Longitudinal experience with Studer neobladders: Outcomes and complications

Abstract

Introduction: This study aims to assess the longer-term functional, anatomical, and metabolic outcomes of patients who underwent Studer neobladder (SNB) urinary diversion.
 Methods: A retrospective review of patients who underwent SNB at a single center from 1995–2017 (n=116) was performed. Demographics, comorbidities, pathological data, and longer-term functional, anatomical, and metabolic outcomes were collected from hospital records. The primary outcome was voiding function of patients at most recent followup. Secondary outcomes included postoperative complications, renal function, nephrolithiasis, infections, and metabolic outcomes.
 Results: Excluding those with incomplete followup data, 72 patients with minimum followup of one year were included for analysis. Median followup was 70±11 months, with 52.8% of patients having ≥5 years of followup. Clean intermittent catheterization (CIC) was used by 22.2% of patient at most recent followup, which was mostly necessitated by bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding. Patients experienced more daytime and nighttime urinary incontinence in the early postoperative setting that improved over time. Generally, renal function declined over time; poorer long-term renal function was predicted by hydronephrosis within one year (p=0.002).
 Conclusions: Longer-term followup of SNB reveals significant but manageable complications. Gradual decline in renal function was common. Strict adherence to bladder emptying protocols (e.g., timed voiding or CIC) may reduce incidence of renal deterioration, metabolic disorders, and urinary dysfunction. Early onset (<1 year) of hydronephrosis may indicate a need for intervention to preserve long-term renal function.

Pitcher pot neourethral modification of ileal orthotopic neobladder achieves satisfactory long‐term functional and quality of life outcomes with low clean intermittent self‐catheterization rate

“…However, an 8.8% dysfunctional voiding rate (independent of physical obstruction to bladder outlet) necessitating CISC has been described by others for SN 19 . A recent series has reported a CISC rate of 22% with SN necessitated by “bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding” 20 . Nerve‐sparing and younger age have been found associated with improved CISC rates 21 .…”

“… 19 A recent series has reported a CISC rate of 22% with SN necessitated by “bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding”. 20 Nerve‐sparing and younger age have been found associated with improved CISC rates. 21 Negligible CISC rate might also have contributed to high observed post‐operative QOL summary scores.…”

Comparative performance of the different orthotopic urinary diversions

“…The incidence of urolithiases in such patients seems to be increased by time. According to a longitudinal study of 72 patients with Studer pouch, urolithiasis (renal and ileal pouch) affected 28.9% of patients, primarily occurring after five years of follow-up [61]. The use of staples also has been shown to increase the risk of urolithiasis.…”

“…The risk of metabolic acidosis is higher in neobladder compared to ileal conduit patients given the longer contact time between urine and bowel mucosa [27]. Studies have reported rates of metabolic acidosis in Studer patients treated with bicarbonate supplementation ranging from 1.1% to 4.4% [61]. However, higher rates have been presented in the literature, especially in the early postoperative period [27].…”