Validation of the effectiveness of a modified Studer orthotopic neobladder in a single center after 3 years of its application

2020 ◽  
Vol 87 (4) ◽  
pp. 167-169
Author(s):  
Matteo Maltagliati ◽  
Riccardo Milandri ◽  
Tommaso Bocchialini ◽  
Pierpaolo Graziotti ◽  
Andrea Guarneri ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Urinary Tract ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Distal Part ◽  
Low Grade ◽  
Orthotopic Neobladder ◽  
Modified Technique ◽  
Afferent Limb ◽  
Psoas Muscles

Introduction and Objective: In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively. Materials and Methods: In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the EAU guidelines. Results: We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4–1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease. Conclusion: The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.

scholarly journals Lower Urinary tract function following Radical Cystectomy and Orthotopic neobladder Urinary diversion

2021 ◽  
pp. 06-11
Author(s):  
Abdulbast Darwish ◽  
Ezaldean AL shibany ◽  
Hael Saeed ◽  
Duyazen Alhosam ◽  
Abdullah Ghamdhan ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Lower Urinary Tract ◽  
Patient Questionnaire ◽  
Orthotopic Neobladder ◽  
Post Surgery ◽  
Lower Urinary Tract Function ◽  
Tract Function ◽  
Lower Urinary

The aim of the study: Orthotopic neobladder reconstruction is the preferred method of urinary diversion after radical cystectomy. We evaluated lower urinary tract function outcomes in patients after orthotopic neobladder using a patient questionnaire. Material and Methods: 40 patients who do radical cystectomy and orthotopic neobladder in EZ Aldean Al-Shi-Bany hospital at Sana'a Yemen between 2010-2018 patients with bladder cancer were included in a clinical trial, randomly assigned to Camey II pouch diversion after radical cystectomy. The patients were mailed a questionnaire 12-24 months after radical cystectomy including items on function, intermittent catheterization, and incontinence. Results: During the study between 2010-2018, 40 neobladder diversion were performed, day incontinence was 55% ((22 cases)) in the first 6 months post-surgery but improved to 12.5% ((5 cases)) after 1-year post-surgery also night incontinence was 62.5% ((25 cases)) in first 6 months postsurgical but improved to 15% ((6 cases)) 1-year post-surgery. Mean age at surgery of 40 patients were sub-segments analysis <50yeas was 12.5 % (5 case), 50-70 years was 65% (26 case), >70 years 22.5% (9 case). Conclusion: Ileal orthotopic neobladder have good lower urinary tract functional result, daytime and nighttime incomitance is coming in neobladder patients following surgery but improved with time. CIC is less common following surgery and improved with time. Keywords: Neobladder; Orthotopic; Lower Urinary Tract Function; Incontinence

scholarly journals Febrile Urinary Tract Infection after Radical Cystectomy with Urinary Diversion: Different Characteristics in Patients with Ileal Conduit and Orthotopic Neobladder

2020 ◽  
Vol 16 (3) ◽  
pp. e38-e46
Author(s):  
Seungsoo Lee ◽  
Seung Ryong Baek ◽  
Won Hoon Song ◽  
Tae Nam Kim ◽  
Sung-Woo Park ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Orthotopic Neobladder ◽  
Febrile Urinary Tract Infection ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Febrile Uti

Background and ObjectiveTo compare the incidence of febrile urinary tract infection (UTI) and bacterial identification between patients with orthotopic neobladder (ONB) and ileal conduit (IC). Materials and MethodsData of 164 patients who underwent radical cystectomy with ONB and IC for bladder cancer between January 2009 and January 2018 at our institution were analyzed. Febrile UTI observed was listed and subsequently compared. Incidence of febrile UTI, clinicopathological characteristics, and microorganisms identified were reported at 3 months interval; and preoperative predictors of febrile UTI were evaluated with Cox regression analysis. Patients were divided into ONB and IC. ResultsThe study cohort included 52 patients with ONB and 112 patients with IC. Febrile UTI was diagnosed in 49 (29.9%) patients. Compared to IC group, ONB group had significantly higher incidence of young age (p=0.00), lower cancer stage (p=0.013), longer hospital stay (p=0.049), longer operation time (p=0.00), and higher incidence of febrile UTI within the first 3 months after surgery (p=0.006). On univariable and multivariable analysis, factors associated with significantly increased febrile UTI risk were diabetes (odds ratio [OR]: 4.52; p=0.002) and ONB diversion (OR: 1.27; p=0.031). Forty-four (89.8%) patients were culture positive. However, significant difference in microorganisms was not detected between patients who under-went ONB or IC diversion. ConclusionDiabetes and ONB diversion were associated with higher risk symptomatic UTI following radical cystectomy.

scholarly journals Retubularization of the ileocystoplasty patch for conversion into an ileal conduit

2013 ◽  
Vol 7 (7-8) ◽  
pp. 462
Author(s):  
Peter A. Massaro ◽  
Jerzy B. Gajewski ◽  
Greg Bailly
Keyword(s):  
Urinary Tract ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Low Grade ◽  
Complication Rates ◽  
Bladder Pain ◽  
Persistent Symptoms ◽  
Additional Surgery ◽  
Patient Reported ◽  
Tract Infections

Introduction: We present the outcomes and long-term follow-up of patients who underwent conversion to an ileal conduit urinary diversion using the retubularized patch from the initial augmentation ileocystoplasty.Methods: We reviewed the charts of all patients who underwent this surgery at our centre. The indications for surgery, workup, clinical outcomes and complication rates were assessed. Patient reported symptom response based on global response assessment (GRA) was determined and used as a subjective measure of overal ltreatment effectiveness.Results: Thirteen patients with either bladder pain syndrome/interstitialcystitis (BPS/IC) (n = 11) or neurogenic bladder (n = 2) were followed for a mean of 80 months. The most common indication for surgical conversion was persistent lower urinary tract symptoms (LUTS) or bladder pain. Late complications were frequent, typically low-grade, and usually manageable with conservative therapy; the most common were urinary tract infections (n = 6) and parastomal hernias (n = 5). Two patients developed ureteric strictures. Nine of 13 patients required additional surgery to manage complications or persistent symptoms. Only 5 of 11 GRA respondents reported a successful therapeutic outcome and BPS/IC patients who underwent concurrent cystourethrectomy tended to be most satisfied (2/3). Nevertheless, several patients still achieved symptom control when no other treatment options were available to them.Conclusion: Conversion to an ileal conduit using the retubularized ileocystoplasty patch offers several technical and therapeutic advantages over creating a urinary diversion from a new bowel segment. It should therefore be considered a viable treatment option in patients who have exhausted more conservative management of their LUTS.

Changes in the Upper Urinary Tract After Radical Cystectomy and Urinary Diversion

2006 ◽  
Vol 175 (1) ◽  
pp. 185???189
Author(s):  
Cheryn Song ◽  
Taejin Kang ◽  
Jun-Hyuk Hong ◽  
Choung-Soo Kim ◽  
Hanjong Ahn
Keyword(s):  
Urinary Tract ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Upper Urinary Tract

Multiple stones in neobladder: Case report and literature review

2019 ◽  
Vol 86 (4) ◽  
pp. 216-219 ◽  
Author(s):  
Alessandro Tafuri ◽  
Antonio B Porcaro ◽  
Akbar N Ashrafi ◽  
Maria Angela Cerruto ◽  
Nelia Amigoni ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Orthotopic Neobladder ◽  
Radical Cystoprostatectomy ◽  
Urinary Tract Symptoms ◽  
Tract Infections ◽  
Abdominal Fullness ◽  
Lower Urinary

Introduction: Neobladder urolithiasis is a rare but important long-term complication of orthotopic urinary diversion. It may be asymptomatic and can be discovered as an incidental finding on a radiological investigation. However, when symptoms occur, they may include lower abdominal pain, dysuria, hematuria, and lower urinary tract symptoms. Case description: We report the case of a 63-year-old male patient with irritative lower urinary tract symptoms, lower abdominal fullness, urinary incontinence, fecaluria, and urinary loss from the left inguinal fold 12 years after a radical cystoprostatectomy with a orthotopic neobladder. Computed tomography scan and urethrocystography showed a distended pouch with multiple large stones, an enterovesical fistula, and neovesicocutaneous fistula. The fistulae were successfully managed conservatively with the placement of a Foley catheter. After 3 months, open cystolithotomy was performed and approximately 50 stones with dimensions varying from 5 mm to 5 cm, with a total weight of 890 g, were removed. After a 1-year follow-up, the patient did not report pain, urinary tract infections, or symptoms suggestive of fistula and imaging evaluation confirmed no recurrence of neobladder stones. Conclusion: Neobladder stones may present with various symptoms. Our patient had irritative lower urinary tract symptoms, lower abdominal fullness, urinary incontinence, fecaluria, and urinary loss from the left inguinal fold 12 years after a radical cystoprostatectomy with a orthotopic neobladder. Our experience demonstrates that open cystolithotomy is an effective intervention for the removal of large stones in neobladder.

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