Urinary diversion and bladder substitution in patients with bladder cancer

Davidsson, Thomas; Wullt, Björn; Könyves, J; Månsson, Alf; Månsson, Wiking

doi:10.1016/s1078-1439(00)00069-7

Cited by 5 publications

(2 citation statements)

References 60 publications

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“…The surgical reconstruction of the lower urinary tract is required in cases of bladder cancer, neurological disorder of the bladder (neuropathic bladder), trauma or other clinical indications for the removal of bladder (cystectomy) (Davidsson et al, 2000;Falagas & Vergidis, 2005;Wullt et al, 2004). The bladder can be replaced via a number of surgical techniques and with a variety of tissues, the most common being the construction of an orthotopic neobladder with ileal or colonic tissue (Falagas & Vergidis, 2005).…”

Section: Introductionmentioning

confidence: 99%

Genomic characterization of asymptomatic Escherichia coli isolated from the neobladder

et al. 2011

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The replacement of the bladder with a neobladder made from ileal tissue is the prescribed treatment in some cases of bladder cancer or trauma. Studies have demonstrated that individuals with an ileal neobladder have recurrent colonization by Escherichia coli and other species that are commonly associated with urinary tract infections; however, pyelonephritis and complicated symptomatic infections with ileal neobladders are relatively rare. This study examines the genomic content of two E. coli isolates from individuals with neobladders using comparative genomic hybridization (CGH) with a pan-E. coli/Shigella microarray. Comparisons of the neobladder genome hybridization patterns with reference genomes demonstrate that the neobladder isolates are more similar to the commensal, laboratory-adapted E. coli and a subset of enteroaggregative E. coli than they are to uropathogenic E. coli isolates. Genes identified by CGH as exclusively present in the neobladder isolates among the 30 examined isolates were primarily from large enteric isolate plasmids. Isolations identified a large plasmid in each isolate, and sequencing confirmed similarity to previously identified plasmids of enteric species. Screening, via PCR, of more than 100 isolates of E. coli from environmental, diarrhoeagenic and urinary tract sources did not identify neobladder-specific genes that were widely distributed in these populations. These results taken together demonstrate that the neobladder isolates, while distinct, are genomically more similar to gastrointestinal or commensal E. coli, suggesting why they can colonize the transplanted intestinal tissue but rarely progress to acute pyelonephritis or more severe disease.

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Section: Introductionmentioning

confidence: 99%

Genomic characterization of asymptomatic Escherichia coli isolated from the neobladder

et al. 2011

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“…Radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle‐invasive and high‐risk superficial bladder cancer [2]. An ileal conduit is an established method of urinary diversion and for the last 50 years has been considered the ‘gold standard’[3]. However, in the last decade, more patients are being offered orthotopic ileal neobladder reconstruction as a standard choice for urinary diversion.…”

Section: Introductionmentioning

confidence: 99%

Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder?

Manoharan¹,

Reyes²,

Kava³

et al. 2005

BJU International

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OBJECTIVE To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle‐invasive and high‐risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis. PATIENTS AND METHODS We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high‐risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed. RESULTS Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow‐up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups. CONCLUSIONS Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.

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