The Studer Orthotopic Neobladder: Long-Term (More Than 10 Years) Functional Outcomes, Urodynamic Features, and Complications

Abstract

PurposeRadical cystectomy and urinary diversion are the standard treatment for invasive bladder cancer. We analyzed the long-term (>10 years postoperatively) functional outcomes, complications, and urodynamic findings in a single center series of patients who underwent cystectomy and a Studer ileal neobladder substitution.Materials and MethodsA retrospective chart review of 108 Studer pouches constructed during 1990 and 2011 was performed. Data were analyzed in terms of long-term (>10 years) outcomes. Complications, incontinence, voiding difficulties, upper urinary tract changes, overall satisfaction, and urodynamic findings of the reservoir were obtained.ResultsWe evaluated 19 out of 50 patients who had lived for over 10 years postoperatively. Another 31 patients were not traced: 7 patients died following recurrence, 15 died due to exacerbation of a comorbidity, and 9 patients were lost to follow-up. Concerning complications, 6 patients had an atrophied kidney, 5 patients had moderate hydronephrosis, 5 patients had chronic recurrence of pylelonephritis, and 2 patients had voiding difficulty because of bladder neck stricture due to clean intermittent catheterization. One patient underwent an operation due to intestinal obstruction. Seven patients had incontinence; all 7 patients showed intermittently at night and 2 patients even in waking hours. Maximum bladder capacity was 484.1±119.2 mL, maximum flow rate was 13.6±9.7 mL/sec, and post-void residual urine volume was 146.8±82.7 mL.ConclusionLong-term outcomes with the Studer orthotopic ileal neobladder have an acceptable complication rate and good functional results. However, potential adverse outcomes such as renal deterioration, dysfunctional voiding should also be considered.

Robotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-related Quality of Life

“…Once the posterior plate is created robotically, it is rotated anticlockwise by 908 before urethra-neobladder anastomosis, followed by double cross-folding and true globularization of the neobladder. Our globular robotic iONBs achieved a mean cystometric volume of 514 cm 3 (range 339-1001), which is consistent with mean volumes reported for open ONB series of 430-600 and 450-524 cm 3 for Hautmann [24,25] and Studer [26][27][28] configurations, respectively. Furthermore, the ability to achieve high volumes at low pressure (high compliance) of the robotic iONB lends support to a lowpressure reservoir.…”

Surgical techniques for facilitating laparoscopic intracorporeal orthotopic neobladder: initial experience

“…Several types of neobladder have been described, but all should have the following features: high capacity, low pressure, absence of reflux, and complete voiding by abdominal straining and perineal relaxation (19). In our study, the neobladder capacity was about 375 mL, which was smaller than mean volumes reported for open neobladder construction of 450-524 cm3 (20,21). However, no patient has hydronephrosis or ureterectasis one year after operation.…”

Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature

“…Although most studies used SCr measurements, IVU , and CT for laboratory and morphological assessment of RFn, none provided absolute figures in the results section. Neuzillet et al.…”