Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy

Huang, Eric Yi Hsiu; Skinner, Eila C.; Boyd, Stuart D.; Cai, Jie; Miranda, Gus; Daneshmand, Siamak

doi:10.1007/s00345-012-0861-x

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…RC after prostate surgery may be challenging due to adhesions which obliterate the anatomic cleavage planes, and there is an increased risk of damage to the rectum and to the continence mechanism at the level of the pelvic floor. Therefore the form of urinary diversion is still debated, and in the literature there are only 29 reported cases of ileal orthotopic bladder substitution after RRP with available data for functional results [1,2,3,4] (table 2). …”

Section: Discussionmentioning

confidence: 99%

“…Moreover long-term follow-up is unavailable, and urodynamic evaluation has never been reported. The largest published series from an academic US centre reflects the experience of different surgeons using different forms of orthotopic bladder substitution, which may increase the variability of perioperative outcomes [4]. Patients with locally advanced bladder tumours were included and artificial urinary sphincters were placed in two cases simultaneously with RC.…”

Section: Discussionmentioning

confidence: 99%

“…Radical cystectomy (RC) in this subgroup is a challenging procedure, since the changes induced by the previous removal of the prostate potentially increase the risk of damage to the pelvic structures and of suboptimal functional results concerning urinary continence and sexual potency. Therefore, the choice of urinary diversion in these cases is still controversial, and ileal orthotopic bladder substitution has been performed in a very limited number of cases [1,2,3,4]. …”

Section: Introductionmentioning

confidence: 99%

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Radical Cystectomy and Ileal Orthotopic Bladder Substitution after Radical Retropubic Prostatectomy: Functional and Oncological Results

et al. 2014

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Men with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62- 72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radical Cystectomy and Ileal Orthotopic Bladder Substitution after Radical Retropubic Prostatectomy: Functional and Oncological Results

et al. 2014

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“…Patients should be counseled that additional continence procedures may be required, with artificial urinary sphincter being placed in around 20% of such patients 14 . Prior radical prostatectomy is not a contraindication in men, especially if they have good continence pre‐operatively 15 …”

Section: Pre‐operative Planningmentioning

confidence: 99%

Orthotopic bladder substitution: Surgical aspects and optimization of outcomes

2021

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Objectives Orthotopic bladder substitution (OBS) is a management option for urinary diversion in men and women undergoing cystectomy. The aim of the procedure is to provide a functional continent urinary reservoir of adequate capacity, compliance and low pressure. We have provided a narrative review of the existing literature and highlighted areas where improvement and standardization can be recommended. Methods Literature search included database search for publications from January 1970 to November 2020, using keywords including OBS, bladder reconstruction, neobladder, radical cystectomy, robotic cystectomy, intracorporeal neobladder, surgical technique, patient selection and outcomes. Results Due to various factors including indications, operative technique and risk of complications, OBS is an enormous undertaking and commitment for patients, surgeons and health professionals involved in the care pathway. The main considerations for patient selection, the technical elements of the procedure and the rationale behind these are discussed. Previously considered to be a choice for a select few, the inclusion criteria have expanded over the last decade. Similarly, surgical techniques including the choice and configuration of bowel segments, construction of anastomosis and nerve or organ sparing procedures have evolved over the years. Minimally invasive laparoscopic and robotic assisted surgery has added further perspectives to the existing literature on OBS. Understanding the principles of operative techniques and assessing the best evidence to influence patient management is crucial as it has a major impact on clinical outcomes. Peri‐ and post‐operative care, focused on the prevention of complications and morbidity, affects long‐term functional and oncological outcomes, which ultimately dictates the quality of life. Conclusions This concise overview of OBS literature highlights the importance of pre‐operative, peri‐operative, and post‐operative aspects with regards to the optimization of patient care. To achieve the best results, meticulous attention should be paid in all these areas, surgical and multi‐disciplinary. Patient education and counseling, with shared decision making are central to the success of the procedure.

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“…Continence after neobladder creation is also of concern, with a continence rate of 57.9% reported in this cohort. They postulate the dissection of the external sphincter can often be difficult to appreciate given the prior surgeries, which increases the risk of postoperative incontinence and is specific to this patient population [24].…”

Section: Comparison Of Diversion Typesmentioning

confidence: 99%

Urinary Diversion for Incontinence and Voiding Dysfunction in Cancer Survivors: a Critical Review of the Literature

Washington

Murphy

Awad

et al. 2017

Curr Bladder Dysfunct Rep

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Purpose of Review Urinary diversion (UD) remains the last option for improving quality of life in patients with treatmentrefractory urinary incontinence (UI) or voiding dysfunction after cancer treatment. We aim to critically review the utility of UD for UI and voiding dysfunction in patients previously treated for malignancy. Recent Findings UD patients are at high risk given their oncologic treatment and multiple procedures prior to UD. The severe impact of UI and voiding dysfunction on quality of life is significant. Despite the risk of complications after UD, men reported significant improvement of their urinary symptoms and were confident that they would have sought UD sooner. Summary UD remains a last option for some men dealing with severe urinary symptoms after treatment of pelvic malignancy in both men and women. Further investigation is needed to better characterize the burden of disease and potential gains surrounding management of these men.

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Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy

Cited by 12 publications

References 13 publications

Radical Cystectomy and Ileal Orthotopic Bladder Substitution after Radical Retropubic Prostatectomy: Functional and Oncological Results

Radical Cystectomy and Ileal Orthotopic Bladder Substitution after Radical Retropubic Prostatectomy: Functional and Oncological Results

Orthotopic bladder substitution: Surgical aspects and optimization of outcomes

Urinary Diversion for Incontinence and Voiding Dysfunction in Cancer Survivors: a Critical Review of the Literature

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