Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent ima...Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.展开更多
Objective:To compare both techniques of detubularized ileocaecal and ileal neobladder post radical cystectomy with regards to functional results in the form of continence(day and night)with the use of urodynamics(for ...Objective:To compare both techniques of detubularized ileocaecal and ileal neobladder post radical cystectomy with regards to functional results in the form of continence(day and night)with the use of urodynamics(for assessment of voiding volume and pouch capacity).Methods:This is a prospective randomized clinical trial that was done at the National Cancer Institute,Cairo University from August 2016 and January 2018.Sixty-two patients presented with muscle invasive urinary bladder cancer and no history of urinary incontinence or urethral stricture were included in this study.All patients underwent preoperative cystoscopic examination.Radical cystectomy was done,and patients were divided into two groups according to the type of diversion.Group A included 31 patients with orthotopoic detubularized ileal neobladder and group B included 31 patients with orthotopic detubularized ileocaecal neobladder.Urodynamic studies were done to 27 patients in group A and 27 patients in group B at just 6 and 12 months postoperatively.Results:The mean age in group A was 59.2±8.0 while in group B was 57.8±6.6.In each group,we compared day and night continence in a period of 3 and 6 months.Postoperatively in group A,day continence after 3 months was 81.5% which improved to 96.3% after 6 months postoperatively with significant P-value(0.025).Night continence after 3 months was fair in 66.7%,unsatisfactory in 33.3% and 0% for good state which improved to 70% for fair state,18% unsatisfactory and 11% for good state after 6 months with significant P-value(0.035)while in group B,day continence after 3 months and 6 months postoperatively was 100% and night continence after 3 months was good in 0.0%,fair in 78.6% and unsatisfactory in 21.4% which improved to 10.7% for good state,85.7% for fair state and 3.6% for unsatisfactory after 6 months with significant P-value(0.005).Conclusion:There are no significant differences between detubularized ileocaecal and ileal neobladder in relation to continence.However,there is significant change in each type of diversion separately with time.展开更多
Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this pape...Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra neobladder anastomosis This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004 Results The operating time was 5 5-8 5 hours with an average of 6 5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml The surgical margins of the bladder specimen were negative in all patients There was no evidence of local recurrence at follow up of 1-21 months in all the patients However lymph node metastases were found in one case at 9 months postoperatively Most of patients achieved urine control 1 to 3 months after surgery The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases) Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases The mean value of neobladder capacity was (296±37) ml The mean value of maximum flow rate was (18 7±7 1) ml/s The mean residual urine volume was (32±19) ml In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up Cystography showed neobladders being similar in shapes to normal Two small ureteral nipples with intermittently efflux of urine were observed at cystoscopy in most patients Postoperative complications occurred in 6 of 33 patients (18%), including pouch leakage in 2 cases, pelvic infection in 1, partial small bowel obstruction in 2 and neobladder vaginal fistula in 1 Conclusions The LRC with orthotopic ileal neobladder is a feasible option for bladder cancer when radical cystectomy is indicated The extracorporeal formation of the ileal pouch and ureteral implantation through a small lower midline incision can simplify the complexity of the procedures, shorten the duration of surgery and reduce the medical expenses展开更多
Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatecto...Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.展开更多
文摘Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.
文摘Objective:To compare both techniques of detubularized ileocaecal and ileal neobladder post radical cystectomy with regards to functional results in the form of continence(day and night)with the use of urodynamics(for assessment of voiding volume and pouch capacity).Methods:This is a prospective randomized clinical trial that was done at the National Cancer Institute,Cairo University from August 2016 and January 2018.Sixty-two patients presented with muscle invasive urinary bladder cancer and no history of urinary incontinence or urethral stricture were included in this study.All patients underwent preoperative cystoscopic examination.Radical cystectomy was done,and patients were divided into two groups according to the type of diversion.Group A included 31 patients with orthotopoic detubularized ileal neobladder and group B included 31 patients with orthotopic detubularized ileocaecal neobladder.Urodynamic studies were done to 27 patients in group A and 27 patients in group B at just 6 and 12 months postoperatively.Results:The mean age in group A was 59.2±8.0 while in group B was 57.8±6.6.In each group,we compared day and night continence in a period of 3 and 6 months.Postoperatively in group A,day continence after 3 months was 81.5% which improved to 96.3% after 6 months postoperatively with significant P-value(0.025).Night continence after 3 months was fair in 66.7%,unsatisfactory in 33.3% and 0% for good state which improved to 70% for fair state,18% unsatisfactory and 11% for good state after 6 months with significant P-value(0.035)while in group B,day continence after 3 months and 6 months postoperatively was 100% and night continence after 3 months was good in 0.0%,fair in 78.6% and unsatisfactory in 21.4% which improved to 10.7% for good state,85.7% for fair state and 3.6% for unsatisfactory after 6 months with significant P-value(0.005).Conclusion:There are no significant differences between detubularized ileocaecal and ileal neobladder in relation to continence.However,there is significant change in each type of diversion separately with time.
文摘Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra neobladder anastomosis This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004 Results The operating time was 5 5-8 5 hours with an average of 6 5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml The surgical margins of the bladder specimen were negative in all patients There was no evidence of local recurrence at follow up of 1-21 months in all the patients However lymph node metastases were found in one case at 9 months postoperatively Most of patients achieved urine control 1 to 3 months after surgery The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases) Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases The mean value of neobladder capacity was (296±37) ml The mean value of maximum flow rate was (18 7±7 1) ml/s The mean residual urine volume was (32±19) ml In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up Cystography showed neobladders being similar in shapes to normal Two small ureteral nipples with intermittently efflux of urine were observed at cystoscopy in most patients Postoperative complications occurred in 6 of 33 patients (18%), including pouch leakage in 2 cases, pelvic infection in 1, partial small bowel obstruction in 2 and neobladder vaginal fistula in 1 Conclusions The LRC with orthotopic ileal neobladder is a feasible option for bladder cancer when radical cystectomy is indicated The extracorporeal formation of the ileal pouch and ureteral implantation through a small lower midline incision can simplify the complexity of the procedures, shorten the duration of surgery and reduce the medical expenses
基金ThisworkwassupportedbythegrantofScienceandTechnologyofGuangdongProvince (No .962 2 0 5 0 0 1)
文摘Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.
