MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER Kathryn Cunningham, Yasmin I. Bootwala, Graciela Nogueras-Gonzalez, Huong Truong, Clay Pendleton, and O. Lenaine Westney Kathryn CunninghamKathryn Cunningham More articles by this author , Yasmin I. BootwalaYasmin I. Bootwala More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Huong TruongHuong Truong More articles by this author , Clay PendletonClay Pendleton More articles by this author , and O. Lenaine WestneyO. Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studer and other investigators have postulated the negative effect of the “funnel-shaped” outlet resulting from utilizing the inferior aspect of the anterior neobladder wall closure for the urethral anastomosis. This technique has been linked to dysfunctional voiding. We aimed to compare the functional results of the two anastomotic types, the “funnel-shaped” or suture line and the neo-orifice technique. METHODS We reviewed the records of patients who underwent a Studer ileal neobladder reconstruction from 1/1/2000 to 5/30/2012 at our institution. In addition to demographic information, the charts were evaluated for anastomotic leak on post-operative cystogram, urinary incontinence (day and/or night), urinary retention and subsequent procedures to correct incontinence or outlet obstruction. Incontinence was defined as any leakage between regularly scheduled voids. RESULTS 363 of 465 patients met the inclusion criteria of follow-up greater than 6 months. The majority were male, 90.6% (n=329), with a mean age at cystectomy of 59.7 years. Mean follow up was 49 months (range, 6.1 - 138.7). Urethral anastomotic technique was divided between suture line and neo-orifice, 47% and 53%, respectively. Any urinary incontinence was identified in 41.8% of patients at last follow up, with 20.3% reporting daytime incontinence and 39.2% complaining of nighttime incontinence. Surgical intervention for urinary incontinence was performed on 23 patients (6.4%) including artificial urethral sphincter (15), male sling (4), ileal conduit/catheterizable diversion (3), and transurethral injection (1). There was no significant difference in regards to urinary incontinence, day or night, with respect to anastomotic type (p=.241) [RR= 1.158 , 95% CI .908 - 1.476]. Urinary retention occurred in 16% of patients, with surgical intervention required in 3.3%. No significant difference was seen in this outcome in regard to type of anastomosis (p=0.247) [RR=1.36, 95%CI .845 - 2.195]. Suture line anastomoses were more likely to have a leak identified on cystogram (24.1 vs. 15.2%, p=0.033, RR=1.59, 95% CI: 1.036 - 2.430). CONCLUSIONS Our data showed no significant difference in urinary functional outcomes – incontinence and retention - when comparing these two anastomotic types. However, the suture-line technique was shown to have a higher risk of anastomotic leak. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e85 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kathryn Cunningham More articles by this author Yasmin I. Bootwala More articles by this author Graciela Nogueras-Gonzalez More articles by this author Huong Truong More articles by this author Clay Pendleton More articles by this author O. Lenaine Westney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...