Study of modified technique of ileal neobladder-Frog neobladder

Abstract

Purpose: Orthotopic neobladder is a well-established technique for continent urinary diversion after radical cystectomy. In this study, we evaluated a new Frog ileal neobladder technique. Since the reconstructed neobladder appears like a frog, the name Frog Neobladder was given to it. We have used two isoperistaltic ileal segments and implanted ureters in the nondetubularized proximal end of the ileal segment. Subjects and Methods: This was a prospective, single-center (tertiary care hospital) study conducted from February 2008 to January 2018. Study patients were aged 39–94 years with biopsy-proven muscle-invasive localized bladder carcinoma. One hundred and twenty patients were included in the study, who had undergone Radical Cystectomy and were offered “FROG BLADDER”– a type of neobladder. Evaluation of complications, renal function, urodynamic parameters, post-void residual urine (PVR), continence, and need for clean intermittent catheterization was done in all patients with neobladder. Results: A total of 120 patients were included in the study, the average age of the patients was 62 years. The operative mean time was 280 ± 29.8 min. There was no perioperative death, and perioperative or early and late complication rates were 31.2% and 18.7%, respectively. Six patients had uretero-enteric anastomosis stricture, of which two were managed by retrograde ureteroscopic dilatation, another three strictures were treated with antegrade approach, and one patient underwent open surgery. All patients were able to void urine, except for three patients who required self-catheterization. The mean capacity was increased to average of 398 ± 220 ml at 12 months in all patients. The mean PVR at 1 year was 46 ± 54.4 ml. Conclusion: The Frog neobladder has similar outcome similar to other neobladder technique, with added advantage of ability to accommodate shorter ureteric length and the ease of accessing ureter by retrograde approach for intervention.

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

“…Both non-invasive and invasive UDS data are of outmost importance in the functional evaluation of patients with ONB, representing the only method to objectively assess the function of these neo-reservoirs. UDS in patients with ONB is not a new effort, since multiple studies have been conducted to investigate long-term changes in urodynamic parameters or to compare differences in urodynamic parameters between orthotopic neobladders with various intestinal segments [10][11][12][14][15][16][17][18][19][21][22][23][25][26][27]29,30,33,34,39,[42][43][44][47][48][49][52][53][54][55][56][57]64,65]. Unfortunately, the timing from the surgery to the UDS in the neobladder is usually not adequately defined.…”

“…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].…”

“…Twenty (33.9%) studies [8,10,14,15,17,23,26,27,32,40,42,44,45,50,51,53,57,61,64,65] reported mean overall operating times. Only 6 studies (10.2%) [23,26,50,51,57,64] specified OT for the reconstructive part of the surgery.…”

“…Concerning the filling phase of the UDS, the most reported parameters (39 studies, 66.1%) were MCC and compliance [7,8,[12][13][14][15][16][19][20][21][22][23][24][25]29,30,[32][33][34][35]37,38,40,41,43,[45][46][47]49,[51][52][53]56,58,60,[62][63][64][65]. Thirteen studies [8,21,29,34,37,45,[48][49][50]52,56,59,…”

“…Concerning the voiding phase Qmax, PVR and ONB pressure at MCC were more commonly reported (24 studies, 40.7%) [7,9,14,15,19,21,[23][24][25]27,29,34,37,[39][40][41]43,44,46,47,52,57,64,65]. The number of patients recurring to CIC is reported in 3 (5.1%) studies [13,37,52].…”