Better Compliance Contributes to Better Nocturnal Continence With Orthotopic Ileal Neobladder Than Ileocolonic Neobladder After Radical Cystectomy for Bladder Cancer

Chen, Zhiwen; Lu, Gensheng; Li, Xin; Li, Xuemei; Fang, Qiang; Ji, Huixiang; Yan, Ji; Zhou, Zhansong; Pan, Jinhong; Fu, Weihua; Li, Weibin; Xiong, Enqing; Song, Bo

doi:10.1016/j.urology.2008.09.076

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…Overall daytime continence rates in literature vary between 77% and 100% and nighttime continence rates from 66% to 80%. [9,10] In our study daytime continence of IN and SN were 93% and 89% respectively and nighttime continence were 91% and 78% respectively. The rate of CIC after neobladder varies broadly in literature from 4% to 43% at 5 years, but seems dependent on which cutoff the authors considers PVRU as clinically significant.…”

Section: Discussionsupporting

confidence: 52%

Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience

Singh

Mandal

Patil

et al. 2014

South Asian J Cancer

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Aim:The aim of this study is to compare urodynamic and continence parameters among patients undergoing orthotropic neo-bladder substitution with sigmoid or ileal segments. Variations in the Urodynamic parameter between the continent and incontinent patients were also evaluated.Patients and Methods:From January 2008 to March 2012, 44 patients underwent ileal neobladder (IN) reconstruction and 36 patients underwent sigmoid neobladder (SN) reconstruction. Evaluation of Urodynamic and Continence parameters was performed at 12 months after surgery.Results:The average capacity of IN and SN was 510 ml and 532 ml respectively. The voiding pressure, mean peak flow rates and post void residual urine (PVRU) for IN and SN were 27.5 cm H2O versus 37 cm H2O, 15ml/s versus 17ml/s and 36 ml versus 25 ml respectively. Daytime continence for IN and SN was 93% (41/44) and 89% (32/36), and night-time continence was 91% (40/44) and 78% (28/36) respectively. The compliance, maximum cystometric capacity and PVRU in the daytime continent (versus incontinent) were 61 (versus 41), 471 (versus 651) and 22 (versus 124) and in the night-time continent (versus incontinent) were 57 (versus 43), 437 (versus 654) and 18 (versus 105) respectively.Conclusion:A neobladder constructed from detubularized ileum or sigmoid achieves urodynamically proven adequate capacity and compliance with 89-93% daytime and 78-91% night time continence. Continent men when compared with incontinent (both daytime and night time) were more likely to have comparatively higher compliance, lower maximum cystometric capacity and lower PVRU. Urodynamic study could predict which incontinent men would improve with pelvic floor exercises and clean intermittent catheterization (CIC).

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Section: Discussionsupporting

confidence: 52%

Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience

Singh

Mandal

Patil

et al. 2014

South Asian J Cancer

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“…Moreover, the aforementioned functional parameters of the orthotopic ileal bladder were further improved at 12 months post-surgery. Thus, these findings further indicate the technical feasibility and improved long-term prognosis of the orthotopic ileal bladder, which is consistent with a previous study (25). …”

Section: Discussionsupporting

confidence: 92%

Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

Wang

Liu

et al. 2014

Oncology Letters

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The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; P<0.001), residual urine content (22.8±10.5 vs. 40.7±12.7 ml; P<0.001), maximum bladder capacity (373.8±62.2 vs. 229.7±56.3 ml; P<0.001) and maximum bladder pressure during filling (35.8±6.7 vs. 26.4±7.0 cm H2O; P<0.001) at 12 months were all improved significantly compared with that at 6 months after the initial surgical treatment. However, there were no significant differences in maximum bladder pressure during voiding (75.7±24.7 vs. 73.1±24.7 cm H2O; P=0.618) and bladder compliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable.

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“…It has been well characterized that night‐time incontinence of a neobladder occurs because of the absence of neurological feedback and sphincter detrusor reflex, as well as relaxation of the pelvis and decreased sphincter tonus at night [17]. As for colonic neobladders, including the SCN, its lower capacity and subsequent low compliance might together have an adverse influence on the continence status [9,19,20]. Collectively, a possible explanation of the favourable continent status in the present series is: (i) a longer segment of sigmoid colon (i.e.…”

Section: Discussionmentioning

confidence: 88%

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

et al. 2010

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follow-up of 55 months, after excluding two who died perioperatively. RESULTSThere 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 nighttime 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. CONCLUSIONSThe modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy. KEYWORDSsigmoid neobladder, radical cystectomy, complication, functional outcome, quality of life Study Type -Therapy (outcomes study) Level of Evidence 2c OBJECTIVESTo retrospectively review our clinical experience with sigmoid neobladder reconstruction. PATIENTS AND METHODSThe 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

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Better Compliance Contributes to Better Nocturnal Continence With Orthotopic Ileal Neobladder Than Ileocolonic Neobladder After Radical Cystectomy for Bladder Cancer

Cited by 30 publications

References 24 publications

Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience

Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience

Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer

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

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