Orthotopic bladder substitution following radical cystectomy in women: Comparative study between sigmoid and ileal neobladders

Furukawa, Junya; Muramaki, Mototsugu; Takenaka, Atsushi; Fujisawa, Masato

doi:10.1016/j.urolonc.2009.11.006

Cited by 12 publications

(23 citation statements)

References 28 publications

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“…7,9,10 Furthermore, in our series the favorable voiding status of SNB was confirmed; that is, more than 90% of the patients could void spontaneously, and their post-void residual urine was less than 25 mL (Table 1). 5,6 Furthermore, daytime and night-time continence rates in SNB were approximately 85 and 60%, respectively, which appeared to be markedly superior to those in previously reported outcomes in SNB (Table 1). [5][6][7]9,10 Considering the low compliance of SNB due to the physiological features of the sigmoid colon characterized by a high pressure with powerful contraction of the thick wall, we used a longer sigmoid segment (35-40 cm) than used in other studies, resulting in an increase in the pouch volume and its compliance.…”

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confidence: 52%

“…In fact, the incidence of complications in our SNB series, including ureterointestinal strictures, enterourethral strictures and vesicoureteral reflux, were lower than that in other SNB series. [1][2][3][4]6,7 Of the several problems associated with neobladder, voiding dysfunction probably has the most adverse impact on a patient's postoperative satisfaction. In general, despite an unfavorable continence status, particularly night-time continence, SNB is likely to acquire an adequate voiding status by emptying the reservoir.…”

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confidence: 99%

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Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction

Fujisawa¹

2011

Int J of Urology

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To date, various procedures for creating an orthotopic neobladder following radical cystectomy have been reported. 1 Although the type of neobladder that provides the best outcomes is disputed , the ileal neobladder (INB) may currently be the most frequently selected form of neobladder worldwide.2 At our institution, however, sigmoid neobladder (SNB) has been preferred for patients undergoing radical cystectomy irrespective of their characteristics. [3][4][5][6][7] As previously described , 3,4 we modified several steps of the original method to create SNB in order to minimize postoperative complications. 8 For example, rotation of the reservoir upside-down and 180°horizontally provides a tension-free enterourethral anastomosis and successfully prevents urethral ischemia (Fig. 1a), while the implantation of ureters to the upper edge of the reservoir facilitates the creation of a submucosal tunnel and allows precise ureterointestinal anastomosis (Fig. 2). In fact, the incidence of complications in our SNB series, including ureterointestinal strictures, enterourethral strictures and vesicoureteral reflux, were lower than that in other SNB series. [1][2][3][4]6,7 Of the several problems associated with neobladder, voiding dysfunction probably has the most adverse impact on a patient's postoperative satisfaction. In general, despite an unfavorable continence status, particularly night-time continence, SNB is likely to acquire an adequate voiding status by emptying the reservoir. 7,9,10 Furthermore, in our series the favorable voiding status of SNB was confirmed; that is, more than 90% of the patients could void spontaneously, and their post-void residual urine was less than 25 mL (Table 1). 5,6 Furthermore, daytime and night-time continence rates in SNB were approximately 85 and 60%, respectively, which appeared to be markedly superior to those in previously reported outcomes in SNB (Table 1). [5][6][7]9,10 Considering the low compliance of SNB due to the physiological features of the sigmoid colon characterized by a high pressure with powerful contraction of the thick wall, we used a longer sigmoid segment (35-40 cm) than used in other studies, resulting in an increase in the pouch volume and its compliance. In addition, a small post-void residual urine, which has been shown to influence continence with a neobladder, 10 may also have contributed to the favorable continence status in our SNB series.It has been well documented that the voiding status of neobladders in women tends to be more frequently impaired over time than in men; however, in our studies, there was no significant difference in voiding status between male and female patients with SNB (Table 1). 4,6 In addition, despite the lack of a significant difference in the continence status between women with SNB and INB, there were significant differences in the proportion of spontaneous voiders and post-void residual urine between the two groups, being more favorable in women with SNB. 6 Other than the issues described above, there are some more advanta...

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confidence: 99%

Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction

Fujisawa¹

2011

Int J of Urology

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“…Some authors reported preserved HRQOL after ONB . In contrast, lower role‐physical and role‐emotional functions have been reported in women with ONB than the normal population, others reported decreased overall HRQOL …”

Section: Discussionmentioning

confidence: 96%

“…None of the previous studies assessed the HRQOL in women, except for two recent studies . In addition, the number of female patients included in all was small.…”

Section: Discussionmentioning

confidence: 99%

Health‐related quality of life after radical cystectomy and neobladder reconstruction in women: Impact of voiding and continence status

et al. 2014

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Abbreviations & AcronymsObjectives: To assess health-related quality of life, and the impact of night-time incontinence and chronic urinary retention on health-related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder. Methods: The study included 74 women who underwent radical cystectomy and orthotopic neobladder, and completed 1 year of follow up. Health-related quality of life was evaluated using the questionnaires of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form. Health-related quality of life was compared with an agematched control group. The impact of night-time incontinence and chronic urinary retention on health-related quality of life was assessed. Results: The study group included 18 completely continent patients with spontaneous voiding, 29 with night-time incontinence and 27 with chronic urinary retention. The study group was statistically significantly lower in all domains of health-related quality of life than the control group. In all domains of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and Functional Assessment of Cancer Therapy bladder cancer-specific form, completely continent women were comparable with those with chronic urinary retention. Women with night-time incontinence had a significantly worse healthrelated quality of life than completely continent women, shown by the mean global health score (P = 0.038), social functioning score (P = 0.012), pain European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire score (P = 0.04), and functional well-being Functional Assessment of Cancer Therapy bladder cancer-specific form (P = 0.049) score. Conclusions: After radical cystectomy and orthotopic neobladder in women, healthrelated quality of life is lower than that of the normal population. Night-time incontinence has a negative impact on social life and most domains of health-related quality of life. Thus, night-time incontinence has a higher social impact than chronic urinary retention.

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“…Scanning the literature, urethral recurrence after orthotopic urinary diversion in women with urothelial cancer was reported in up to 9% [12][13][14][15][16][17][18][19][20][21][22][23], as seen in Table II. The results of Stein et al [15] are similar to the 13 pT3 bladder cancers in the present study, showing a safe oncological approach to the problem of invasive bladder cancer with a recurrence rate of 15.4% (pT3), 16.6% (pT1 and/or CIS) and 16.6% (pT2).…”

Section: Discussionmentioning

confidence: 99%