Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

Nabi, Ghulam; Cody, June D; Dublin, Norman; McClinton, Samuel; N’Dow, James; Neal, David E.; Pickard, Robert; Yong, Sze Ming

doi:10.1002/14651858.cd003306

Cited by 12 publications

(3 citation statements)

References 35 publications

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“…Likewise, there was no reported difference between ileal and colonic conduits with respect to pyelonephritis and uretero-intestinal anastomotic strictures. Similar results were seen with continent versus conduit diversion and, importantly, there was no difference in the rate of upper tract deterioration, unrelated to the type of anastomosis performed (refluxing vs. antirefluxing) [33].…”

Section: Urinary Diversionsupporting

confidence: 69%

Surgical management of the neurogenic bladder after spinal cord injury

et al. 2018

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Section: Urinary Diversionsupporting

confidence: 69%

Surgical management of the neurogenic bladder after spinal cord injury

et al. 2018

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“…The overall long-term complication rate of urinary diversions approaches 60%, with stomal complication and UTIs being the most common [67].…”

Section: Urinary Diversionsmentioning

confidence: 99%

Current Concepts in the Management of Muscle Invasive Bladder Cancer

Krishna

Konety

2016

Indian J Surg Oncol

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Bladder cancer is the ninth most common cancer in the world. Twenty to twenty-five percent of all newly diagnosed bladder cancers are muscle invasive in nature, and further, 20-25% of patients who are diagnosed with high-risk nonmuscle invasive disease will eventually progress to muscle invasive disease in due course of time irrespective of adjuvant intravesical therapies. Availability of newer imaging modalities improves appropriate identification of patients with muscle invasive disease. Radical cystectomy remains the mainstay of treatment for management of muscle invasive disease. Availability of neoadjuvant chemotherapy has improved overall survival. Risk stratification systems are now in consideration to identify patients who benefit maximally from neoadjuvant chemotherapy. Urinary diversion is a major cause of morbidity in these patients, and several strategies are being employed to reduce morbidity. In this article, we review available literature on various aspects of management of muscle invasive disease. Histologically, over 90% of bladder tumors are transitional cell carcinomas. The other subtypes, such as squamous cell and adenocarcinoma, are uncommon and account for 5 and <2%, respectively. Bladder cancer is a heterogeneous disease with a variable natural progression. Urothelial carcinomas can have a component of Bvariant histology^such as squamous differentiation, micropapillary, or adenocarcinoma. Micropapillary variant of urothelial carcinoma is associated with worse prognosis than pure urothelial carcinoma. Around 70% of the patients present with tumors that are superficial and have a tendency to recur. The remaining 30% present with muscle invasive tumors [4]. PathologyLow-grade tumors represent 50-60% of the cases. Majority of the tumors are stage Ta, i.e., confined to the urothelium. These tumors tend to recur and generally require repeated transurethral resection (TURBT) and surveillance cystoscopies [5].High-grade (HG) lesions account for 20-25% of all new cases. These lesions can either be sessile or papillary lesions. These tumors have a tendency to invade into the bladder wall if left untreated, especially in the presence of carcinoma in situ (CIS). Despite treatment in the form TURBT and chemotherapy, more than 20% of the patients with high-grade lesions progress to muscle invasive bladder cancer (MIBC) [6,7]. This has led to a lot of controversy regarding aggressive treatment in the form of early radical cystectomy vs. TURBT along with intravesical therapy, particularly in patients with HG

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“…8 Another review, which considered urinary diversion and bladder replacement surgery, found only two eligible randomised trials, both with little usable evidence. 6 Although sacral nerve stimulation has potential as an effective management option, numbers of patients in published trials have been small and uncertainty remains about the most effective and reliable implantation techniques and the best ways to select patients. 5 In recent US clinical practice guidelines on bladder management after spinal cord injury, only one of the 57 detailed recommendations relating to conservative, surgical, and pharmacological interventions is based on evidence from a sufficiently powered randomised controlled trial.…”

Section: What Is the Evidence Of Uncertainty?mentioning

confidence: 99%