You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2010758 STAPLED CREATION OF ILEAL NEOBLADDERS REVISITED Matthew Ercolani, Christopher Wright, Murali Ankem, and Robert Weiss Matthew ErcolaniMatthew Ercolani More articles by this author , Christopher WrightChristopher Wright More articles by this author , Murali AnkemMurali Ankem More articles by this author , and Robert WeissRobert Weiss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the introduction of the Camay reservoir in 1959, urologists have tried to improve construction and reduce complications for ileal neobladders in patients with muscle-invasive bladder cancer. Linear anastomotic staplers, particularly ones with polyglycolic acid absorbable staples, were briefly evaluated in the 1990s as a tool for faster pouch creation, but fell out of favor due to reports in the urologic literature of increased rates of stone formation, decreased mean pouch capacity, and increased day and nighttime incontinence. Newer reports in recent years have supported the use of stapled neobladders as a safe and functional method for continent urinary diversion. The use of stapled pouches is also supported in the colorectal literature. Our aim was to review the experience with stapled pouches and evaluate their functional outcomes and complications. METHODS A MEDLINE search was performed from 1990 to present with keywords ileal neobladder, stapled, U-shaped, W-shaped, and Y-shaped. 9 peer-reviewed articles were identified of which 5 had adequate data for review. The following data points were compared: number of patients, neobladder type, median construction time, use of absorbable staples, median follow-up time, mean pouch capacity, mean end-filling pressure, presence of pouch stones, presence of daytime incontinence, presence of ureteroneobladder anastomotic stricture (UNAS) and presence of any neobladder-associated anastomotic leak (NAAL). RESULTS The analysis is shown in Table 1 below. Median pouch creation time was 23 minutes and average pouch capacity was 427.2 mL. Median follow up time was 16.4 months. Mean end-filling pressures were within limits for protection of the upper urinary tracts. Complication rates were as follows: pouch stones 3/116 (2.6%), daytime incontinence 20/116 (17.2%), UNAS 4/116 (3.4%), and NAAL was 2/116 (1.7%). Table 1. Montie (1996) Cecchi (1997) Ugyur (2000) Fontana (2004) Abreu (2006) Totals # of Patients 19 14 30 50 3 116 Pouch Type W W U Y U Absorbable? Yes Yes Yes No No Median Creation Time (minutes) 20 20 15 20 40 23 Median Follow-Up (months) 15 18 26 20 3 16.4 Mean Pouch Capacity (mL)⁎ 526 377 521 390 322 427.2 Mean End-Filling Pressure (cm H2O) 23⁎⁎⁎ 23.8 30⁎⁎ 18 Not Done 20.9 Pouch Stones 0/19 0/14 0/30 3/50 0/3 3/116 Daytime Incontinence 8/19 1/14 1/30 10/50 0/3 20/116 Ureteroneobladder Anastomotic Stricture 0/19 1/14 1/30 2/50 0/3 4/116 Neobladder Anastomotic Leak 0/19 0/14 1/30 0/50 1/3 2/116 ⁎ As determined by measurement at last follow-up by urodynamic evaluation ⁎⁎ Individual pressures not listed in study but all pressures reported as less than 30 cm H2O ⁎⁎⁎ 7/19 patients had pressures above 40 cm H20 prior to end filling; Average listed is for the remaining 12 patients CONCLUSIONS Ileal neobladders can be constructed using both absorbable and non-absorbable staple types with a short creation time, an adequate pouch volume capacity, and few postoperative complications. A larger prospective, randomized study is warranted to assess complications and functional outcomes, particularly with long-term urodynamic evaluation. New Brunswick, NJ© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e296-e297 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Ercolani More articles by this author Christopher Wright More articles by this author Murali Ankem More articles by this author Robert Weiss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...