Ileal Neobladder Formation Research Articles

CT Evaluation of the Findings of Nutcracker Syndrome in Patients with Bladder Cancer after Radical Cystectomy and Ileal Neobladder Formation: A Correlation with Hematuria.

Patients with bladder cancer may show hematuria after radical cystectomy with ileal neobladder formation, causing anxiety regarding tumor recurrence. Here, we aim to show that the nutcracker syndrome (NCS) can be a cause of hematuria post-operation, and is a common, rather than a rare syndrome. A retrospective review of contrast-enhanced abdominopelvic CT (CE-APCT) and urine analysis (UA) findings of 255 patients with bladder cancer who underwent radical cystectomy and ileal neobladder formation between 2011 and 2016 was performed. In the CE-APCT review, the left renal vein flow patterns were evaluated to determine the presence of NCS findings. In the UA review, patients were classified according to the percentage of UA tests with positive hematuria among the total number of UA tests. CT findings of NCS were present in 31.9% of the 135 patients. In the positive hematuria group, there were 26% more patients with NCS findings than those without. NCS findings are prevalent even for bladder cancer patients after surgery, and there is a strong correlation between NCS findings and hematuria. Furthermore, the prevalence of NCS findings is much higher than urinary tract recurrence after the surgery.

V13-08 ROBOTIC INTRACORPOREAL ORTHOTOPIC ILEAL NEOBLADDER: REPLICATING OPEN SURGICAL PRINCIPLES OF Y-SHAPED TECHNIQUE

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-08 ROBOTIC INTRACORPOREAL ORTHOTOPIC ILEAL NEOBLADDER: REPLICATING OPEN SURGICAL PRINCIPLES OF Y-SHAPED TECHNIQUE Tommaso Silvestri, Federico Germinale, Giovanni Costa, Bernardino De Concilio, Guglielmo Zeccolini, Giorgio Mazzon, and Antonio Celia Tommaso SilvestriTommaso Silvestri More articles by this author , Federico GerminaleFederico Germinale More articles by this author , Giovanni CostaGiovanni Costa More articles by this author , Bernardino De ConcilioBernardino De Concilio More articles by this author , Guglielmo ZeccoliniGuglielmo Zeccolini More articles by this author , Giorgio MazzonGiorgio Mazzon More articles by this author , and Antonio CeliaAntonio Celia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is the fourth most common cancer diagnosed in men in the Europe and currently radical cystectomy is yet the gold-standard treatment in patient fit for surgery. In the last five years, there was a progressively evolution in robotic technique for ileal neobladder. Herein, we describe our step-by-step technique for robotic intracorporeal neobladder formation. METHODS: We present the case of a 59 years old patient with a diagnosis of an muscular-invasive bladder cancer underwent neoadjuvant chemotherapy and then radical cystectomy and super-extended bilateral pelvic lymphadenectomy. The presented video is a focus on our approach and technique for the configuration of the Y-shaped neobladder. The main surgical steps to forming the intracorporeal orthotopic ileal neobladder are: isolation of 45 cm of small bowel (length varies in relation to the characteristics of ileum); neobladder-urethral anastomosis; small bowel anastomosis; bowel detubularisation; suture of the posterior wall of the neobladder; and cross folding of the pouch; and uretero-enteral anastomosis. Improvements have been made to these steps to enhance time efficiency without compromising neobladder configuration. RESULTS: From January 2017 to July 2020 we performed our technique in 25 patients. Our technical improvements have resulted in a decreasing in operative time from 400 to 200 min. Postoperative surgical complications occurred in four of the 18 patients (22.1%), including one surgical Clavien-Dindo Grade III and three Grade I, postoperative medical Clavien-Dindo Grade II complications occurred in three (16.7%) patients. On urodynamic examination (available in 5 [20%] patients) the median (IQR) reservoir cystometric capacity, compliance, and post-void residual were 220 (190-256) mL, 17 (11.8-20.1) mL/cmH2 O, and 0 (0-56) mL, respectively. CONCLUSIONS: We describe our step-by-step technique of robot-assisted intracorporeal orthotopic ileal neobladder formation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1080-e1080 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tommaso Silvestri More articles by this author Federico Germinale More articles by this author Giovanni Costa More articles by this author Bernardino De Concilio More articles by this author Guglielmo Zeccolini More articles by this author Giorgio Mazzon More articles by this author Antonio Celia More articles by this author Expand All Advertisement Loading ...

Locally Advanced Bladder Paraganglioma Managed with Robot-assisted Radical Cystectomy with Intracorporeal Neobladder- A Case Report

Paragangliomas are neuroendocrine tumours of extra-adrenal origin. Primary bladder paragangliomas are rare and have variable functional status, which presents a challenge in their management by minimally invasive surgery. Surgical resection necessitates minimal intraoperative handling of tumour, minimising physiological deterioration. Here in, a case is reported of incidentally detected locally advanced bladder paraganglioma which was managed successfully with robot-assisted radical cystectomy and intracorporeal ileal neobladder formation.

Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique.

To describe our, step-by-step, technique for robotic intracorporeal neobladder formation. The main surgical steps to forming the intracorporeal orthotopic ileal neobladder are: isolation of 65 cm of small bowel; small bowel anastomosis; bowel detubularisation; suture of the posterior wall of the neobladder; neobladder-urethral anastomosis and cross folding of the pouch; and uretero-enteral anastomosis. Improvements have been made to these steps to enhance time efficiency without compromising neobladder configuration. Our technical improvements have resulted in an improvement in operative time from 450 to 360 min. We describe an updated step-by-step technique of robot-assisted intracorporeal orthotopic ileal neobladder formation.

Total Bladder and Posterior Urethral Reconstruction: Salvage Technique for Defunctionalized Bladder with Recalcitrant Posterior Urethral Stenosis

Recalcitrant posterior urethral stenosis is a challenging disease. When combined with a defunctionalized bladder, cutaneous urinary diversion is the most common surgical option. We present a novel technique of total lower urinary tract reconstruction, combining salvage cystectomy, ileal neobladder formation and urethral pull-through, as an orthotopic alternative in patients with a defunctionalized bladder and recalcitrant posterior urethral stenosis. We completed a retrospective review of 8 patients who underwent salvage cystectomy, orthotopic ileal neobladder formation and urethral pull-through. Artificial urinary sphincter placement was performed in a staged fashion. Six patients received prostate cancer treatment including radiation therapy, 1 had urethral disruption after robotic radical prostatectomy, and 1 experienced bladder rupture and urethral distraction injury during a motorcycle accident. Patient demographics, operative variables and postoperative outcomes were examined. No high grade complications were observed after salvage cystectomy, orthotopic neobladder formation and urethral pull-through. After staged artificial urinary sphincter placement, a median of 2 revision surgeries (range 0 to 4) was required to establish social continence. All patients maintained functional urinary storage, urethral patency and social continence at a median followup of 58 months. No patient had complications related to orthotopic neobladder formation, including ureteroileal anastomotic stricture or pyelonephritis, and no patient required cutaneous diversion. Total lower urinary tract reconstruction with cystectomy, ileal neobladder formation and urethral pull-through offers an orthotopic alternative for patients with recalcitrant posterior urethral stenosis and defunctionalized bladders. Although it requires staged placement of an artificial urinary sphincter, this approach can offer functional urinary storage, durable urethral patency and avoidance of cutaneous urinary diversion.

Oncologic, Functional, and Complications Outcomes of Robot-assisted Radical Cystectomy with Totally Intracorporeal Neobladder Diversion

BackgroundRobot-assisted radical cystectomy (RARC) with totally intracorporeal neobladder diversion is a complex procedure that has been reported with good outcomes in small series. ObjectiveTo present complications and oncologic and functional outcomes of this procedure. Design, setting, and participantsBetween 2003 and 2012 in a tertiary referral center, 70 patients were operated on by two experienced robotic surgeons. Data were collected prospectively and reviewed retrospectively. InterventionRARC with totally intracorporeal modified Studer ileal neobladder formation. Outcome measurements and statistical analysisThe overall outcome of RARC with a totally intracorporeal neobladder was presented by assessing (1) surgical margins, (2) recurrence or cancer-specific death at 24 mo, (3) 30-d and 90-d complications graded according to the modified Clavien-Dindo system, (4) daytime and nighttime continence (no or one pad per day) at 6 and 12 mo, and (5) satisfactory sexual activity or potency at 6 mo and 12 mo. Survival rates were estimated by Kaplan-Meier plots. Results and limitationsMedian follow-up of the cohort was 30.3 mo (interquartile range: 12.7–35.6). We recorded negative margins in 69 of 70 patients (98.6%). Clavien 3–5 complications occurred in 22 of 70 patients (31.4%) at 30 d and 13 of 70 (18.6%) at >30 d. At 90 d, the overall complication rate was 58.5%. Clavien <3 and Clavien ≥3 complications were recorded in 15 of 70 patients (21.4%) and 26 of 70 (37.1%), respectively. Kaplan-Meier estimates for recurrence-free, cancer-specific, and overall survival at 24 mo were 80.7%, 88.9%, and 88.9%, respectively. Daytime continence and satisfactory sexual function or potency at 12 mo ranged between 70% and 90% in both men and women. Limitations of this study include its retrospective design, selection bias due to the learning curve phase, and missing data. ConclusionsIn this expert center for RARC, outcomes after RARC with totally intracorporeal neobladder diversion appear satisfactory and in line with contemporary open series.

V1858 PROSTATE-SPARING RADICAL CYSTECTOMY WITH PROSTATIC CAPSULE AND VASA DEFERENTIA SPARING BY MEANS OF MILLIN PROSTATECTOMY

You have accessJournal of UrologyBladder Oncology1 Apr 2013V1858 PROSTATE-SPARING RADICAL CYSTECTOMY WITH PROSTATIC CAPSULE AND VASA DEFERENTIA SPARING BY MEANS OF MILLIN PROSTATECTOMY Rafael Sanchez-Salas, Petr Macek, Francois Rozet, Eric Barret, Marc Galiano, Luca Lunelli, and Xavier Cathelineau Rafael Sanchez-SalasRafael Sanchez-Salas Paris, France More articles by this author , Petr MacekPetr Macek Paris, France More articles by this author , Francois RozetFrancois Rozet Paris, France More articles by this author , Eric BarretEric Barret Paris, France More articles by this author , Marc GalianoMarc Galiano Paris, France More articles by this author , Luca LunelliLuca Lunelli Paris, France More articles by this author , and Xavier CathelineauXavier Cathelineau Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2277AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is a major surgery with risks including incontinence, erectile dysfunction and loss of ejaculations. There are various approach how to improve functional results. One of the proposed methods is prostate sparing by various techniques. The objective is to present the technique of prostate-sparing RC (PSRC) with prostatic capsule and vasa deferentia sparing by means of Millin prostatectomy. METHODS To describe the technique we present a case of 63 year healthy male with T2 N0 M0 urothelial bladder cancer located at the posterior bladder wall. His erectile function was normal and he strongly wished to maintain ejaculation. Following a discussion on management options a PSRC was chosen. His PSA was 1,67 and due to the type of treatment 12-core prostate biopsy was performed with negative result. He underwent 2 courses of neoadjuvant chemotherapy and robot-assisted PSRC was performed. RESULTS We use transperitoneal approach in Trendelenburg position. Bilateral extended pelvic lymph node dissection was performed initially with care not to divide vasa deferentia. Once completed posterior peritoneum is open above the tips of seminal vesicles a dissection is done laterally to isolate vas deference and ureters. Distal ureteral margins were sent for frozen section. Dissection continues posteriorly between vasa and seminal vesicles to identify the base of prostate. Then anterior incision of prostatic capsule is done and enucleation of adenoma is started. At the level of uretra catheter is clipped and divided. Afterwards the bladder is detached laterally to identify the sides of prostate. Opening of prostatic capsule is done posteriorly, extended ventrally on both sides and enucleation of adenoma is completed. The whole specimen is removed in the bag via small midline incision, which is also used for extracorporeal ileal neobladder formation with uretero-neobladder anastomosis as usually. Pouch is placed back to pelvis, laparotomy closed and robotic system redocked. Anastomosis of neobladder to the prostatic capsule is done with running 3/0 V-loc stitches and 2 Redon drains are placed. Final histology was pT0 pN0 (26/0) for bladder and no cancer in the prostate. Three weeks later the patients was continent and had penile tumescence. CONCLUSIONS PSRC is an alternative for highly selected patients who wish to maintain erectile function and/or ejaculation.Robotic?assistance may be beneficial for patient and surgeon. The surgeon needs to be familiar with the technique and adenoma enucleation may be more difficult in small prostates. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e762 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Sanchez-Salas Paris, France More articles by this author Petr Macek Paris, France More articles by this author Francois Rozet Paris, France More articles by this author Eric Barret Paris, France More articles by this author Marc Galiano Paris, France More articles by this author Luca Lunelli Paris, France More articles by this author Xavier Cathelineau Paris, France More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

1170 OUTCOMES OF ARTIFICIAL URINARY SPHINCTER PROSTHESIS IMPLANTATION FOR TREATMENT OF STRESS URINARY INCONTINENCE IN PATIENTS WITH ILEAL NEOBLADDER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy1 Apr 20111170 OUTCOMES OF ARTIFICIAL URINARY SPHINCTER PROSTHESIS IMPLANTATION FOR TREATMENT OF STRESS URINARY INCONTINENCE IN PATIENTS WITH ILEAL NEOBLADDER Dominic Lee, Peter Hinh, and O.Lenaine Westney Dominic LeeDominic Lee Houston, TX More articles by this author , Peter HinhPeter Hinh Houston, TX More articles by this author , and O.Lenaine WestneyO.Lenaine Westney Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.780AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A review on outcomes of artificial urinary sphincter (AUS), AMS-800 (American Medical Systems, Minnetonka, Minnesota) performed in men with severe stress urinary incontinence (SUI) following cystoprostatectomy and orthotopic ileal neobladder formation in a single institution. METHODS This is a retrospective analysis of nine (9) men who had an AUS implanted for severe stress urinary incontinence following cystoprostatectomy and ileal neobladder formation. Two Validated questionnaires - ICS male (SF) questionnaire and Incontinence Symptom Index (ISI) score was used to quantify the incontinence and quality of life symptoms. The length of stay, operating time, estimated blood loss, urinary symptom and peri-operative pad use, quality of life (QOL) scale and postoperative complications were evaluated. RESULTS The mean age of patients was 69 years and the mean duration of follow up was 28.8 months (range 3.8 to 81.7). Five (50.6%) of 9 patients underwent a cuff placement via trans-scrotal route and four (44.4%) via perineal route. Eight (88.9%) out of 9 patients had single cuff insertion while the remaining patient had a tandem cuff placement. Seven (77.8%) patients had 4.0cm cuff size implanted and 1 patient had a 4.5 cm cuff and the tandem cuff patient had 4.0/4.5cm cuff. Average pad use decreased from 6 to 1 per day (p< 0.005). The mean score on the ICS male(SF) scale was 13.7 and the mean for the ISI symptom score index was 14.2. Complications included 2 cases of explantation for erosion from infection and severe penile tip pain. Mean time to explantation was 3.5 months post AUS implantation. No revisions were required in the remaining patients. CONCLUSIONS AUS is a feasible option for management of severe stress urinary incontinence in men with orthotopic ileal neobladder following radical cystoprostatectomy. With intermediate term follow up, there is a significant decrease in pad use with concurrent improvement in quality of life. In addition the complication rate is low and is comparable to most series with non high risk features. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e469 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominic Lee Houston, TX More articles by this author Peter Hinh Houston, TX More articles by this author O.Lenaine Westney Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lessons Learned From 1,000 Neobladders: The 90-Day Complication Rate

We report the 90-day morbidity of the ileal neobladder in a large, contemporary, homogenous series of patients who underwent radical cystectomy at a tertiary academic referral center using a standard approach. Between January 1986 and September 2008 we performed 1,540 radical cystectomies. A total of 281 patients had an absolute contraindication for orthotopic reconstruction. The remaining 1,259 patients were candidates for a neobladder. Of these patients 1,013 (66%) finally received a neobladder and form the basis of this report. All patients had a thorough followup until December 2008 or until death. All complications within 90 days of surgery were defined, categorized and classified by an established 5 grade and 11 domain modification of the original Clavien system. Of 1,013 patients 587 (58%) experienced at least 1 complication within 90 days of surgery. Infectious complications were most common (24%) followed by genitourinary (17%), gastrointestinal (15%) and wound related complications (9%). The 90-day mortality rate was 2.3%. Of the patients 36% had minor (grade 1 to 2) and 22% had major (grade 3 to 5) complications. On univariate analysis the incidence and severity of the 90-day complications rate correlate highly significantly with age, tumor stage, American Society of Anesthesiologists score and preoperative comorbidity. Radical cystectomy and ileal neobladder formation represent a major surgery with potential relevant early complications even in the most experienced hands. The rate of severe and lethal complications is acceptably low.

CYSTECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER: THE IMPACT ON FEMALE SEXUALITY

January 1986 and September 2003 cystectomy and formation of an ileal neobladder were performed in 86 female patients. In this retrospective study we focused on the impact of orthotopic reconstruction on female sexuality. To assess female sexuality the standardized self-reporting instrument female sexual function index was mailed to 44 patients who were 70 years or younger at cystectomy with a recurrence-free followup of greater than 1 year, no pelvic irradiation and no concomitant diseases impairing sexual functions. The questionnaire analyzes 6 domains (desire, arousal, lubrication, orgasm, satisfaction and pain) with 19 items. It was returned by 29 patients (65.9%) with a median age of 65.0 years. The indication for cystectomy was benign disease in 8 cases and malignancy in 21. Factors influencing female sexuality were age younger than 60 years, benign disease, partnership at surgery and current partnership. Clean intermittent catheterization, urinary stress incontinence and hormonal therapy did not affect the results. The 11 of 17 patients who remained sexually active after cystectomy even had slight improvement in all female sexual function items. Six patients ceased to be sexually active postoperatively due to erectile dysfunction or partner death. One patient with interstitial cystitis became sexually active following cystectomy due to the loss of pelvic pain. Another 12 patients remained sexually inactive postoperatively. All aspects of female sexuality may remain unchanged following cystectomy and ileal neobladder formation as long as sexual activity is not ceased due to other reasons. Even fertility can be preserved when the internal genitalia do not have to be removed.