ILEAL NEOBLADDER AND ITS VARIANTS
Authors:
G. Gakis; A. Stenzl
Authors‘ workplace:
Department of Urology Eberhard-Karls University Tuebingen
Published in:
Urol List 2011; 9(3): 27-33
Overview
Orthotopic neobladder substitution represents an important step in the evolution of urinary diversion and is nowadays considered, both in males and females, as the diversion of choice for the majority of patients undergoing cystectomy with which other types of diversion have to compare. Nevertheless, in the preoperative setting, all options of urinary diversion should be explained comprehensibly to the patient as well as potential short- and long-term risks along with beneficial effects of each type of diversion. With regard to the risk of urethral recurrence the decision to perform a neobladder depends ultimately on the intraoperative frozen section analysis of the distal urethral margin. Neobladder construction is based on the concept of detubularisation and folding to construct a low-pressure reservoir. All parts of the small and large intestine as well as the stomach have been intensely studied for the construction of neobladders. In this respect, there is substantial agreement in the literature that the terminal ileum possess superior anatomical and functional characteristics. In light of the lack of prospective randomised trials controversies still exist with regard to the technique of preventing reflux in orthotopic substitutes and superiority of one neobladder technique over others provided the detubularized intestinal segment is reconfigurated to an adequate-sized spherical reservoir. Based on current evidence, orthotopic neobladder substitution is nowadays considered, both in male and female patients, as the diversion of choice for the majority of patients undergoing cystectomy with which other types of diversion have to compare.
Key words:
antireflux, diversion, ileum, low-pressure reservoir, orthotopic neobladder
Sources
1. Le Duc A, Camey M. A procedure for avoiding reflux in uretero-ileal implantations during enterocystoplasty. J Urol Nephrol 1979; 85(7–8): 449–454.
2. World Health Organization (WHO) Consensus Conference in Bladder Cancer, Hautmann RE, Abol--Enein H, Hafez K, Haro I et al. Urinary diversion. Urology 2007; 69 (1 Suppl):17–49.
3. Iwakiri J, Gill H, Anderson R et al. Functional and urodynamic characteristics of an ileal neobladder. J Urol 1993; 149(5): 1072–1076.
4. Gerber WL. Is urethral sparing at cystectomy a safe procedure? Urology 1990; 36(4): 303–304.
5. Stenzl A, Draxl H, Posch B et al. The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract? J Urol 1995; 153 (3 Pt 2): 950–955.
6. Stein JP, Penson DF, Lee C et al. Long-term oncological outcomes in women undergoing radical cystectomy and orthotopic diversion for bladder cancer. J Urol 2009; 181(5): 2052–2058.
7. Colleselli K, Stenzl A, Eder R et al. The female urethral sphincter: a morphological and topographical study. J Urol 1998; 160(1): 49–54.
8. Hinman F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol 1988; 139(3): 519–523.
9. Basford JR. The Law of Laplace and its relevance to contemporary medicine and rehabilitation. Arch Phys Med Rehabil 2002; 83(8): 1165–1170.
10. Goodwin WE, Winter CC. Technique of sigmoidocystoplasty. Surg Gynecol Obstet 1959; 108(3): 370–372.
11. Schrier BP, Laguna MP, van der Pal F et al. Comparison of orthotopic sigmoid and ileal neobladders: continence and urodynamic parameters. Eur Urol 2005; 47(5): 679–685.
12. Hohenfellner M, Bürger R, Schad H et al. Reservoir characteristics of Mainz pouch studied in animal model. Osmolality of filling solution and effect of oxybutynin. Urology 1993; 42(6): 741–746.
13. Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol 1999; 161(4): 1057–1066.
14. Stenzl A. Bladder Substitution. Curr Opin Urol 1999; 9(3): 241–245.
15. Nguyen DH, Mitchell ME. Gastric bladder reconstruction. Urol Clin North Am 1991; 18(4): 649–657.
16. Adams MC, Mitchell ME, Rink RC. Gastrocystoplasty: an alternative solution to the problem of urological reconstruction in the severely compromised patient. J Urol 1988; 140 (5 Pt 2): 1152–1156.
17. Lin DW, Santucci RA, Mayo ME et al. Urodynamic evaluation and long-term results of the orthotopic gastric neobladder in men. J Urol 2000; 164(2): 356–359.
18. Lockhart JL, Davies R, Cox C et al. The gastroileoileal pouch: an alternative continent urinary reservoir for patients with short bowel, acidosis and/or extensive pelvic radiation. J Urol 1993; 150(1): 46–50.
19. Stenzl A, Cowan NC, De Santis M et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 2009; 55(4): 815–825.
20. Stein JP, Clark P, Miranda G et al. Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients. J Urol 2005; 173(4): 1163–1168.
21. Gakis G, Schilling D, Perner S et al. Sequential resection of malignant ureteral margins at radical cystectomy: a critical assessment of the value of frozen section analysis. World J Urol 2010; DOI 10.1007/s00345-010-0581-z.
22. Elmajian DA, Stein JP, Esrig D et al. The Kock ileal neobladder: updated experience in 295 male patients. J Urol 1996; 156(3): 920–925.
23. Steven K, Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 2000; 164(2): 288–295.
24. Hafron J, Mitra N, Dalbagni G et al. Does body mass index affect survival of patients undergoing radical or partial cystectomy for bladder cancer? J Urol 2005; 173(5): 1513–1517.
25. Kouba E, Sands M, Lentz A et al. Incidence and risk factors of stomal complications in patients undergoing cystectomy with ileal conduit urinary diversion for bladder cancer. J Urol 2007; 178 (3 Pt 1): 950–954.
26. Abol-Enein H, Ghoneim MA. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol 2001; 165(5): 1427–1432.
27. Kassouf W, Spiess PE, Brown GA et al. Prostatic urethral biopsy has limited usefulness in counseling patients regarding final urethral margin status during orthotopic neobladder reconstruction. J Urol 2008; 180(1): 164–167.
28. Stein JP, Dunn MD, Quek ML et al. The orthotopic T pouch ileal neobladder: experience with 209 patients. J Urol 2004; 172(2): 584–587.
29. Stenzl A, Jarolim L, Coloby P et al.Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors. Cancer 2001; 92(7): 1864–1871.
30. Minervini A, Boni G, Salinitri G et al. Evaluation of renal function and upper urinary tract morphology in the ileal orthotopic neobladder with no antireflux mechanism. J Urol 2005; 173(1): 144–147.
31. Månsson W, Colleen S, Mårdh PA. The microbial flora of the continent cecal urinary reservoir, its stoma and the peristomal skin. J Urol 1986; 135(2): 247–250.
32. Hautmann RE, Volkmer BG, Schumacher MC et al. Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 2006; 24(3): 305–314.
33. Gotoh M, Yoshikawa Y, Sahashi M et al. Urodynamic study of storage and evacuation of urine in patients with a urethral Kock pouch. J Urol 1995; 154(5): 1850–1853.
34. Stein JP, Freeman JA, Esrig D et al. Complications of the afferent antireflux valve mechanism in the Kock ileal reservoir. J Urol 1996; 155(5): 1579–1584.
35. Studer UE, Spiegel T, Casanova GA et al. Ileal bladder substitute: antireflux nipple or afferent tubular segment? Eur Urol 1991; 20(4): 315–326.
36. Skinner EC, Skinner DG. Does reflux in orthotopic diversion matter? A randomized prospective comparison of the Studer and T-pouch ileal neobladders. World J Urol 2009; 27(1): 51–55.
37. Le Duc A, Camey M, Teillac P. An original antireflux ureteroileal implantation technique: long-term follow--up. J Urol 1987; 137(6): 1156–1158.
38. Sagalowsky A. Early results with split-cuff nipple ureteral reimplants in urinary diversion. J Urol 1995; 154(6): 2028–2031.
39. Kock NG, Nilson AE, Nilsson LO et al. Urinary diversion via a continent ileal reservoir: clinical results in 12 patients. J Urol 1982; 128(3): 469–475.
40. Studer UE, Burkhard FC, Schumacher M et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. J Urol 2006; 176(1): 161–166.
41. Pagano F, Artibani W, Ligato P et al. Vescica Ileale Padovana: a technique for total bladder replacement. Eur Urol 1990; 17(2): 149–154.
42. Stenzl A, Hobisch A, Strasser H et al. Ureteroileal anastomosis in orthotopic urinary diversion: how much or how little is necessary? Tech Urol 2001; 7(3): 188–195.
43. Hautmann RE, de Petriconi R, Gottfried HW et al. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 1999; 161(2): 422–427.
44. Pantuck AJ, Han KR, Perrotti M et al. Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol 2000; 163(2): 450–455.
45. Hobisch A, Tosun K, Kinzl J et al. Life after cystectomy and orthotopic neobladder versus ileal conduit urinary diversion. Semin Urol Oncol 2001; 19(1): 18–23.
46. Hautmann RE, Paiss T. Does the option of the ileal neobladder stimulate patient and physician decision toward earlier cystectomy? J Urol 1998; 159(6): 1845–1850.
47. Chang SS, Hassan JM, Cookson MS et al. Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol 2003; 170 (4 Pt 1): 1085–1087.
48. Stenzl A, Höltl L. Orthotopic bladder reconstruction in women--what we have learned over the last decade. Crit Rev Oncol Hematol 2003; 47(2): 147–154.
49. Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol 2005; 173(4): 1318–1322.
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2011 Issue 3
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