer [11,12] , modified Reddy [13] , Hautmann [14] and Mainz I NB [15] , have been performed after radical cystectomy at our institutions; therefore, in the present study, the postoperative outcomes of 235 men, who underwent NB reconstruction and were followed for at least 3 years, were retrospectively analyzed to clarify their long-term clinical characteristics according to the types of orthotopic NB.…”

Laparoscopic radical cystectomy with orthotopic gastric neobladder: technique and initial outcomes

“…Post-operative continence was deWned according to Kulkarni et al (2003). No patient reported preoperative incontinence.…”

Alternativen zur Zystektomie

“…In dieses Kollektiv gingen alle Patienten ein, die in diesem Zeitraum an einem muskelinvasiven Urothelkarzinom litten, also einschließlich derjenigen mit lymphatisch metastasiertem oder fernmetastasiertem Befund. Liegt keine lymphatische oder Fernmetastasierung vor und ist das lokale Tumorstadium <pT4, werden auch Kollektive mit 5-Jahres-Überlebensraten >80% beschrieben [2,3] …”