Sigmoid Neobladder in Women After Radical Cystectomy

Fujisawa, Masato; Gotoh, Akinobu; Miyazaki, Shingo; Nakamura, Ichiro; Hara, Isao; Okada, Hiroshi; Arakawa, Soichi; Kamidono, Sadao

doi:10.1016/s0022-5347(05)67652-5

Cited by 11 publications

(14 citation statements)

References 16 publications

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“…It also has little effect on metabolic and nutritional status and preserves the renal function. [3][4][5][6][7] Collectively, these findings suggest that the reconstruction of orthotopic SNB could facilitate at least equivalent or even better clinical outcomes than that of INB, particularly in women, considering their favorable postoperative voiding status. Benefit of sigmoid neobladder…”

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confidence: 83%

“…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 advantages in selecting SNB, such as the low incidence of urinary tract infection in its use.…”

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confidence: 93%

“…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%

“…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.…”

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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: 83%

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confidence: 93%

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confidence: 99%

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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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“…Since 1983, several types of orthotopic neobladder substitution, using ileal, ileocolic, right colonic or sigmoid segments, have been used in patients with bladder cancer who had a RC at our institution [2,3]. Based on our long‐term experience with neobladder reconstruction, we currently prefer to select the sigmoid colon neobladder (SCN) in both men and women, using the modified technique described previously [4,5]. However, after the initial report by Reddy et al.…”

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Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients

et al. 2010

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follow-up of 55 months, after excluding two who died perioperatively. RESULTSThere were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero-intestinal stricture in four and entero-urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and nighttime continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B 12 . The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age-matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. CONCLUSIONSThe modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy. KEYWORDSsigmoid neobladder, radical cystectomy, complication, functional outcome, quality of life Study Type -Therapy (outcomes study) Level of Evidence 2c OBJECTIVESTo retrospectively review our clinical experience with sigmoid neobladder reconstruction. PATIENTS AND METHODSThe study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health-related quality of life (HRQL, using the Short-Form 36 instrument) were evaluated in 80 patients with a mean

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