Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience

Yadav, Sher Singh; Gangkak, Goto; Mathur, Rajendra Mohan; Yadav, Ram Gopal; Tomar, Vinay

doi:10.1016/j.urology.2016.04.013

Cited by 14 publications

(15 citation statements)

References 28 publications

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“…Average neobladder capacity in the study was 450 ml at 12 months after surgery. Yadav et al [8] reported an increase of the neobladder capacity up to three years after surgery. They created modified ileal neobladder using 45 centimeters of ileum and reported bladder capacity of 410 ml, 502 ml, and 588 ml at one, two, and three years after surgery, respectively.…”

Section: Discussionmentioning

confidence: 97%

Modified orthotopic ileal neobladder - surgical technique and initial results

et al. 2018

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Introduction/Objective Vesica ileale Padovana is the surgical technique for reconstruction of lower urinary tract following radical cystectomy using isolated ileal segment. This operative technique requires dissection of both ureters in full length that cannot be possible in some cases. The paper is aimed to present our experience with modified surgical technique of vesica ileale Padovana using 40 cm of an isolated ileal segment. Methods Ten male patients received modified ileal neobladder following radical cystectomy at our institution during the period from 2008 to 2011. The mean age of patients was 59 years (range 45-70). Median follow-up was 76 months (range 62-93). Patients were monitored cautiously for functional outcome, local recurrence, and distant progression. Results Perioperative, early, and late postoperative mortality have not been noticed. There were only two major complications: prolonged postoperative ileus and prolonged urinary leakage requiring percutaneous nephrostomy and subsequent ureteral reimplantation due to stenosis of ureterovesical anastomosis in one patient (10%). Average ileal neobladder capacity was 450 ml. Daytime and night continence were achieved in nine (90%) and seven (70%) patients, respectively. Conclusion This modification of orthotopic ileal neobladder has not been difficult to perform in our hands. Modified technique provides a clear advantage in easier ureteral implantation more proximally than in the original technique, requiring less length of ureters. Initial encouraging results should be confirmed in further clinical practice.

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Section: Discussionmentioning

confidence: 97%

Modified orthotopic ileal neobladder - surgical technique and initial results

et al. 2018

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“…The vast majority of articles included in our SR were retrospective, with only a few (28.8%) prospective trials [8,12,13,15,[21][22][23]25,33,46,48,49,53,60,[63][64][65]. Only 13 (22%) report institutional review board approval [8,[13][14][15][20][21][22]25,33,40,53,64,65].…”

Section: General Aspectsmentioning

confidence: 99%

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

Asimakopoulos,

Finazzi Agrò,

Piechaud

et al. 2024

Cancers

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Introduction: The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. Objective: To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. Methods: A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001–December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Results and Conclusion: Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9–433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5–25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7–89.1%) and 61.7% (95% CI: 51.9–71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.

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“…Zuletzt konnte an einer Serie von 42 Patienten mit einem Ileumsegment von lediglich 25 cm gezeigt werden, dass eine Langzeitprophylaxe mit Bikarbonat nur bei 7 % der Patienten notwendig war. Keiner der Patienten hatte einen Vitamin-B12-Mangel und in keinem Fall lag ein negativer Einfluss auf die Funktionalität vor [48]. In Langzeitbeobachtungen sind eine Steinbildung in Neoblasen sowie eine subvesikale Obstruktion durch eine Anastomosenstriktur selten und wird bei 0,3 % und 1,2 % [46] festgestellt.…”

Section: Metabolische Veränderungenunclassified

Blasenkarzinom − Komplikationen der Harnableitung

Pfister

Niegisch

2021

TumorDiagnostik & Therapie

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ZusammenfassungAuch heute noch stellt die radikale Zystektomie mit Anlage einer Harnableitung einen der komplikationsträchtigsten Eingriffe in der Uroonkologie dar. Insbesondere im Langzeitverlauf, aber auch perioperativ spielen dabei durch die Harnableitung bedingte Probleme eine wesentliche Rolle. Perioperativ stehen dabei im Wesentlichen gastrointestinale Probleme wie etwa ein Ileus, aber auch Infekte und frühe Komplikationen der unterschiedlichen Anastomosen im Vordergrund. Während ein Ileus ebenso wie perioperative Infekte i. d. R. medikamentös behandelt werden können, erfordern Insuffizienzen der intestinalen Anastomose regelhaft und Insuffizienzen der ureterointestinalen Anastomosen häufig operative Revisionen.Im Langzeitverlauf können Narbenbildungen zu chronischen Harnabflussbehinderungen und bei kontinenten Harnableitungen zur Steinbildung führen und ebenso wie parastomale Hernien weitere Therapien erforderlich machen. Funktionelle Darmprobleme können die Lebensqualität der Patienten nachhaltig beeinflussen.Durch eine verbesserte Vorbereitung präoperativ und die begleitenden Maßnahmen während des stationären Aufenthalts können nicht operationsbedingte Komplikationen signifikant reduziert werden.Die Zystektomie mit der therapieassoziierten Morbidität ist ein Paradebeispiel für eine zentrumsbasierte Operation, um Komplikationen sowohl perioperativ als auch im weiteren Follow-up zu reduzieren.

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Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience

Cited by 14 publications

References 28 publications

Modified orthotopic ileal neobladder - surgical technique and initial results

Modified orthotopic ileal neobladder - surgical technique and initial results

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

Blasenkarzinom − Komplikationen der Harnableitung

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