Ileal Neobladder Construction Research Articles

Retrograde Radical Cystectomy and Ileal Neourethra Add to Achieve Immediate Continence in Patients Undergoing Orthotopic Ileal Neobladder

Objective: Main concern in the patients undergoing orthotopic neobledder construction following radical cystectomy has been urinary incontinence and need of clean self in-termittent catheterization. Our objective is to assess conti-nence rate associated with technique of retrograde radical cystectomy and ileal neobladder with ileal neourethra as compared to the standard antegrade technique. Methods: We retrospectively analysed the results of 130 patients who underwent radical cystectomy and ileal neobladder in our department during last 19 years. First 32 patients underwent classical antegrade cystectomy and ileal neobladder construction as described by Hautmann et al. Last 98 patients underwent retrograde radical cystectomy followed by ileal neobladder with ileal neourethra construction. Results: Continence rates were much better in the patients undergoing retrograde radical cystectomy and ileal neobladder with neourethra formation without any added morbidity. Our immediate daytime continence rates improved from 81 to 94% and nocturnal rates from 53 to 91%. Most of our patients are having adequate neobladder capacity and functional urethral length. Conclusions: Retrograde method of radical cystectomy preserves the rhabdosphincter with preservation of good length of urethra. Ileal neourethra further increase urethral length. Spherical shape of neobladder leads to complete emptying of bladder without need of clean self intermittent catheterization.

Uterus-, Fallopian Tube-, Ovary-, and Vagina-sparing Cystectomy Followed by U-shaped Ileal Neobladder Construction for Female Bladder Cancer Patients: Oncological and Functional Outcomes

To evaluate oncological outcomes and voiding functions after orthotopic neobladder reconstruction with preservation of gynecologic organs in female bladder cancer patients. A total of 30 consecutive female patients who underwent radical cystectomy and U-shaped ileal neobladder (constructed using 40 cm of a double-folded ileal loop) substitution were retrospectively analyzed. Of the 30 patients, 29 had urothelial carcinoma and 1 had leiomyosarcoma. Computed tomography was performed every 6 months. Urethroscopic examination was performed at 3-month intervals during the first and second years, and at 6-month intervals thereafter. Pressure flow studies, including urethral pressure profilometry, were performed 3, 6, 9, and 12 months after surgery. During a median follow-up of 35.7 months, 1 patient exhibited local recurrence and 6 patients died of bladder cancer. Maximum neobladder pressure examined 12 months after surgery improved significantly as compared with that examined after 3 months (P<.01). Maximal urethral closure pressure also improved significantly 12 months after surgery as compared with that after 3 months (P<.05). The capacity of the ileal neobladder 3 months after operation was 204+/-84 mL, and it showed a gradual increase, reaching 311+/-95 mL at 12 months (P<.01). None of the patients required catheterization for residual urine. Twenty-four patients (80%) remained completely dry day and night, voiding once or twice during the night. Orthotopic neobladder reconstruction with preservation of gynecologic organs is feasible for female bladder cancer patients. Although the follow-up period was not long, the present technique provided acceptable oncological outcome and voiding function.

Laparoscopic radical cystectomy with orthotopic ileal neobladder in the female: report of 14 cases

Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder in female patients with bladder carcinoma. From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4 - 5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope. The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively. Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hysterectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation. LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is required to confirm the neobladder function and oncological outcomes.

Long-term urodynamic and functional analysis of orthotopic “W” ileal neobladder following radical cystectomy

In this study, we evaluated the long-term functional outcomes and urodynamic results of the "W" orthotopic ileal neobladder. Twenty patients whose long-term follow-up data were available and willing to participate in this project were enrolled into the study. The operations were performed between 1997 and 2005. Following standard radical cystoprostatectomy and pelvic lymphadenectomy, "W"-shaped orthotopic ileal neobladder with extramural serous-lined tunnel ureteral implantation was performed. Urodynamic evaluation consisted of standard three-channel filling cystometry with 0.09% sodium chloride solution, and uroflowmetry with postvoiding residual (PVR) urine measurement. All patients were men. The mean duration to postoperative urodynamic study was 38.5 months. Mean cytometric capacity (MCC), compliance, maximal pouch pressure (MPP) and PVR were 584.7 ml, 42.4 ml/cmH2O, 34.8 cmH2O, and 83.5 ml, respectively. Seventeen patients (85%) had complete daytime continence. Total continence (nighttime and daytime) rate was 40%. Three patients (15%) were totally incontinent. Pearson correlation test revealed a positive correlation between MCC and compliance (P<0.05). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethrapouch anastomosis stricture was found to be significantly related with increased PVR. Continence status was not correlated with any urodynamic parameter. In this study, we found that "W" ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. Urodynamic evaluation of the "W" neobladder revealed similar results to that of a normal bladder. We conclude that "W" ileal neobladder construction results in a near-normal-functioning orthotopic reservoir that can be safely offered to patients.

La cystite glandulaire pseudo tumorale

To analyse diagnosis, management and prognosis of florid cystitis glandularis (pseudoneplastic entity). A retrospective study of 6 consecutive patients with florid cystitis glandularis seen at the department of Urology of Monastir (Tunisia) from January 1996 to July 2006. All patients underwent ultrasonography, and cystoscopy. Computed tomography (CT) was performed in four patients and magnetic resonance imaging (MRI) in one patient. The six patients, all of whom were male, ranged from 22 to 68 (average 42) years of age. The most common complaints was haematuria. Radiological examination and cystoscopy suggested a bladder tumor in all patients. Histopathology revealed features of cystitis glandularis of intestinal type. Features of the pelvic CT and MRI were consistent with the diagnosis of pelvic lipomatosis in one patient. The endoscopic resection was performed in 5 patients. Recurrence occurred in one of these 5 patients within one and 7 years of follow-up. The other patient had developed a low compliance small-capacity bladder and bilateral ureteral obstruction. A total cystoprostatectomy and ileal neobladder construction was considered, but it was declined by the patient. The patient was treated with anti-inflammatory drug (Indometacine 100 mg/day). Cystitis glandularis may be mistaken for bladder tumor The diagnosis is histological. Treatment is based on eradication of the irritative factors and endoscopic resection of the tumoral masses. The clinical course is unclear, requiring long-term fellow-up.

Orthotopic ileal W-shaped neobladder: Functional results and oncological outcome

There still exists an ongoing debate regarding the optimal method of ureterointestinal reimplantation in continent urinary diversion. The main objectives of the present study was to analyze the long-term functional results and the oncological outcome after the construction of orthotopic ileal neobladders, based on the antireflux serous-lined extramural tunnel technique. A total of 32 bladder cancer patients (30 males and 2 females, mean age 588 years), who underwent between 1/9/1996 and 1/9/2006 extended pelvic lymphadenectomy and radical cystectomy, followed by the construction of orthotopic W-shaped ileal neobladder, entered the study. All ureters were reimplanted via serous-lined extramural tunnels for reflux prevention. Adjuvant systemic chemotherapy with gemcitabine plus cisplatin was applied in 17 cases. All patients were evaluable for follow up (mean follow up - 53.938 months). Evaluation included clinical, radiographic and urodynamical studies to determine functional and oncological outcomes. None of the patients died in the hospital. Various early and late complications occurred in 18.8% and 21.9% of the patients, respectively. The overall incidence of day- and nighttime continence was 93.8% and 78.1%. Stenosis at the anastomotic site occurred in 2 uretero-ileal anastomoses (3.2%), while none of the patients showed evidence of pouchoureteral reflux. Renal function was stabilized or improved in 96.8% of the reimplanted renal units. Eight oncological failures were observed during follow-up: 1 local tumor recurrence and 7 metastatic tumor spreads. The overall and disease-specific patient survival was 72% and 81%, resp. The serous-lined extramural tunnel technique provides an effective and safe ureteroileal anastomosis, achieving nonobstructed unidirectional flow of urine. The results are durable and sustained with time. Therefore, this technique should be recommended whenever a construction of a continent intestinal urinary reservoir is considered.

MP-07.08: Functional results of the implementation of the serous-lined extramural tunnel technique of ureterointestinal reimplantation

The optimal method of ureteral reimplantation to an intestinal reservoir constructed to replace the bladder after radical cystectomy is still a matter of debate. The aim of this study was to analyze the functional results after the construction of orthotopic ileal neobladder and rectosigmoid reservoir based on the antireflux serous-lined extramural tunnel technique.

Surgical treatment for urethral recurrence after ileal neobladder reconstruction in patients with bladder cancer

To report a retrospective study evaluating the management of superficial urethral recurrence after ileal neobladder construction in patients with bladder cancer. In 77 consecutive patients with ileal neobladder after radical cystectomy for invasive bladder cancer, urethral recurrence was evaluated and transurethral resection (TUR) used as an initial treatment for superficial urethral recurrence. Urethrectomy with urinary re-diversion was performed when further recurrence developed. Four patients (5%) presented with a superficial urethral recurrence and all four were treated by TUR as initial therapy. One patient has had no evidence of recurrence after initial TUR, although the other three patients were later treated with salvage urethrectomy due to repeated urethral recurrence. As a result, the stage of urethral recurrence advanced from pTa to pT1-pT2 in two of the three patients. For urinary re-diversion, one patient had a conversion from a Studer pouch to an ileal conduit, using the afferent limb, and the other two were converted from a Hautmann pouch to a continent reservoir using the Appe-Mainz procedure. There was no evidence of metastasis or local recurrence in any of the four patients. Urethral preservation at initial therapy for superficial recurrence might be reasonable, and sequential urethrectomy after attempted urethral preservation might be strategically feasible. Urinary re-diversion from a neobladder to a catheterizable continent reservoir using the appendix would be a good choice and maintains the quality of life.

Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Totally Intracorporeal Ileal Neobladder

To describe robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal orthotopic ileal neobladder construction. With the use of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA), we performed laparoscopic radical cystectomy and intracorporeal construction of an orthotopic ileal neobladder (modified W pouch). The total operative time was 12 hours, and the estimated blood loss was 100 mL. There were no intraoperative or postoperative complications, and the patient?s hospital stay was 5 days. At early follow-up, oncologic and functional results are good. Robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal ileal neobladder construction is technically feasible. However, its role in the management of invasive bladder cancer remains to be defined.

Spontaneous Rupture of Ileal Neobladder: A Case Report

A 63-year-old male patient suffered from diabetes, hypertension, and a bladder tumor. He had undergone radical cystectomy and ileal neobladder construction 1 year prior to this admission. He came to our emergency room complaining of abdominal pain after recent alcohol consumption. Muscle guarding and abdominal rebounding pain developed after conservative treatment for 1 day. The next day, emergency laparotomy for acute peritonitis revealed two small perforations in the neobladder and calculus formation within it. In addition, severe intraperitoneal adhesion was noted. After removing the neobladder stone and repairing the neobladder, a Foley catheter was inserted for urine drainage. The patient's postoperative recovery was excellent.

Cystoprostatectomy and neobladder construction for florid cystitis glandularis

Cystitis glandularis is a benign proliferative disease of the bladder mucosa with a characteristic histopathologic appearance. If a mass lesion is identified, it is resected transurethrally. More extensive surgical management for severe or recurrent cases is poorly characterized in published studies. We present a patient with multiple rapid recurrences of polypoid masses on the trigone causing irritative voiding symptoms. He developed a low-compliance small-capacity bladder and bilateral ureteral obstruction. The patient underwent total cystoprostatectomy with cavernosal nerve sparing and ileal neobladder construction. We advocate such aggressive surgical management in select cases of this disease.

Cystectomy and Orthotopic Ileal Neobladder Construction

Introduction: This study evaluates the outcome of orthotopic neobladder construction in a regional hospital setting. Material and Methods: Orthotopic ileal neobladders were constructed in 51 patients between 1990 and 2001. All complications were reported systematically and continence was evaluated in a standardized manner. Results: One patient died perioperatively (2%). Early complications occurred in 56.9%. They were related to the neobladder in 21.6% and unrelated to the neobladder in 47.1%. 31.4% experienced complications in the late postoperative period. In 25.5%, these complications were neobladder related and in 11.8% they were not. After 1 year, daytime continence was 91.7% and nighttime continence 80.6%. Our results are comparable to those reported by others. Conclusion: We conclude that the construction of a Hautmann neobladder can be performed with acceptable results in a regional hospital. The democratization of recent bladder replacement techniques may offer more patients a better quality of life and prevent the formation of waiting lists. Radical treatment may then be opted for sooner and thus improve cancer-related survival.

URACHAL CARCINOMA ASSOCIATED WITH INCREASED CARBOHYDRATE ANTIGEN 19-9 AND CARCINOEMBRYONIC ANTIGEN

A 41-year-old woman presented with intermittent gross hematuria in January 2000. Cystoscopic examination revealed a thumb tip sized, nonpapillary sessile tumor on the bladder dome. Diagnosis was adenocarcinoma, which was confirmed by transurethral tumor biopsy. Serum carbohydrate antigen 19-9 was 53 units per ml. (normal less than 35) and carcinoembryonic antigen was 6.9 ng./ml. (normal less than 2.5). Contrast enhanced computerized tomography of the abdomen and pelvis demonstrated a soft tissue density mass arising from the anterior wall of the bladder with infiltration into the anterior adipose tissue. There was no evidence of lymphadenopathy. Other radiological imaging studies excluded distant metastasis and primary bowel cancer. Total cystectomy with en bloc removal of the umbilicus, pelvic lymphadenectomy and ileal neobladder construction as urinary diversion were performed. Histopathological examination of a specimen revealed features of mucin secreting, well differentiated adenocarcinoma of the urachus (fig. 1). Postoperatively 2 cycles of adjuvant chemotherapy consisting of 5-fluorouracil, doxorubicin and cisplatin were administered because lymph node metastasis to a right external iliac node was demonstrated by frozen section examination. The patient was clinically free of disease with normal results on followup abdominal and pelvic computerized tomography, and normal levels of 2 serum tumor markers.

A TECHNIQUE OF TRANSRECTAL ULTRASOUND GUIDED TRANSPERINEAL PERCUTANEOUS DRAINAGE OF PELVIC ABSCESS AFTER RADICAL CYSTECTOMY

Purpose: Pelvic abscess after pelvic surgery may be a serious complication. We describe a technique of accurate transrectal ultrasound guided transperineal percutaneous drainage.Material and Methods: Drainage of a pelvic abscess was required in a patient 30 days after radical cystectomy and ileal neobladder construction were performed for bladder cancer. Drainage was performed via perineal access under transrectal ultrasound guidance.Results: The procedure was painless and easily performed. About 100 ml. of pus were removed. The next day the patient was afebrile and 5 days later he was discharged from the hospital.Conclusions: Pelvic abscess after pelvic surgery is a serious complication. Percutaneous perineal ultrasound guided drainage is a safe and effective therapeutic option.

A TECHNIQUE OF TRANSRECTAL ULTRASOUND GUIDED TRANSPERINEAL PERCUTANEOUS DRAINAGE OF PELVIC ABSCESS AFTER RADICAL CYSTECTOMY

Pelvic abscess after pelvic surgery may be a serious complication. We describe a technique of accurate transrectal ultrasound guided transperineal percutaneous drainage. Drainage of a pelvic abscess was required in a patient 30 days after radical cystectomy and ileal neobladder construction were performed for bladder cancer. Drainage was performed via perineal access under transrectal ultrasound guidance. The procedure was painless and easily performed. About 100 ml. of pus were removed. The next day the patient was afebrile and 5 days later he was discharged from the hospital. Pelvic abscess after pelvic surgery is a serious complication. Percutaneous perineal ultrasound guided drainage is a safe and effective therapeutic option.

Experiences with the entero-ureteral anastomosis via the extramural serous-lined tunnel: procedure of abol-enein

Objectives. Ureteral reimplantation in any urinary diversion setting should be easy, reproducible, nonrefluxive, and without complications. In this study, we present our experiences with the entero-ureteral anastomosis via the extramural serous-lined tunnel, a technique introduced by Abol-Enein. Methods. In the period between 1995 and 1998 we performed the Abol-Enein technique in 50 patients who underwent radical cystectomy and ileal neobladder construction. Preoperatively 10 patients had unilateral ureteral dilatation. Results. The technique was performed easily, and any serious complications did not occur in the early postoperative period. Leakage of the urethral-intestinal anastomosis was seen in 2 patients and transient hydronephrosis in 2 patients. Among the most serious late complications were two strictures of the urethral-intestinal anastomosis and four unilateral strictures of the ureteral-intestinal anastomosis. Only 1 patient presented with unilateral grade IV urinary reflux. Four patients developed metabolic acidosis. In all cases, renal function was stabilized or improved, and preoperative dilatation of the ureters was alleviated. Conclusions. The low stricture rates of the uretero-intestinal anastomosis, as well as the low reflux rates of the procedure of Abol-Enein, render this procedure a safe method of uretero-intestinal anastomosis when an orthotopic ileal neobladder is formed. The method can be performed with equal or even greater ease in very dilated ureters that in many situations other techniques either cannot deal with or require ureteral tailoring. Although this technique seems to meet most of the criteria for an ideal uretero-intestinal anastomosis, further studies that involve longer follow-up periods are necessary to allow a definitive value of this method.

An Ileal Neobladder for a Female Patient after a Radical Cystectomy to Ensure Voiding from the Urethra: A Case Report

An ileal neobladder construction realizing normal micturition was successfully performed after a total cystectomy, with preservation of the urethra, for a 69-year-old female patient with invasive bladder cancer. Approximately 60 cm of terminal ileum was selected, detubularized and re-sutured to create an oval-shaped intestinal pouch to which the bilateral ureters were anastomosed. The bottom of the pouch was anastomosed to the urethral remnant. Three months after surgery, the patient achieved daytime continence, and now enjoys almost the same lifestyle as before. This is the first case of successful neobladder construction to be precisely reported for a female patient. For normal micturition, the ileal neobladder will be one of the possible choices for urinary diversion in not only selected male, but also female, patients.