Anyone familiar with Neobladders?

augigi, CNS · Dec 12, 2006

No experience, but plenty of articles about longterm outcomes.

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Studer UE. et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. Journal of Urology. 176(1):161-6, 2006 Jul

PURPOSE: We present the long-term results of a large consecutive series of patients undergoing ileal orthotopic bladder substitution following radical cystectomy. MATERIALS AND METHODS: Between April 1985 and 2005 orthotopic bladder substitution with an ileal low pressure reservoir was performed in 482 patients (including 40 women) after radical and, if possible, nerve sparing cystectomy. In 447 cases the procedure was combined with an afferent ileal isoperistaltic tubular segment. The patients were followed prospectively. RESULTS: In the 482 patients 61 early (less than 30 days) diversion related complications requiring prolonged hospital stay or readmission were noted and 115 late complications required treatment. At 1 year continence was good in 92% of patients during the day and in 79% at night. At last followup 93% of patients could void spontaneously. Of 442 evaluable men 99 (22.4%) reported having erections without and 68 (15.4%) with medical assistance. Ureteroileal stenosis was observed in 12 of 447 (2.7%) patients. Urethral recurrence was detected in 25 of 482 (5%) patients. A total of 15 (5%) patients received vitamin B12 substitution. Renal parenchyma decreased only in patients with preoperative or postoperative ureteral obstruction. After 10 years patients with normal renal function had no long-term acidosis and in 20 patients the incidence of osteoporosis resembled that of the normal population. CONCLUSIONS: Ileal orthotopic bladder substitution combined with an afferent ileal tubular segment allows for good long-term functional results provided patients are restrictively selected, postoperative instructions are followed carefully, and typical complications such as outlet obstruction and hernias are treated early.

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Perimenis P. Burkhard FC. Kessler TM. Gramann T. Studer UE. Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern. European Urology. 46(5):604-9, 2004 Nov.

OBJECTIVE: Assessment of the long-term morbidity of the upper urinary tract and of the voiding pattern in men with an ileal orthotopic bladder substitute with an afferent tubular segment. MATERIALS AND METHODS: Men surviving more than 5 years after radical cystectomy and orthotopic bladder substitution were evaluated. The urinary tract was regularly assessed with ultrasound and IVU while functional reservoir capacity and continence status were prospectively assessed by voiding volume diaries and a standardized questionnaire. RESULTS: After 5 years 129, after 10 years 45 and after 15 years 8 patients were evaluable. Median age at surgery was 63 years (range 36-80) and median follow-up was 73 months (range 60-201). Of the 254 renal units assessed between April 1985 and September 1998, 199 (78%) had some degree of dilatation in the 20-minute IVU film but rarely at 60 minutes. In 246 (97%) the parenchyma size was normal. Ureteral obstruction presented in 9 (3.5%) units, 4 of which were complete (3 had obstruction preoperatively and 1 postoperatively). Mean creatinine levels remained unchanged from the preoperative values. Functional reservoir capacity averaged 462 ml after 1 year, remained stable and then decreased slightly after 5 years. The daytime continence rate was 94% and 91% after 5 and 10 years, while the nighttime rate was 72% and 60% respectively. Patient age at the time of surgery was an important determinant for reservoir capacity and continence status. CONCLUSIONS: These data suggest that an orthotopic bladder substitution combined with an afferent tubular segment offers a sufficient protection of the upper tract with a low complication rate and has good long-term voiding and continence results. Meticulous lifelong follow-up is an important factor for satisfactory functional long-term outcome.

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Gschwend JE. Bladder substitution. Current Opinion in Urology. 13(6):477-82, 2003 Nov

PURPOSE OF REVIEW: Radical cystectomy and urinary diversion is the accepted standard of care for invasive bladder cancer, with orthotopic neobladders as the preferred method of bladder substitution in male and female patients. Last year's studies and reports on this subject are summarized and reviewed. RECENT FINDINGS: Today, most patients considered candidates for radical cystectomy, independent of sex, are potential candidates for orthotopic bladder substitution. It has been shown that orthotopic bladder replacement is well tolerated and feasible even in selected patients with locally advanced tumors with or without positive nodes. The complication rates for orthotopic bladder substitutes are similar to, or lower than, the morbidity rates after conduit formation or continent cutaneous diversion. It has been shown that an afferent tubular segment without any antireflux flap-valve-type implantation techniques protects the upper urinary tract adequately for more than a decade. The true impact of the chosen type of urinary diversion on distress symptoms, quality of life and patients' well-being among survivors of bladder cancer remains controversial and requires further clinical investigation. SUMMARY: The excellent functional outcome and voiding pattern with orthotopic bladder substitution, even in the long-term, argues in favor of this technique as the preferred method for lower urinary tract reconstruction following radical cystectomy for invasive bladder cancer.

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Madersbacher S. Mohrle K. Burkhard F. Studer UE. Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. Journal of Urology. 167(5):2052-7, 2002 May.

PURPOSE: Good long-term functional outcome of orthotopic bladder substitution will ultimately decide whether it is here to stay. Therefore, we analyzed exclusively voiding patterns of long-term survivors with an orthotopic ileal bladder substitute. MATERIALS AND METHODS: In all patients with an ileal orthotopic bladder substitute day and nighttime continence status, voiding frequency, bladder capacity and pad usage were prospectively assessed by frequency volume charts and a standardized questionnaire. All men surviving 5 or more years with a median followup of 95 months (range 60-132) were evaluated. RESULTS: Spontaneous voiding was possible in 82 of 86 (95.3%) evaluable patients after catheter removal. Daytime continence increased from 61% after 3 months to 92% at 12 months and remained stable throughout the following 4 years yet decreased slightly thereafter. Nocturnal continence rates were 10% to 15% lower throughout the study period. Functional reservoir capacity averaged 473 ml. after 12 months and did not change in subsequent years. After a decrease during the first 12 months, daytime frequency (4.1 to 4.8 times daily) and nocturia (1.8 to 2.3 a night) did not change in the next decade. Patient age at surgery was an important determinant for long-term reservoir capacity, nocturia and continence status. CONCLUSIONS: These data provide evidence for good long-term functional outcome following orthotopic ileal bladder substitution up to 11 years. We attribute the sustained ability to void to the relatively small reservoir size, which is made of 40 to 44 cm. of ileum, the avoidance of any funnel shaped outlet but rather a side-to-end intestine-urethral anastomosis as well as lifelong meticulous followup.

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Hautmann RE. Bladder reconstruction: a critical reappraisal. Current Opinion in Urology. 10(3):213-7, 2000 May.

The operative management of muscle invasive bladder cancer has been dramatically advanced by the advent of orthotopic reconstruction. Several studies reported during the past year have further demonstrated the utility of this form of urinary diversion. The long-term safety and efficacy of bladder replacement with respect to both surgical and metabolic complications has been demonstrated. As series include more patients with sufficient follow up, we are gaining a better appreciation of the results of treatment that patients and urologists can expect in terms of function and risk of complications. Taken together, published studies have made the following important points. Exenterative surgery as currently performed alters pelvic floor/urethral physiology. Early reports of complications in studies with short periods of follow up are not meaningful. When basic principles and complication rates are established for a procedure in the long term, sufficient follow up is required before it can be established that a modification to that procedure really is better. The occurrence of retention in a female patient with orthotopic bladder continues to be poorly understood.