Radical cystectomy with a Y-shaped orthotopic ileal neobladder, early uretero-neobladder anastomosis outcomes at Khon Kaen Hospital
DOI:
https://doi.org/10.52786/isu.a.47Keywords:
Bladder cancer, radical cystectomy, neobladder, uretero-neobladder anastomosisAbstract
Objective: To evaluate the clinical complications and functional outcomes associated with the modified Y-pouch neobladder technique, in particularly those related to the prevention of anastomosis stricture.
Materials and Methods: Functional outcomes and associated complications were evaluated in 25 patients (23 men, 2 women) who underwent radical cystectomy with Y-pouch neobladder by isolating 50 cm of the ileum between October 2010 and December 2020. Clinical complications included anastomosis stricture formation, hydronephrosis, pyelonephritis, vesical stone formation, and renal deterioration.
Results: No cases exhibited uretero-neobladder anastomosis stricture, urethro-neobladder anastomosis stricture, or vesical stones. In addition, no complications were observed in relation to metabolic acidosis. One year after surgery, daytime and nighttime continence rates among patients were 88% and 72%, respectively, with almost every case exhibiting near-normal voiding frequency. The average maximal neobladder capacity was 425.60±20.83 ml with a mean follow-up period of 2.8 years. There was a no statistically significant increase in creatinine with values of 1.45 mg/dl, 1.14 mg/dl, 1.21 mg/dl, and 1.35 ml/dl being recorded at preoperative baseline, 3, 6 and 12 months, respectively.
Conclusions: The Y-pouch neobladder created by isolating 50 cm of the ileum showed a low incidence of uretero-neobladder anastomosis and urethra-anastomosis stricture rate. In addition it was a straightforward procedure with a quickly reconstructed reservoir, had good functional outcomes which were comparable to most popular orthotopic neobladders, had no significant increase in postoperative creatinine levels and improved quality of life for patients.
References
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001; 19:666-75.
Cerruto MA, D’ Elia C, Siracussano S, Gedeshi X, Mariotto A, Niero M, et al. Systematic review and meta-analysis of non RCTs on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol 2016;42:343-60.
Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T, et al. The ileal neobladder: complications and functional results in 363 patients after 11 years of follow-up. J Urol 1999; 161:422-7.
Abol-Enein H, Ghoneim MA. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol 2001;165:1427-32.
Studer UE, Burckard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years’ experience with an ileal orthotopic low-pressure bladder substitute lesson to be learned. J Urol 2006; 176:161-6.
Fontana D, Bellina M, Fasolis G, Frea B, Scarpa RM, Mari M, et al. Y-neobladder: an easy, fast, and reliable procedure. Urology 2004;63:699-703.
Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G. Rationale and technique of nerve-sparing radical cystectomy prior to an orthotopic neobladder in the female. J Urol 1995;154:2044-9.
Davis NF, Burke JP, McDermott T, Flynn R, Manecksha RP, Thornhill JA. Bricker versus Wallace anas- tomosis: a meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc J 2015;9:E284-90.
Benson MC, Olsson CA. Continent urinary diver- sion. Urol Clin North Am 1999;26:125-47.
Skinner EC, Skinner DG, Stein JP. Orthotopic urinary diversion. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peter CA, editors. Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 2446-94.
Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. J Urol 2006;68:58-64.
Pantuck AJ, Han KR, Perrotti M, Weiss RE, Cummings KB. Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus non-refluxing techniques. J Urol 2000;163:450-5.
Kim BK, Song MH, Du SH, Yang WJ, Song YS. Neovesical-urethral anastomotic stricture successfully treated by ureteral dilation balloon catheter. Korean J Urol 2010;51:660-2.
Madersbacher S, Mohrle K, Burkhard F, Studer UE. Long- term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol 2002;167:2052-7.
Studer UE, Danuser H, Merz VW, Springer JP, Zingg EJ. Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J Urol 1995; 154:49-56.
Suriano F, Daneshmand S, Buscarini M. Use of non-absorbable staples for urinary diversion: a step in the wrong direction. Urol Int 2013;90:125-9.
Abreu SC, Fonseca GN, Cerqueira JBC, Nobrega MS, Costa MR, Machado PC. Laparoscopic radical cystectomy with intracorporeally constructed Y-shaped orthotopic ileal neobladder using non-absorbable titanium staples exclusively. Urology 2005;66:657.
Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol 2008;179:582-6.
Almassi N, Cha EK, Vertosick EA, Huang C, Wong N, Dason S, et al. Trends in Management and Outcomes Among Patients with Urothelial Carcinoma Undergoing Radical Cystectomy from 1995 to 2015: The Memorial Sloan Kettering Experience. J Urol 2020;204:677-84.
Stein JP, Skinner DG. Orthotopic Urinary Diversion. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell Urology. 9th ed. Philadelphia: Elsevier Saunders; 2007. p. 2613-48.
Berglund RK, Herr HW. Surgery for Bladder Cancer. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 2375-85.
Skinner EC, Skinner DG, Stein JP. Orthotopic Urinary Diversion. In: Kavoussi LR, Wein AJ, Novick AC, Partin AW, Peters CA, editors, Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 2497-506.
Tanaka T, Kitamura H, Takahashi A, Masumori N, Itoh N, Tsukamoto T. Long-term functional outcome and late complications of Studer’s ileal neobladder. Jpn J Clin Oncol 2005; 35:391-4.
Lantz AG, Saltel ME, Cagianos I. Renal and func- tional outcomes following cystectomy and neobladder reconstruction. Can Urol Assoc J 2010;4:328-31.
Sirikul T, Sriplakich S, Amantakul A. Comparison of open and laparoscopic radical cystectomy as regards long-term oncological outcomes for bladder cancer. Insight Urol 2021;42:123-30.
Ramart P, Chaiyaprasithi B, Pradniwat K, Ratanarapee S, Amornvesukit T, Taweemonkongsap T, et al. Outcome of open radical cystectomy with pelvic lymph node dissection for bladder urothelial cancer in Siriraj hospital between 1998-2003. Thai J Urol 2010;31:27-39.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
