Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments

Santucci, Richard A.; Park, Choal H; Mayo, Michael E.; Lange, Paul H.

doi:10.1016/s0090-4295(99)00098-9

“…This is comparable to other reports which are in the range of 67% to 100% for daytime, and nighttime incontinence in the range of 45% to 65%. 1,[5][6][7][8][9][10][11][12] Continence rates improved throughout follow-up, which was to be expected. It is known that as the neobladder capacity increases over time, continence improves.…”

Section: Discussionsupporting

confidence: 60%

Renal and functional outcomes following cystectomy and neobladder reconstruction

Lantz¹,

Saltel²,

Cagiannos³

2013

CUAJ

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Background: Orthotopic reconstruction following cystectomy has evolved in an attempt to restore anatomy and function to as close as possible to the preoperative state. We review the renal and functional outcomes of patients who underwent cystectomy and neobladder reconstruction at our institution. Methods: Between December 2003 and October 2007, 31 patients underwent cystectomy with Studer neobladder reconstruction at the Ottawa Hospital, Ottawa, Ontario, Canada. Follow-up data were obtained regarding renal function (serum creatinine, mmol/L), continence, urinary flow rates and post-void residual (PVR) at 3, 6 and 12 months after surgery. Change in creatinine from preoperative baseline was calculated and analyzed by student t-test to determine if there was a significant rise in creatinine. Results: There was a statistically significant increase in creatinine from preoperative baseline, with an average increase of 17.3 mmol/L, 21.8 mmol/L and 26.3 mmol/L at 3, 6 and 12 months, respectively. Six patients developed hydronephrosis. Excluding patients with hydronephrosis, there continued to be a statistically significant rise in creatinine with an average increase of 11.9 mmol/L, 14.7 mmol/L and 19.4 mmol/L at 3, 6 and 12 months, respectively. At 1 year, daytime continence was achieved by 89% of patients; 70% were continent at night. Interpretation: Orthotopic neobladders have excellent functional outcomes with low rates of incontinence, which improved throughout follow-up. A significant proportion of patients developed hydronephrosis, highlighting the need for close follow-up to prevent reversible renal deterioration. Creatinine increased during follow-up irrespective of the development of hydronephrosis, but the clinical significance is unknown.

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“…In the present study 54/62 (79.1%) of the patients have diurnal continence according to our criteria and these figures were comparable to other published series where postoperative urinary continence ranged from 60% to 96% (1,3,5,(7)(8)(9). In order to maintain erectile function and urinary continence, Schlling & Friesen (10) since 1987, had already been made routine diagnostic staging of the cancer with transurethral resection of the prostate to permit a transprostatic selective cystectomy with an ileal bladder, cutting through the apex of the prostate thus, leaving a wide funnel-shaped tunnel of the prostatic urethra, for the anastomosis with the M or W shaped ileal reservoir.…”

Section: Commentssupporting

confidence: 91%

The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

Arruda

¹

,

Suarez

²

,

Srougi

³

et al. 2003

Int. braz j urol.

0

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Objective: To establish if previous surgery for benign prostatic hyperplasia (transurethral resection of the prostate or open prostatectomy), age, and preservation of prostatic apex can influence postoperative urinary continence in patients submitted to radical cystectomy and orthotopic ileal neobladder.Patients and Methods: We analyzed 62 patients with bladder cancer who were treated with radical cystectomy and orthotopic ileal neobladder between 1987 and 1998 and had been followed for at least 24 months. The average age and median follow up were 61 years and 53 months, respectively. Postoperative urinary continence was correlated with 3 factors: patient age, preservation of prostatic apex during surgical excision and prior prostatic surgery for benign disease. Patients were defined as incontinent when they had to use more than 1 protective pad at the daytime.Results: The overall incidence of urinary incontinence was 12.9% (8 out of 62 patients). The only statistically significant factor that impacted upon urinary continence was previous prostatic surgery, with respectively 33% versus 7% rate of incontinence for patients previously operated on and for those without previous operation (p = 0.023 odds ratio = 6.5, 95% confidence interval). Preservation of prostatic apex did not reach difference, 12% versus 13%, for those with and without preservation, and age also did not influence the postoperative continence rate.Conclusions: Prior prostatic surgery for benign prostatic hyperplasia probably can increases the risk for postcystectomy incontinence and preservation of prostate apex did not affect the continence rate. This issue deserves to be considered by the surgeon and must be discussed previously with the patients when planning an orthotopic bladder replacement.

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“…This is comparable to other reports which are in the range of 67% to 100% for daytime, and nighttime incontinence in the range of 45% to 65%. 1,[5][6][7][8][9][10][11][12] Continence rates improved throughout follow-up, which was to be expected. It is known that as the neobladder capacity increases over time, continence improves.…”

Section: Discussionsupporting

confidence: 57%

Functional outcomes after urinary diversion: The importance of long-term assessment

Rourke

¹

2013

CUAJ

0

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Background: Orthotopic reconstruction following cystectomy has evolved in an attempt to restore anatomy and function to as close as possible to the preoperative state. We review the renal and functional outcomes of patients who underwent cystectomy and neobladder reconstruction at our institution. Methods: Between December 2003 and October 2007, 31 patients underwent cystectomy with Studer neobladder reconstruction at the Ottawa Hospital, Ottawa, Ontario, Canada. Follow-up data were obtained regarding renal function (serum creatinine, mmol/L), continence, urinary flow rates and post-void residual (PVR) at 3, 6 and 12 months after surgery. Change in creatinine from preoperative baseline was calculated and analyzed by student t-test to determine if there was a significant rise in creatinine. Results: There was a statistically significant increase in creatinine from preoperative baseline, with an average increase of 17.3 mmol/L, 21.8 mmol/L and 26.3 mmol/L at 3, 6 and 12 months, respectively. Six patients developed hydronephrosis. Excluding patients with hydronephrosis, there continued to be a statistically significant rise in creatinine with an average increase of 11.9 mmol/L, 14.7 mmol/L and 19.4 mmol/L at 3, 6 and 12 months, respectively. At 1 year, daytime continence was achieved by 89% of patients; 70% were continent at night. Interpretation: Orthotopic neobladders have excellent functional outcomes with low rates of incontinence, which improved throughout follow-up. A significant proportion of patients developed hydronephrosis, highlighting the need for close follow-up to prevent reversible renal deterioration. Creatinine increased during follow-up irrespective of the development of hydronephrosis, but the clinical significance is unknown. Les données concernant la fonction rénale (créatinine sérique, µmol/L), la continence, le débit urinaire et le volume résiduel postmictionnel ont été obtenues pendant le suivi 3, 6 et 12 mois après l'intervention. Les variations de la créatinine sérique par rapport aux valeurs préopératoires ont été calculées et analysées par test t afin de déterminer la présence d'une hausse significative de la créatinine sérique. Résultats : On a noté une hausse significative du taux de créatinine sérique par rapport aux valeurs de départ (avant l'intervention); la valeur moyenne de la hausse était de 17,3 µmol/L, 21,8 µmol/L et 26,3 µmol/L après 3, 6 et 12 mois, respectivement. Six patients ont présenté une hydronéphrose. Si on exclut les patients ayant signalé une hydronéphrose, on note toujours une hausse significative sur le plan statistique du taux de créatinine, la valeur moyenne de la hausse étant de 11,9 µmol/L, 14,7 µmol/L et 19,4 µmol/L après 3, 6 et 12 mois, respectivement. Après 1 an, 89 % des patients étaient continents le jour, et 70 % étaient continents la nuit. Interprétation : La reconstruction néovésicale orthotopique produit d'excellents résultats fonctionnels démontrés par les faibles taux d'incontinence, qui se sont améliorés pendant le suivi. Une proportion s...

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Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments

Cited by 91 publications

References 20 publications

Renal and functional outcomes following cystectomy and neobladder reconstruction

Renal and functional outcomes following cystectomy and neobladder reconstruction

The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

Functional outcomes after urinary diversion: The importance of long-term assessment

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