Continent urinary tract reconstruction – the Lund experience

Abstract

The Department of Urology in Lund, Sweden, has a long association with innovations in reconstructive urology. The authors from that department describe their experience over a long period with orthotopic bladder substitution and continent cutaneous urinary diversion. They conclude that continent urinary tract reconstruction is associated with a high incidence of early and late complications. They also found that for storage and emptying, their Lundiana pouch was superior to the Goldwasser neobladder. OBJECTIVE To assess the early and late complications and functional results in patients undergoing continent reconstruction of the urinary tract, i.e. orthotopic bladder substitution (OBS) or continent cutaneous diversion (CCD). PATIENTS AND METHODS The medical records of all patients undergoing OBS (Goldwasser technique) or CCD (‘Lundiana’ technique) for malignant or benign disease during 1987–1999 and followed to December 2001 were reviewed. There were 67 patients with neobladders, 77 with a Lundiana pouch who had undergone radical cystectomy and 22 with a Lundiana pouch operated for benign disorders. RESULTS Early complications requiring reoperation occurred in 12% of the cystectomy group, with no difference with type of reconstruction, and in 10% with benign diseases. Four patients (3%) undergoing radical cystectomy died from early cardiovascular complications, two after surgery for intra‐abdominal complications. Intestinally related complications and wound dehiscence requiring re‐operation occurred in nine and six patients, respectively. The incidence of late complications requiring open surgery was 22% and 23% after cystectomy with OBS and CCD, respectively. The value in patients with benign diseases undergoing CCD was also 23%. Stone formation in the pouch was common, occurring in 12% in patients with OBS and in 10% after CCD. The pouch perforated or ruptured in four patients. The incidence of uretero‐intestinal stricture using the Le Duc technique was 2.4% and renal function was well preserved. The incidence of revisional surgery of the Lundiana pouch outlet for incontinence was low and all patients but four were continent. The functional outcome in patients with OBS was less good; some needed pouch augmentation or an artificial urinary sphincter. Most patients used incontinence products and many needed clean intermittent self‐catheterization. CONCLUSION Continent urinary tract reconstruction is associated with a high incidence of early and late complications. For storage and emptying, the CCD Lundiana pouch is superior to the OBS of Goldwasser.

Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?

“…This may be associated with an increased complication rate. Also, continent diversions are associated with significant reoperation rates, even into late follow-up periods [5], which produces high morbidity especially for elderly and frail patients, with relatively short life expectance. On the other hand, uretero-ureterocutaneostomy (UUC) is the simplest form of incontinent urinary diversion, which could reduce the well-known risks of ileus and pulmonary complications in aggravated patients, with American Society of Anaesthesiologists (ASA) score of 3 [6].…”

Working Capacity and Well-Being after Radical Cystectomy with Continent Cutaneous Diversion

“…The patient group worked on the bicycle for 11 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) minutes and the control group 10 (7-16) minutes (n.s. ).…”

“…Patients eligible for inclusion were male residents below 80 years of age, living in the hospital's primary catchments area, with at last 12 months follow-up after radical cystectomy and continent cutaneous diversion a m Lundiana [7,8]. They should have no signs of recurring malignancy, have no diabetes, and be able to perform the test for musculoskeletal, cardiac, and pulmonary reasons.…”

Current Trends in Urinary Diversion in Men

“…The colon is then folded in a Heineke-Mikulicz manner and closed with a running absorbable suture. The ureterocolonic anastomosis is then performed [55].…”