Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy

Kang Jun Cho; Dong Wan Sohn; Sae Woong Kim

doi:10.4111/kju.2007.48.5.494

Journal List > Korean J Urol > v.48(5) > 1004916

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Sohn, and Kim: Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy

Original Article

Korean J Urol 2007;48(5):494-499.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.5.494

Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy

Kang Jun Cho, Dong Wan Sohn, Sae Woong Kim

¹From the Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Dongwan Son Catholic University College of Medicine Department of Urology Yeouido-dong, Yeongdeungpo-gu, Seoul 62 150-713 TEL: 02-3779-1223 FAX: 02-761-1626 E-mail: uroking@naver.com

Received 5 January 2007 Accepted 3 April 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

mil|||| The objective of this study was to compare the complications and urodynamic parameters of the patients who underwent orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy for treating invasive bladder cancer.

Materials and Methods:

MMMMb flBft MMMto Between January 1990 and April 2006, 260 patients with invasive bladder cancer underwent radical cystectomy and construction of the urinary diversion; ileal conduit, indiana pouch, ileocolic neobladder, ileal neobladder were all done at St. Mary's Hospital. The mean age of the patient was 61.8 years (range: 46-86). The ratio of male and female was 88%/12%. Forty nine patients received an orthotopic ileocolic neobladder and 45 patients received an orthotopic ileal neobladder. The complications and urodynamic parameters were compared in both groups.

Results:

RHuHH The orthotopic ileocolic neobladder after radical cystectomy for treating invasive bladder cancer has been performed between 1990 and 1996 and the orthotopic ileal neobladder has been performed between 1996 and 2006. Ileocolic neobladder related complications developed in 10 patients; neobladder leakage in 1 (2%), neobladder rupture in 1 (2%), stricture of the ureteroenteric anastomosis site in 4 (8.2%), and stricture of the urethral anastomosis site in 4 (8.2%). Ileal neobladder related complications developed in 11 patients; ureteroenteric stricture in 7 (15.5%), stricture of the urethral anastomosis site in 3 (6.6%) and acute pyelonephritis in 1 (2.2%). The results of the mean maximal flow rate and mean postvoid residual volume were better in the ileal neobladder group than those in the ileocolic neobladder group.

Conclusions:

There were no significant differences in complications between ileocolic neobladder and ileal neooladder. The maximal uroflow and residual urine volume of the ileal neobladder were superior to those of the ileocolic neobladder on urodynamic study. j

Keywords: Urinary diversion, Ileum, Colon, Urodynamics, Complications

REFERENCES

1.Simon J. Extrophia vesicae (absence of the anterior walls of the bladder and pubic abdominal parietes); operation for directing the orifices of the ureters into the rectum; temporary sucess; subsequent death; autopsy. Lancet. 1852. 2:568–70.

2.Skinner DG., Studer UE., Okada K., Aso Y., Hautmann H., Koontz W, et al. Which patients are suitable for continent diversion or bladder substitution following cystectomy or other definitive local treatment? Int J Urol. 1995. 2(Suppl 2):105–12.

3.Santucci RA., Park CH., Mayo ME., Lange PH. Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments. Urology. 1999. 54:252–7.

4.Oh KS., Cho YH., Yoon MS. Urodynamic analysis of the ileocolic neobladder. Korean J Urol. 1994. 35:779–86.

5.Abol-Enein H., Ghoneim MA. A novel uretero-ileal reimplantation technique: the serous lined extramural tunnel. A preliminary report. J Urol. 1994. 151:1193–7.

6.Iwakiri J., Gill H., Anderson R., Freiha F. Functional and urodynamic characteristics of an ileal neobladder. J Urol. 1993. 149:1072–6.

7.Garry RC., Roberts TO., Todd JK. Reflexes involving the external urethral sphincter in the cat. J Physiol. 1959. 149:653–65.

8.Mahony DT., Laferte RO., Blais DJ. Integral storage and voiding reflexes. Neurophysiologic concept of continence and micturition. Urology. 1977. 9:95–106.

9.Hugonnet CL., Danuser H., Springer JP., Studer UE. Decreased sensitivity in the membranous urethra after orthotopic ileal bladder substitute. J Urol. 1999. 161:418–21.

10.Steven K., Klarskov P., Jakobsen H., Bay-Nielsen H., Rasmussen F. Transpubic cystectomy and ileocecal bladder replacement after preoperative radiotherapy for bladder cancer. J Urol. 1986. 135:470–5.

11.Jakobsen H., Steven K., Stigsby B., Klarskov P., Hald T. Pathogenesis of nocturnal urinary incontinence after ileocaecal bladder replacement. Continuous measurement of urethral closure pressure during sleep. Br J Urol. 1987. 59:148–52.

12.Khafagy MM., el-Kalawy M., Ibrahim A., Safa M., Meguid HA., Bassioni M. Radical cystectomy and ileocaecal bladder reconstruction for carcinoma of the urinary bladder. A study of 130 patients. Br J Urol. 1987. 60:60–3.

13.Khafagy M., Shaheed FA., Moneim TA. Ileocaecal vs ileal neobladder after radical cystectomy in patients with bladder cancer: a comparative study. Br J Urol. 2006. 97:799–804.

14.Casanova GA., Springer JP., Gerber E., Studer UE. Urodynamic and clinical aspects of ileal low pressure bladder substitutes. Br J Urol. 1993. 72:728–35.

15.Leissner J., Stein R., Hohenfellner R., Kohl U., Riedmiller H., Schroder A, et al. Radical cystoprostatectomy combined with Mainz pouch bladder substitution to the urethra: long-term results. BJU Int. 1999. 83:964–70.

16.Steven K., Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol. 2000. 164:288–95.

17.Kwon BS., Han CH., Yoon MS. The ileocolic neobladder: 5-year experience in 49 male bladder cancer patients. Korean J Urol. 1997. 38:1210–6.

18.Jung PB., Yoon DK., Kim DS., Cho JH. Analysis of posto perative results according to the types of urinary diversion after radical cystectomy. Korean J Urol. 2000. 41:229–34.

19.Hautmann RE., de Petriconi R., Gottfried HW., Kleinschmidt K., Mattes R., Paiss T. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol. 1999. 161:422–7.

20.Hautmann RE., Egghart G., Frohneberg D., Miller K. The ileal neobladder. J Urol. 1988. 139:39–42.

21.Schrier BP., Laguna MP., van der Pal F., Isoma S., Witjes JA. Comparison of orthotopic sigmoid and ileal neobladders: continence and urodynamic parameters. Eur Urol. 2005. 47:679–85.

22.Light JK., Engelmann UH. Le Bag: total replacement of the bladder using an ileocolonic pouch. J Urol. 1986. 136:27–31.

23.Benjany DE., Politano VA. Modified ileocolonic bladder: 5 years of experience. J Urol. 1993. 149:1441–4.

24.Hinman F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol. 1988. 139:519–23.

25.Sidi AA., Reinberg Y., Gonzalez R. Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty. J Urol. 1986. 136:1201–4.

26.Narayan P., Broderick GA., Tanagho EA. Bladder substitution with ileocaecal (Mainz) pouch. Clinical performance over 2 years. Br J Urol. 1991. 67:588–95.

Table 1.

Clinical comparison for orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy

	Group 1	Group 2	p-value
Total No. of patients	49	45	>0.05
Mean age (years)	56.0 (34-74)	64.5 (49-77)	>0.05
Mean op time (hours)	9	6.5	>0.05
Mean postop. stay (days)	20.2	14.0	>0.05
Voiding frequency (No./day)	6.9 ±1.0	7.3 ±2.0	>0.05
Functional capacity (ml)	359.0 ±41	349.2 ±32	> 0.05
Continent rate
Daytime	89.8%	95.1%	> 0.05
Nighttime	83.7%	80.5%	> 0.05

Group 1: ileocolic neobladder, Group 2: ileal neobladder

Table 2.

Comparison of the major early complications for orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy

	Group 1 (n=49)	Group 2 (n=45)	p-value
Related neobladder
Neobladder leak (%)	1 (2.0)	0	> 0.05
Ureteroenteric anastomosis
Obstruction (%)	0	0	> 0.05
Reflux (%)	0	0	> 0.05
Urethral anastomosis
Stricture (%)	0	0	> 0.05
Outlet resistance (%)	0	0	> 0.05
Kidney
Acute pyelonephritis (%)	0	0	> 0.05
Not related to neobladder
Wound infection:
Superficial (%)	2 (4.0)	0	> 0.05
Deep (%)	2 (4.0)	2 (4.4)	> 0.05
Bowel
Prolonged ileus (%)	3 (6.1)	2 (4.4)	> 0.05
Anastomosis leakage (%)	2 (4.0)	0	> 0.05
Gastrointestinal bleeding (%)	0	0	> 0.05
Respiratory
Pneumonia (%)	1 (2.0)	0	> 0.05

Group 1: ileocolic neobladder, Group 2: ileal neobladder

Table 3.

Comparison of the major late complications for orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy

	Group 1 (n=49)	Group 2 (n=45)	p-value
Related neobladder
Neobladder rupture (%)	1 (2.0)	0	> 0.05
Ureteroenteric anastomosis
Obstruction (%)	4 (8.2)	7 (15.5)	> 0.05
Reflux (%)	0	0	> 0.05
Urethral anastomosis
Stricture (%)	4 (8.2)	3 (6.6)	> 0.05
Outlet resistance (%)	0	0	> 0.05
Kidney
Acute pyelonephritis (%)	0	1 (2.2)	> 0.05
Renal/ ureteral calculus (%)	0	0	> 0.05
Not related to neobladder
Wound infection
Superficial (%)	0	0	> 0.05
Deep (%)	0	0	> 0.05
Bowel
Obstruction (%)	0	0	> 0.05
Persistent diarrhea (%)	0	0	> 0.05
Deterioration of renal function (%)	0	1 (2.2%)	> 0.05
Respiratory
Pulmonary embolus (%)	0	0	> 0.05

Group 1: ileocolic neobladder, Group 2: ileal neobladder

Table 4.

Urodynamic comparison for orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy

	Group 1 (n=49)	Group 2 (n=45)	p-value
Max. capacity (ml)	554 ±71.5	540 ±34.1	> 0.05
Max. filling pressure (cmH₂O)	23.4 ±6.1	24.9 ±3.5	> 0.05
Max. urethral closure pressure (cmH₂O)	52.0 ±11.4	55.6±21.5	> 0.05
Max. flow rate (ml/sec)	10.0 ±7.0	15.5 ±3.2	<0.05
Post-void residual volume (ml)	55.6 ±6.1	30.1 ±16.5	<0.05

Group 1: ileocolic neobladder, Group 2: ileal neobladder

TOOLS

Similar articles