PDF
ePub
Citation
Print
Abstract
During the last decade, urinary diversion has evolved from simply diverting the urine through a conduit to continent urinary diversion, especially orthotopic bladder substitution. At present, all the patients undergoing cystectomy are neobladder candidates. In general, if sphincter sparing surgery is possible, then orthotopic bladder substitution is performed; if this can't be done, then continent catheterizable reservoirs or noncontinent cutaneous diversion are viable options. The rate of complications of neobladders is actually similar to the true complication rates after conduit formation, which is in contrast to the popular view that conduits are simple and safe. The need for reflux prevention is not the same as for creating a ureterosigmoidostomy conduit or continent diversion. Reflux prevention in neobladders is even less important than in a normal bladder. When using nonrefluxing techniques, the risk of obstruction is at least twice that after direct anastomosis. Strict patient selection criteria and improved surgical technique have had a positive influence on the outcome, not only on survival but also on quality of life issues. Until a better solution is devised, orthotopic bladder reconstruction remains the best option for patients requiring cystectomy.
References
1. 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.
2. Stein JP, Skinner DG. Application of the T-mechanism to an orthotopic (T-pouch) neobladder: a new era of urinary diversion. World J Urol. 2000; 18:315–23.
3. Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, et al. Urinary diversion. Urology. 2007; 69:17–49.
4. Studer UE, Zingg EJ. Ileal orthotopic bladder substitutes. What we have learned from 12 years' experience with 200 patients. Urol Clin North Am. 1997; 24:781–93.
5. Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950; 30:1511–21.
6. Couvelaire R. Substitute ileal reservoir following total cystectomy in the male. J Urol Med Chir. 1951; 57:408–17.
7. Kock NG, Nilson AE, Nilsson LO, Norlen LJ, Philipson BM. Urinary diversion via a continent ileal reservoir: clinical results in 12 patients. J Urol. 1982; 128:469–75.
8. Wang JS, Hong YP. Uretero-ileocystoplasty. A report of one case. Korean J Urol. 1960; 1:147–50.
9. Lee SC. Ileal loop cutaneous urinary diversion. A clinical review on 8 cases. Korean J Urol. 1971; 12:379–85.
10. Bae BC, Park YK. Clinical experiences of continent urinary diversion. Korean J Urol. 1986; 27:641–8.
11. Yoon YD, Shin HC, Chung SK, Kim BW, Chang SK. Bladder augmentation and continent diversion using the Mainz pouch (mixed augmentation ileum and cecum). Korean J Urol. 1988; 29:299–306.
12. Chung MK, Kim HS. The experience of the bladder augmentation and substitution with Studer's ileal cup-patched bladder. Korean J Urol. 1991; 32:811–8.
13. Singh G, Wilkinson JM, Thomas DG. Supravesical diversion for incontinence: a longterm follow-up. Br J Urol. 1997; 79:348–53.
14. Madersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, et al. Long-term outcome of ileal conduit diversion. J Urol. 2003; 169:985–90.
15. Rowland RG, Mitchell ME, Bihrle R, Kahnoski RJ, Piser JE. Indiana continent urinary reservoir. J Urol. 1987; 137:1136–9.
16. Rowland RG, Kropp BP. Evolution of the Indiana continent urinary reservoir. J Urol. 1994; 152:2247–51.
17. Bihrle R. The Indiana pouch continent urinary reservoir. Urol Clin North Am. 1997; 24:773–9.
18. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: longterm results in 1,054 patients. J Clin Oncol. 2001; 19:666–75.
19. Gschwend JE, Fair WR, Vieweg J. Radical cystectomy for.
20. Hinman F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol. 1988; 139:519–23.
21. Goodwin WE, Winter CC, Barker WF. Cup-patch technique of ileocystoplasty for bladder enlargement or partial substitution. Surg Gynecol Obstet. 1959; 108:240–4.
22. Colding-Jorgensen M, Poulsen AL, Steven K. Mechanical characteristics of tubular and detubularised bowel for bladder substitution: theory, urodynamics and clinical results. Br J Urol. 1993; 72:586–93.
23. Burkhard FC, Kessler TM, Mills R, Studer UE. Continent urinary diversion. Crit Rev Oncol Hematol. 2006; 57:255–64.
24. 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.
25. Davidsson T, Akerlund S, Forssell-Aronsson E, Kock NG, Mansson W. Absorption of sodium and chloride in continent reservoirs for urine: comparison of ileal and colonic reservoirs. J Urol. 1994; 151:335–7.
26. Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol. 1999; 161:1057–66.
27. Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW, et al. Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol. 2004; 172:1323–7.
28. Pfitzenmaier J, Lotz J, Faldum A, Beringer M, Stein R, Thuroff JW. Metabolic evaluation of 94 patients 5 to 16 years after ileocecal pouch (Mainz pouch 1) continent urinary diversion. J Urol. 2003; 170:1884–7.
29. Studer UE, Danuser H, Thalmann GN, Springer JP, Turner WH. Antireflux nipples or afferent tubular segments in 70 patients with ileal low pressure bladder substitutes: longterm results of a prospective randomized trial. J Urol. 1996; 156:1913–7.
30. Studer UE, Danuser H, Hochreiter W, Springer JP, Turner WH, Zingg EJ. Summary of 10 years' experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment. World J Urol. 1996; 14:29–39.
31. Hautmann RE, Egghart G, Frohneberg D, Miller K. The ileal neobladder. J Urol. 1988; 139:39–42.
32. Abol-Enein H, Ghoneim MA. Further clinical experience with the ileal W-neobladder and a serous-lined extramural tunnel for orthotopic substitution. Br J Urol. 1995; 76:558–64.
33. Studer UE, deKernion JB, Zimmern PE. A model for a bladder replacement plasty by an ileal reservoir–an experimental study in dogs. Urol Res. 1985; 13:243–7.
34. 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.
35. Montie JE, Pontes JE, Smyth EM. Selection of the type of urinary diversion in conjunction with radical cystectomy. J Urol. 1987; 137:1154–5.
36. Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC, et al. Urethral recurrence in patients with orthotopic ileal neobladders. J Urol. 1996; 156:1615–9.
37. Stein JP, Cote RJ, Freeman JA, Esrig D, Elmajian DA, Groshen S, et al. Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens. J Urol. 1995; 154:1329–33.
38. Stein JP, Esrig D, Freeman JA, Grossfeld GD, Ginsberg DA, Cote RJ, et al. Prospective pathologic analysis of female cystectomy specimens: risk factors for orthotopic diversion in women. Urology. 1998; 51:951–5.
39. Iselin CE, Robertson CN, Webster GD, Vieweg J, Paulson DF. Does prostate transitional cell carcinoma preclude orthotopic bladder reconstruction after radical cystoprostatectomy for bladder cancer? J Urol. 1997; 158:2123–6.
40. 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.
41. 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.
42. Elmajian DA, Stein JP, Esrig D, Freeman JA, Skinner EC, Boyd SD, et al. The Kock ileal neobladder: updated experience in 295 male patients. J Urol. 1996; 156:920–5.
43. Hautmann RE, Simon J. Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men. J Urol. 1999; 162:1963–6.
44. Yossepowitch O, Dalbagni G, Golijanin D, Donat SM, Bochner BH, Herr HW, et al. Orthotopic urinary diversion after cystectomy for bladder cancer: implications for cancer control and patterns of disease recurrence. J Urol. 2003; 169:177–81.
45. Madersbacher S, Hochreiter W, Burkhard F, Thalmann GN, Danuser H, Markwalder R, et al. Radical cystectomy for bladder cancer today–a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003; 21:690–6.
46. Gschwend JE. Bladder substitution. Curr Opin Urol. 2003; 13:477–82.
47. Varol C, Thalmann GN, Burkhard FC, Studer UE. Treatment of urethral recurrence following radical cystectomy and ileal bladder substitution. J Urol. 2004; 172:937–42.
48. Hart S, Skinner EC, Meyerowitz BE, Boyd S, Lieskovsky G, Skinner DG. Quality of life after radical cystectomy for bladder cancer in patients with an ileal conduit, cutaneous or urethral kock pouch. J Urol. 1999; 162:77–81.
Table 1.
Criteria for ideal urinary diversion
Table 2.
How the experts divert at medical centers
| No. of cystectomies | Period | Neobladder (%) | Continent cutaneous pouch (%) | Conduit (%) | UC/TUU∗ (%) | Anal (%) | Others (%) | |
|---|---|---|---|---|---|---|---|---|
| Ann Arbor, MI | 643 | 02/1995–09/2004 | 45.1 | 1.4 | 53.5 | 0.0 | 0.0 | 0.0 |
| Bern | 327 | 01/1999–09/2004 | 54.0 | 3.0 | 37.0 | 0.0 | 3.0 | NA† |
| Dallas, TX | 228 | 01/1999–09/2004 | 30.0 | 6.0 | 64.0 | 0.0 | 0.0 | 0.0 |
| Kobe, Japan | 87 | 02/1989–09/2004 | 46.0 | 2.3 | 10.3 | 41.4 | 0.0 | 0.0 |
| Los Angeles | 1,359 | 08/1971–12/2001 | 51.6 | 25.8 | 22.3 | 0.0 | 0.0 | 0.3 |
| Lund, Sweden | 119 | 01/2000–09/2004 | 28.6 | 31.1 | 40.3 | 0.0 | 0.0 | 0.0 |
| Mansoura, Egypt | 3,157 | 01/1980–01/2004 | 39.1 | 3.5 | 34.4 | 0.0 | 23.1 | 0.0 |
| Ulm, Germany | 1,209 | 01/1986–09/2004 | 66.2 | 0.5 | 22.6 | 8.9 | 1.5 | 0.4 |
| Total | 7,129 | 46.9 | 7.6 | 32.7 | 2.0 | 10.6 | 0.1 |
Table 3.
Indications for external collecting device diversion
XML Download