Orthotopic bladder substitute in renal transplant recipients: experience with Studer technique and literature review

Abstract

Summary Renal transplant recipients with high‐risk bladder cancer following cystectomy need a urinary diversion preserving the renal function and possibly maintaining body image, while still offering the best oncological outcome. The aim of this report is to describe our experience of radical cystectomy and orthotopic ileal neobladder with Studer technique in this population, and to review the literature. We performed radical cystectomy and Studer ileal neobladder in four male patients (median age 67 years) after median time of 9.5 years following renal transplantation. Pathology revealed pT1HGN+ transitional cell carcinoma in one case, pT1HGN0 in two and pT3aHGN0 in one. Two patients presenting aggressive disease (N+ and pT3a) died of tumour progression after 20 and 14 months, respectively, while the other two are alive after 56 and 36 months of follow‐up with no evidence of disease, stable serum creatinine (2.29 and 1.6 mg/dl) and mild metabolic acidosis. Day and night‐time urinary continence were satisfactory in all patients. Good functional outcomes have been reported in the 20 cases of ileal orthotopic neobladder with different techniques published so far and the global experience of 24 cases with a median follow‐up of 39 months documents a cancer specific survival of 62.5%.

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

“…Similarly to reports by many other authors, we prefer reconstructive surgeries before RTx to avoid the possible adverse effects of immunosuppression, such as delayed wound healing and severe infection, in addition to the prevention of any harmful effect of LUTD on the graft [16,19]. It may not always be necessary to intervene in patients with borderline bladder compliance, however, as a small non-compliant bladder may improve after transplantation in some cases after restoration of urinary flow, sparing the patients a reconstructive surgery [10,21,22]. This requires close follow-up after transplantation to continuously assess the bladder and decide early on augmentation if needed.…”

Radical Cystectomy and Orthotopic Urinary Reconstruction in Patients With Bladder Cancer After Renal Transplantation: Clinical Outcomes and Description of Technique

“…Manassero et al identified four patients who had Studer neobladder formation after RC for bladder cancer. 13 Two patients died of disease at 14 and 20 months, while the remaining two patients are alive without disease at 36 and 56 months followup. They reported satisfactory day and nighttime continence in all patients.…”

“…12,13,15 Kamal et al reported 5 patients who underwent either urethral hemi-Kock pouch formation or Hautmann-type neobladder diversion with serous lined extramural tunnels. 12 Two patients with pT3 disease died of metastasis at 3 and 14 months, one died of cerebrovascular accident at 14 months, and the remaining two were alive without disease at 28 and 12 months.…”

“…Other centers argue against prophylactic nephroureterectomy as they have not found any asynchronous development of upper tract urothelial carcinoma to date. 13 Though the true risk of upper tract disease is unknown, the immunosuppressed state of the patient in conjunction with the presence of potentially malignant non-functional urothelium leads us to advocate performance of native nephroureterectomy.…”

Long-Term Outcome of Simultaneous or Staged Urinary Diversion and Kidney Transplantation

“…ileal conduit formation, and continent cutaneous diversion) and orthotopic substitution for these patients. In several recent reports, continent cutaneous diversion and orthotopic substitution showed good functional and safe outcomes [13,14,15]. However these surgeons mainly chose staged operations.…”