>Cirugía y Cirujanos
>Year 2009, Issue 6
Martínez-Cornelio A, Hernández-Toriz N, Quintero-Becerra J, Flores-López D, Moreno-Palacios J, Vázquez-Martínez E
Trece años de experiencia en el manejo de cáncer vesical con neovejiga ortotópica de Studer
Cir Cir 2009; 77 (6)
PDF: 157.57 Kb.
[Full text - PDF]
Background: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy. Methods: The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A¾60 years old or younger and group B¾›60 years old. Results: From 306 patients submitted to a radial cystectomy with urinary derivation, there were 42 patients (13.7%) included whose derivation was a Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 ml requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in 7 (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%. Conclusions: The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.
||Bladder cancer, radical cystectomy, orthotopic neobladder.
1.Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H,Fleischmann A, et al. Twenty years experience with an ileal orthotopic, low pressure bladder substitute. Lessons to be learned. J Urol 2006;176:161-166.
Lemoine G. Creation d’une vessie nouvelle par un procede personnel après cystectomie totale pour cancer. J Urol Med Chir 1913;4:367.
Camey M, Le Duc A. Ló’entérocystoplastie avec cystoprostatectomie totale pour cancer de la vessie. Ann Urol 1979;13:114-119.
Studer UE, deKernion JB, Zimmern PE. A model for a bladder replacement plasty by an ileal reservoir¾an experimental study in dogs. Urol Res 1985;13: 243-247.
Benson MC, Seaman EK, Olsson CA, The ileal neobladder is associated with a high success and low complication rate. J Urol 1996;155:1585-1588.
Hinman F Jr. Selection of intestinal segments for bladder substitution: physical and physiological characteristics. J Urol 1998;139:519-523.
Davidsson TP, Poulsen AL, Hedlund H. A comparative urodynamic study of the ileal and colonic neobladder. Scand J Urol Nephrol 1992;142:143.
Meyer JP, Drake B, Boorer J, Gillatt D, Persad R, Fawcett D. A threecentre experience of orthotopic neobladder reconstruction after radical cystectomy: initial results. BJU Int 2004;94:1317-1321.
Paananen L, Ohtonen P, Perttila I, Jonsson O, Edlund C, Wiklund C, et al. Orthotopic bladder substitutes at 1 year: which is the best? J Urol 2009;181:181-182.
Studer UE, Ackermann D, Casanova GA, Zingg EJ. Three years experience with an ileal low pressure bladder substitute. Br J Urol 1989;63:43-52.
Studer UE, Varol C, Danuser H. Orthotopic ileal neobladder. BJU Int 2004;93:183-193.
12.Saika T, Suyama B, Murata T, Manabe D, Kurashige T, Nasu Y, et al. Orthotopic neobladder reconstruction in elderly bladder cancer patients. Int J Urol 2001;8:533-538.
Nagele U, Kuczyk M, Anastasiadis AG, Sievert KD, Seibold J, Stenal A. Radical cystectomy and orthotopic bladder replacement in females. Eur Urol 2006;50:249-257.
Hautmann RE, Simon J. Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men. J Urol 1999;162:1963-1966.
15.Stein JP, Stenzl A, Esrig D, Freeman JA, Boyd SD, Lieskovsky G, et al. Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience. J Urol 1994;152(5 Pt 1):1404-1408.
Chen ME, Pisters LL, Malpica A, Pattaway CA, Dinney CP. Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M. D. Anderson cancer center. J Urol 1997;157:2120-2123.
Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol 1999;161:1057-1056.
Skinner DG, Studer UE, Okada K, Aso Y, Hautmann H, Koontz W, et al. Which patients are suitable for continent diversion or bladder substitution. Int J Urol 1995;2:105-112.
19.Tschopp AB, Lippuner K, Jaeger P, Merz VW, Danuser H, Studer UE. No evidence of osteopenia 5 to 8 years after ileal orthotopic bladder substitution. J Urol 1996;155:71-75.
Cosnes J, Gendre JP, Le Quintrec Y. Role of the ileocecal valve and sites of intestinal resection in malabsorption after extensive small bowel resection. Digestion 1978; I8:329-336.
Hagedorn CH, Alpers DH, Distribution of intrinsic factor-vitamin B12 receptors in human intestine. Gastroenterology 1977;73:1019-1022.
Anderson H, Bosaeus I, Fasth S, Hellberg R, Hulten L. Cholelithiasis and urolithiasis in Crohn’s disease. Scand J Gastroenterol 1987;22:253-256.
Hofmann AF. Bile acid malabsorption caused by ileal resection. Arch Intern Med 1972;130:597-605.
Alpers D, Wessler S, Avioli LV. Ileal resection and bile salt metabolism. JAMA 1971;215:101-104.
McDougal WS, Koch MO. Effect of sulfate on calcium and magnesium homeostasis following urinary diversion. Kidney Int 1989;35:105-115.
Fossa SD, Heilo A, Bormer O. Unexpectedly high serum methotrexate levels in cystectomized bladder cancer patients with an ileal conduit treated with intermediate doses of the drug. J Urol 1990;143:498-501.
Sridhar KN, Samuell CT, Woodhouse CR, Absorption of glucose from urinary conduits in diabetics and non-diabetics. Br Med J 1983;287:1327-1329.
Zehnder P, Dhar N, Thurairaja R, Ochsner K, Studer UE. Effect of urinary tract infection on reservoir function in patients with ileal bladder substitute. J Urol 2009;181:2545-2549.
Thurairaja R, Studer UE. How to avoid clean intermittent catheterization in men with ileal bladder substitution J Urol 2008;180:2504-2509.
Mansson A, Caruso A, Capovilla E, Colleen S, Bassi P, Pagano F, et al. Quality of life after radical cystectomy and orthotopic bladder substitution: a comparison between Italian and Swedish men. BJU Int 2000;85:26-31.
>Cirugía y Cirujanos
>Year 2009, Issue 6