Orthotopic Bladder Substitution (Neobladder)

Herdiman, Olivia; Ong, Kevin; Johnson, Liana; Lawrentschuk, Nathan

doi:10.1097/won.0b013e31827e8499

Cited by 19 publications

(18 citation statements)

References 34 publications

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“…As a general functional criterion for neobladders, patients should have good renal and hepatic function before surgery. This is due to the inherent risks of complications related to electrolyte disturbances . In addition, each patient's ability to adapt to nocturnal incontinence should be weighed, since this can occur in up to 79% of cases after 12 months of surgery …”

Section: Resultsmentioning

confidence: 99%

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

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Section: Resultsmentioning

confidence: 99%

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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“…Besides avoiding the occurrences of urine and stool mixing and urine extravasation, the physiological function of the orthotopic bladder is also extremely close to the original bladder compared with other traditional urinary diversion surgeries (20). Considering the functional association between the bladder and bowel, the potent clinical application values of orthotopic ileal neobladder following radical cystectomy have been widely assessed (21–23).…”

Section: Discussionmentioning

confidence: 99%

Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

Wang

Liu

et al. 2014

Oncology Letters

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The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; P<0.001), residual urine content (22.8±10.5 vs. 40.7±12.7 ml; P<0.001), maximum bladder capacity (373.8±62.2 vs. 229.7±56.3 ml; P<0.001) and maximum bladder pressure during filling (35.8±6.7 vs. 26.4±7.0 cm H2O; P<0.001) at 12 months were all improved significantly compared with that at 6 months after the initial surgical treatment. However, there were no significant differences in maximum bladder pressure during voiding (75.7±24.7 vs. 73.1±24.7 cm H2O; P=0.618) and bladder compliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable.

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“…These ions are absorbed in exchange with sodium and bicarbonate from the blood stream, thus resulting in hyperchloremic, hyperkalemic metabolic acidosis and salt-loss syndrome. [ 6 7 ] These conditions can manifest clinically with lethargy, fatigue and dehydration. It is important to detect and treat metabolic acidosis early as it can induce calcium resorption from bone and hypophosphatemia thus leading to osteoporosis and osteomalacia.…”

Section: Electrolyte Disordersmentioning

confidence: 99%

“…If required, patients may also increase their intra-abdominal pressure by leaning forward or exert gentle manual pressure over the lower abdomen and suprapubic area. [ 6 ] Pelvic floor muscular awareness and education are also critical in recovery and is well-summarized elsewhere. [ 6 9 ] As with radical prostatectomy stress incontinence may ensue early, but gradually recovers with correct pelvic floor muscle contraction assisting with strength and control.…”

Section: Neobladder Trainingmentioning

confidence: 99%

“…During the early stages, frequent neobladder emptying is performed 2–3 hourly daily and 3-hourly timed nightly to avoid overflow incontinence. [ 6 22 ] Voiding intervals can then be increased gradually over the next few weeks to achieve the aim of voiding every 5–6 h during the day and just once at night. It is also important to note that high post-void residual urine volumes will require the need to void more frequently as the neobladder fills up more rapidly.…”

Section: Neobladder Trainingmentioning

confidence: 99%

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Orthotopic neobladder reconstruction

Chang

Lawrentschuk

2015

Urol Ann

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Orthotopic neobladder reconstruction is becoming an increasingly common urinary diversion following cystectomy for bladder cancer. This is in recognition of the potential benefits of neobladder surgery over creation of an ileal conduit related to quality of life (QoL), such as avoiding the need to form a stoma with its cosmetic, psychological and other potential complications. The PubMed database was searched using relevant search terms for articles published electronically between January 1994 and April 2014. Full-text articles in English or with English translation were assessed for relevance to the topic before being included in the review. Patients with neobladders have comparable or better post-operative sexual function than those with ileal conduits. They also have comparable QoL to those with ileal conduits. Orthotopic neobladder is a good alternative to ileal conduit in suitable patients who do not want a stoma and are motivated to comply with neobladder training. However, the selection of a neobladder as the urinary diversion of choice requires that patients have good renal and liver functions and are likely to be compliant with neobladder training. With benefits also come potential risks of neobladder formation. These include electrolyte abnormalities and nocturnal incontinence. This short review highlights current aspects of neobladder formation and its potential advantages.

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Orthotopic Bladder Substitution (Neobladder)

Cited by 19 publications

References 34 publications

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

Orthotopic neobladder reconstruction

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