Ileal Neobladder for Urinary Bladder Replacement following Total Pelvic Exenteration for Rectal Carcinoma

Abstract

Objective: The aim of this study was to determine the feasibility of using the ileal neobladder as a substitute for the urinary bladder following total pelvic exenteration for rectal carcinoma. Patients and Methods: Between 1992 and 1998, we performed total pelvic exenteration with ileal neobladder in 5 men with rectal carcinoma. Four patients had primary tumors, and one had recurrent disease after low anterior resection for rectal carcinoma. Histological types were adenocarcinoma in 4 and squamous cell carcinoma in 1. Invaded organs were: the urinary bladder in 1, the urinary bladder and prostate in 2, the prostate and seminal vesicle in 1, and the prostate in 1. Results: There was no operative death. In 1 patient, an ileal conduit was needed because of partial necrosis of the neobladder. Minor leakage on the dorsal wall of the neobladder occurred in 2 patients, which was successfully stopped with simple closure and a gluteus maximus fasciocutaneous flap, respectively. All except one patient with the ileal conduit could void via the urethra. Complete daytime urinary continence was achieved, but nocturnal continence was maintained with voiding once or twice per night. As the urodynamic state, the mean maximum flow rate was 20.9 ml/s (range 9.0–34.1), the mean average flow rate was 7.7 ml/s (range 3.0–11.0), and the mean voided volume was 285.5 ml (range 160–432). The mean length of follow-up was 47.8 months. One patient died of local recurrence 38 months postoperatively, and 1 died of pneumonia 10 months postoperatively. Both patients could void via the urethra until death. The other three patients are currently alive without any evidence of recurrence. Conclusions: Although total pelvic exenteration is a laborious surgical procedure, an ileal neobladder could be a good alternative to the urinary bladder enabling the patients to void via the urethra with urinary continence.

Multivisceral Resection for T4 or Recurrent Colorectal Cancer

“…Locally advanced rectal cancers invading adjacent pelvic organs and involving the pelvic floor often require pelvic exenteration with total extirpation of the whole bladder and rectum followed by the formation of a permanent colostomy and ileal conduit. While infralevator pelvic exenteration is always required for a tumour involving the trigone or the prostate, supralevator exenteration with neobladder pouch formation [51,52] can be performed in selected cases to preserve the patient’s urinary continence [53,25]. Pelvic floor reconstruction can be achieved by a combination of pelvic omentoplasty, porcine dermal collagen implantation or myocutaneous flaps [17].…”

Experience with Various Types of Orthotopic Neobladder in Japanese Men: Long-Term Follow-Up

“…All patients could void spontaneously with no assistance before surgery, and remained free of cancer at the analysis for this study. The types of NB reconstruction used in this series were as follows: modified Studer type ileal NB [11,12] in 136 (57.9%), modified Reddy type sigmoid NB [13] in 51 (21.7%), Hautmann type ileal NB [14] in 32 (13.6%) and Mainz I type ileocolic NB [15] in 16 (6.8%). The indications for different types of NB have not been strictly determined, however either modified Studer type ileal NB or modified Reddy type sigmoid NB tended to be selected according to the preference of each surgeon in the last decade.…”

“…Since 1983, several types of NB replacement, such as modified Studer [11,12] , modified Reddy [13] , Hautmann [14] and Mainz I NB [15] , have been performed after radical cystectomy at our institutions; therefore, in the present study, the postoperative outcomes of 235 men, who underwent NB reconstruction and were followed for at least 3 years, were retrospectively analyzed to clarify their long-term clinical characteristics according to the types of orthotopic NB.…”

Survival in Colorectal Cancer Patients With Urinary Tract Invasion

“…If the patient is to be offered a chance to be cured, then radical surgery with en bloc resection of all or part of the urinary organ should be performed. 5,7,12,25 A total pelvic exenteration (TPE) is appropriate for direct tumor invasion of the trigone, vesicoureteric junction, or intramural ureter in the absence of distant metastases and has been used in both primary and locally recurrent disease. 5 An extended resection for locally advanced colorectal cancer is associated with a morbidity of approximately 20 to 44 percent and a mortality of 0 to 12 percent.…”