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

Abstract

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.

Laparoscopic versus Open Radical Cystectomy in Bladder Cancer: A Systematic Review and Meta-Analysis of Comparative Studies

“…There is few literature comparing post-op neobladder function after radical cystectomy between LRC and ORC and only four studies in Chinese were identified, in which three studies adopted orthotopic neobladder reconstruction and one study had ileal conduit. Our included three studies reported daytime continence rates of 91%, 94%, 92% and a nighttime rate of 88%, 82%, 78% respectively, and compared favourably with previously reported values in other single LRC series daytime rate (89–98%) and nighttime rate (78–88%) [46]–[48]. In the present meta-analysis, Qmax, neobladder capacity, IVP, RUV, day time and night time continence rate were similar in the two groups, which demonstrated the efficacy of LRC in post-op neobladder function.…”

Long-Term Outcomes of Patients Who Underwent Ureterocutaneostomy

“…In addition, the cost of the procedure must also be taken into account (7). As there is no single option suitable for every patient, it is important to know and consider the different diversion methods.…”

Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? Opinion: Yes

“…Large retrospective non-selected series from single institutions have shown that the recurrence-free survival (RFS) rates following RC ranges from 62% to 68% and 50% to 66% at 5 years and 10 years, respectively (3-5). Moreover, Hautmann et al published similarly long-term oncologic outcomes among 1,100 patients who underwent RC; they exhibited an overall 10-year cancer-specific survival (CSS) rate of 67% (6).…”