Orthotopic Sigmoid Neobladder Research Articles

Long-term Follow-up of Detaenial Sigmoid Neobladder Reconstruction for Paediatric Patients with Bladder and Prostate Rhabdomyosarcoma: Technique and Results from a Single High-volume Centre

BackgroundRhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma. Approximately 15–20% of RMS cases arise from the bladder and prostate (B/P). The optimal treatment strategy for B/P RMS remains unclear. ObjectiveTo retrospectively evaluate the applicability of our procedure performed to treat paediatric patients with B/P RMS. Design, setting, and participantsThis is a retrospective analysis from a single tertiary referral hospital. From August 2003 to March 2021, 62 children pathologically diagnosed with B/P RMS underwent radical cystectomy and orthotopic detaenial sigmoid neobladder reconstruction in our centre. Surgical procedureSurgical procedures included laparoscopic radical cystectomy and detaenial sigmoid neobladder reconstruction, which is demonstrated in the accompanying video. MeasurementsDemographic, clinical, and follow-up data were collected. Perioperative and long-term oncological and functional outcomes were reported. A logistic regression analysis was also performed. Results and limitationsAll surgeries, including three intracorporeal laparoscopic surgeries, were completed successfully. Of the 62 patients, 54 were alive without evidence of disease recurrence or metastasis at the last follow-up. Five of the 14 >12-yr-old boys reported that they experienced erections. Two female patients >12 yr old reported that they menstruated. However, this was a retrospective study conducted at a single centre with limited surgeon experience. ConclusionsOur results confirmed the safety and feasibility of primary orthotopic sigmoid neobladder reconstruction after radical cystectomy for paediatric patients with B/P RMS. Good outcomes in terms of oncological control and functional recovery were achieved. The high histocompatibility and tissue adaptability of children are inspiring. Patient summaryWe describe our stepwise technique of radical cystectomy and detaenial sigmoid neobladder reconstruction for paediatric patients with bladder and prostate rhabdomyosarcoma. With this technique, we were able to achieve good functional recovery without compromising cancer control and significantly increasing complications.

Long-term outcomes of sigmoid neobladder after radical cystectomy in Indian population: a single centre experience

Background: Radical cystectomy with orthotopic neobladder is the standard of care for MIBC. Long-term data on sigmoid neobladder is limited. Sigmoid neobladder offers the advantage of low long-term metabolic and nutritional complications, due to sparing of ileum and ileo-caecal valve. We present our experience and long-term results of orthotopic sigmoid neobladder reconstruction after radical cystectomy.Methods: The study included 57 male patients who underwent radical cystectomy and orthotopic sigmoid neobladder for muscle-invasive carcinoma of bladder from January 2002 to December 2019. Data was collected with regards to complication rate, voiding patterns, continence status, recurrence-free and overall survival.Results: Mean age was 52.7 years (range 35 to 74). Median duration of follow-up was 62 months. There were 3 (5.3%) perioperative deaths. 15 patients (26.3%) developed early and 5 patients (8.7%) developed delayed complications. Node positive disease (N+) was found in 11 (19.3%) patients and 17 (29.8%) required adjuvant chemotherapy. 94.7% patients were continent and 42 (82.4%) patients had spontaneous voiding pattern. Daytime and nocturnal incontinence rate were 5.3% and 24.6%, respectively. Clean intermittent catheterization (CIC) was required in 8 (14.1%) cases. The recurrence-free survival (RFS) and overall survival (OS) were 57% and 50% at 5 years and 62.5% and 35.8% at 10 years, respectively.Conclusions: Sigmoid neobladder remains a viable form of orthotopic urinary diversion and provides satisfactory long-term continence and voiding results with acceptable rate of complications. Good long-term results in sigmoid neobladder in Indian population may be due to long sigmoid colons in Indian patients with low incidence of diverticulosis.

Laparoscopic nerve-sparing cystoprostatectomy with intracorporeal orthotopic sigmoid neobladder formation

The following clinical case is presented: performing of minimally invasive laparoscopic nerve-sparing cystoprostatectomy with intracorporeal orthotopic sigmoid neobladder formation for patient aged 62 with invasive bladder cancer. This case proves that the performed method of urine derivation is safe and can be used as alternative to other techniques in patients who underwent radical laparoscopic cystoprostatectomy.

Intraneobladder Hem-o-Lok Migration with Stone Formation after Orthotopic Neobladder Cystectomy.

Introduction. Laparoscopic and robot-assisted laparoscopic surgery are widely performed in urology field, so Hem-o-Lok clips are thus extensively used in the laparoscopic procedures. We describe the first case of Hem-o-Lok clip which migrated into the neobladder with calculus formation 26 months after laparoscopic orthotopic neobladder cystectomy, which causes symptoms of gross hematuria and frequent urination. Case Presentation. A 57-year-old man with T2a muscle invasive bladder cancer underwent laparoscopic orthotopic sigmoid neobladder reconstruction after cystectomy which was complicated by intestinal anastomosis leak and peritoneal abscess requiring transverse colostomy and drainage 15 days postoperatively. Twenty-six months after cystectomy, he complained of gross hematuria and frequent urination. Computerized tomography and plain pelvic X-ray revealed a stone measuring approximately 2.8 cm in diameter in the neobladder. During cystoscopy, a closed whitish Hem-o-Lok clip was seen in the center of the calculi. No anastomotic leak or neoplasm was found during cystoscopy. Conclusion. Hem-o-Lok clip migration into the bladder after laparoscopic orthotopic neobladder cystectomy is a rare complication; the first reported case in the literature. To prevent Hem-o-Lok clip migration, it is recommended to avoid extensive use of Hem-o-Lok clip close to anastomosis site, and any loose Hem-o-Lok clip should be retrieved before closure.

Orthotopic Detaenial Sigmoid Neobladder after Radical Cystectomy: Technical Considerations, Complications and Functional Outcomes

In recent years the orthotopic neobladder has gained increasing popularity in patients who undergo radical cystectomy. However, there are only a few reports of orthotopic neobladders reconstructed from the sigmoid without detubularization. We investigated the complications and functional outcomes of the orthotopic sigmoid neobladder reconstructed using our detaenial technique. We performed a retrospective study of the detaenial sigmoid neobladder in 210 consecutive patients who underwent radical cystectomy at our institution from January 2003 to March 2010. ANOVA was used to investigate urodynamic finding differentials with time. Univariable and multivariable analyses were done to determine factors influencing continence. Median followup was 48 months. Early complications (90 days or less) were observed in 65 patients (31%). Late complications (greater than 90 days) were observed in 45 patients (21.5%). Five-year daytime and nighttime complete continence rates were 74.6% and 57.1%, respectively. Younger age was the only independent factor associated with complete continence during the day (OR 2.342, 95% CI 1.803-3.041, p <0.001) and night (OR 1.193, 95% CI 1.087-1.310, p <0.001). Mean maximal capacity and post-void residual urine were 328.8 and 22.2 ml, respectively. The mean maximal flow rate was 18.5 ml per second. The mean end filling pressure, pressure at maximal capacity and maximal intravesical pressure were 35.8, 55 and 60.6 cm H2O, respectively. These parameters remained stable with time (each p >0.05). This study confirms that detaenial sigmoid neobladder is a safe, feasible alternative for urinary diversion.

Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients

To retrospectively review our clinical experience with sigmoid neobladder reconstruction. The study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health-related quality of life (HRQL, using the Short-Form 36 instrument) were evaluated in 80 patients with a mean follow-up of 55 months, after excluding two who died perioperatively. There were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero-intestinal stricture in four and entero-urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and night-time continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B(12). The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age-matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients. The modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy.

Clinical significance of bacteriuria in patients with orthotopic sigmoid neobladder after radical cystectomy

To evaluate the incidence and clinical significance of bacteriuria in patients who underwent sigmoid neobladder substitution after radical cystectomy. The study included 149 patients with invasive bladder carcinoma who underwent radical cystectomy and orthotopic sigmoid bladder substitution. Diagnosis of bacteriuria was made by freshly collected midstream urine culture at 3, 6 and 12 months postoperatively. Positive urinary culture was defined as >100 000 colony forming units (CFU)/ml. The data collected were evaluated in correlation to the clinical status of the patients. Overall 466 urine samples from 149 patients were cultured during the follow-up period. Out of these 149 patients, 18 were lost to follow-up and 11 patients developed new stone formation in the neobladder with an incidence of bacteriuria of 91%. These 29 patients were excluded from the study. Among the remaining 120 patients, positive urine culture with significant growth of uropathogens was seen in 64%, 47% and 33% at 3, 6 and 12 months, respectively. Two thirds of patients with positive urine cultures were asymptomatic. The commonest uropathogen encountered was E Coli (72%) followed by Klebsiella (12%). Sigmoid neobladder substitution is associated with a high incidence of bacteriuria. Despite, the spontaneous clearance of bacteriuria over time without antimicrobial manipulation, antimicrobial therapy was needed in some patients, particularly those with a large post-void residual (PVR) urine volume, persistent urosepsis and stone formation in the neobladder.

UP-2.178: Long-Term Outcome of Ureteral Implantation In Orthotopic Sigmoid Neobladder After Radical Cystectomy

UP-2.178: Long-Term Outcome of Ureteral Implantation In Orthotopic Sigmoid Neobladder After Radical Cystectomy

MP-2.15: Long-term Outcomes of Sigmoid Neobladder After Radical Cystectomy in an Indian Population: A Single Centre Experience

Radical cystectomy and orthotopic urinary diversion is now the standard treatment for muscle invasive carcinoma of bladder. However extensive long-term data on sigmoid neobladder is limited. Sigmoid neobladder offers the advantage of low long-term metabolic and nutritional complications, due to sparing of ileum and ileo-caecal valve. We present our experience and long-term results of orthotopic sigmoid neobladder reconstruction after radical cystectomy.

Skeletal Muscle Metastasis from Transitional Cell Carcinoma of the Urinary Bladder: Clinicoradiological Features

AIM: To define the clinicoradiological characteristics of skeletal muscle metastasis from transitional cell carcinoma of the urinary bladder. MATERIALS AND METHODS: A retrospective review of all patients with skeletal muscle metastasis was undertaken between January 1999 to December 2001. Patients suspected of having a metastasis on radiological examinations, and subsequently proven to have metastatic disease on histological examination were included in study. The clinical presentation and radiological features of five patients with skeletal muscle metastasis from bladder tumours were reviewed from hospital records. RESULTS: Twenty-four patients had skeletal muscle metastasis from various primaries. Of these five patients had previous or concurrent primary tumours in the bladder. Patients were aged between 27–70 years (mean 52 years), and all had persistent, localized pain with or without accompanying swelling. The muscles involved were psoas in three patients, adductor muscles of thigh in one and rectus abdominis in one. Four patients had radical cystectomy with urinary diversion (two ileal conduit and two orthotopic sigmoid neobladder). One patient presented with bladder tumour and concomitant muscular metastasis. All patients underwent helical computed tomography (CT) before confirmation of diagnosis by fine-needle aspiration (FNA) or biopsy. The typical appearance of low-density enhancing lesions on CT was mistaken for abscess in two patients and failure to respond to conservative treatment led to suspicion of metastasis. Diagnosis was proven histologically in all patients (FNA in three and biopsy in two). All patients had palliative chemotherapy (Mitomycin, Vincristine, Adriamycin and Cyclophosphamide). Two patients had local palliative 3500 rad radiotherapy for persistent pain. Mean survival was 8 months (range 6–12 months). CONCLUSION: Muscular metastasis from urothelial tumours typically presents with persistent localized pain with or without swelling. The characteristic low-density, ring-enhancing lesions on CT in a patient with previous or concomitant urothelial tumours should raise the suspicion of metastasis until proven otherwise. Prognosis is dismal.