Options in Replacement Cystoplasty Following Radical Cystectomy: High Hopes or Successful Reality

Martins, Francisco E.; Bennett, Carol J.; Skinner, Donald G.

doi:10.1016/s0022-5347(01)67406-8

Cited by 48 publications

(21 citation statements)

References 80 publications

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“…A large, detubularized reservoir accommodates a higher volume at a lower pressure than does any other type of reservoir. This accounts for the improved nighttime continence [7].…”

Section: Discussionmentioning

confidence: 93%

The ileal neobladder — updated experience with 306 patients

et al. 1996

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From April 1986 through May 1995, 306 men with primary urothelial carcinoma underwent radical cystoprostatectomy and orthotopic bladder substitution via the ileal neobladder. Altogether, 7.5% of the patients suffered general early complications, including thrombosis, embolism, wound infection, and pneumonia. Specific early complications directly related to formation of the neobladder and requiring surgery included ileus (4%), abscess drainage (2%), and leakage of the ileal anastomosis (0.5%). The early reoperation rate was 6.5%. Early complications that required temporary percutaneous drainage were lymphocele formation (3%) or ureteral obstruction (6%). In all, 9% of our patients required prolonged catheter drainage for leakage of the ileouretheral anastomosis. Late complications requiring reoperation were ileus (2%), abscess drainage (1%), neobladder fistula to the colon (1.5%), ureteral reimplantation because of obstruction (3.6%), and nephrectomy for hydronephrosis (1%). A transurethral incision of the ileouretheral anastomosis was necessary in 7% of cases. Continence was separately addressed by sending each patient and his home physician a detailed questionnaire: Using our criteria (no diapers, no awakenings) the night and day continence rate increased from 67% at 6 months, to 72% at 1 year to 85% at 2 years, finally reacting 90% after 4 years. In part II of this presentation we address the question as to whether the option of orthotopic bladder replacement has any impact on the patient's and physician's decision toward earlier cystectomy. We compared our ileal neobladder cohort with a group of 137 patients that had been operated on during the same time span by the same group of surgeons. There was no negative selection with regard of the tumor stage of our patients. However, as compared with the conduit group, the neobladder cohort had a significantly improved survival rate. This phenomenon is explainable by the significantly lower number of previous transurethral resections of the bladder (TUR-Bs) performed in the neobladder group. The time span between primary diagnosis and cystectomy was 10 months in the neobladder group as compared with 18 months in the conduit patients. These data reinforce our belief that orthotopic bladder replacement using the ileal neobladder yields an extraordinary functional result that can be accomplished with a high degree of patient satisfaction and minimal complication. The availability of orthotopic bladder replacement does indeed stimulate the physicians and patients decision toward earlier cystectomy.

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“…A large, detubularized reservoir accommodates a higher volume at a lower pressure than does any other type of reservoir. This accounts for the improved nighttime continence [7].…”

Section: Discussionmentioning

confidence: 93%

The ileal neobladder — updated experience with 306 patients

et al. 1996

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“…If a urethrectomy is performed then a reconstruction utilizing a continent cutaneous stoma should be considered. The presence of multifocal tumors and carcinoma-in-situ also increases the risk of later urethral recurrence, but most surgeons would only recognize these as relative contraindications to this surgery [5]. Some surgeons take the view that the presence of positive pelvic lymph nodes contraindicates reconstruction, as these patients have a poor long-term prognosis, but although the procedure of reconstruction does not alter the patient's cancer survival it just may improve his or her remaining quality of life [6].…”

Section: Indicationsmentioning

confidence: 99%

The use of small intestine in bladder reconstruction

Kashif

Holmes

1998

Int Urogynecol J

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Reconstruction of the bladder is a treatment available to patients who have a diseased or damaged bladder, and small bowel is the most commonly used tissue. Augmentation cystoplasty increases the total bladder capacity, whereas substitution cystoplasty replaces the whole organ. This is either drained through a continent cutaneous stoma or is reanastomosed to the urethra as an orthotopic reconstruction. Although the treatment for invasive bladder cancer has not changed greatly in the last few decades, the use of orthotopic bladder reconstruction allows for a great improvement in the quality of life for patients who undergo cystectomy. These reconstructive techniques can also be offered to patients with other forms of pelvic malignancy that involve the bladder.

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“…Although renal function is not altered by interposing an intestinal loop [8], good emunctory renal function is required to compensate for the metabolic acidosis caused by the loss of bicarbonates from the interposing loop [9]. In order to avoid possible metabolic difficulties, some urologists consider serum creatinine levels of over 2.0 mg/dl a relative contraindication [10]. It is, however, in oncological urology, where radical cystectomy is the standard treatment for infiltrating bladder carcinoma [11], that bladder substitution has proved most successful.…”

Section: Indicationsmentioning

confidence: 99%

“…At present, whichever substitution is chosen, the technical progress made has reduced mortality to acceptable levels and diminished the occurrence of complications and reoperation (reportedly up to 12%) [10]. Thus bladder substitution has become a standard treatment and is safe enough to propose as an option for females following cystectomy.…”

Section: Experience In Malesmentioning

confidence: 99%

Bladder replacement in women: A new experience

et al. 1997

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Bladder replacement in women in a new experience. In this article the authors reviewed in a critical way the patho-physiological principles involved in the previous male bladder replacement techniques and the results achieved both leading to the recent experience of bladder replacement in women. The authors present the recent acquirements about pelvic surgical anatomy and postcystectomy oncological radicality in female, and the more common surgical techniques for building a neobladder in women with the results achieved up to now. They also examined the problems arising from this exciting but precocious experience which will surely involve the urological community in the future.

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Options in Replacement Cystoplasty Following Radical Cystectomy: High Hopes or Successful Reality

Cited by 48 publications

References 80 publications

The ileal neobladder — updated experience with 306 patients

The ileal neobladder — updated experience with 306 patients

The use of small intestine in bladder reconstruction

Bladder replacement in women: A new experience

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