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World Journal of Urology

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01-01-2016 | Topic Paper

Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy

Authors: Khurram M. Siddiqui, Jonathan I. Izawa

Published in: World Journal of Urology | Issue 1/2016

Abstract

Purpose

Ileal conduit (IC) is the most frequent urinary diversion (UD) performed after radical cystectomy (RC). We reviewed the literature to investigate the factors influencing the choice of this diversion and its complications.

Methods

A literature search (PubMed) was performed for all English language publications on UDs performed for treatment of bladder cancer from 1950 to 2015. The literature review was focused on studies reporting outcome of IC and its comparison with other types of UDs.

Results

IC is the most common UD performed in elderly patients undergoing RC for bladder cancer. Long-term studies looking at the change in renal function after UD report a universal decline in the glomerular filtration rate; however, this decline in renal function is the least for IC. There is a significant morbidity of RC (20–56 %), which can be attributed to patient factors, surgical technique and hospital volume. Modern concepts of bowel preparation, postoperative nutrition, early enteral feeding and involvement of stoma therapists have helped improve the outcomes. The quality of life is preserved, and in many including elderly, it may be improved with IC UD.

Conclusions

IC is the most commonly performed UD following radical cystectomy. It is associated with acceptable morbidity and has the lowest reoperation rates as compared to continent diversion. It is also the procedure of choice for most patients’ elderly patients as well as patients with limited dexterity, poor motivation, anatomical restrictions and poor renal function. Studies measuring HRQOL report excellent patient acceptability, especially in the elderly population.

Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29. doi:10.3322/caac.21254 PubMedCrossRef

Patel HD, Ball MW, Cohen JE, Kates M, Pierorazio PM, Allaf ME (2015) Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology 85:552–559. doi:10.1016/j.urology.2014.11.034 PubMedCrossRef

Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164–174. doi:10.1016/j.eururo.2008.07.031 PubMedCrossRef

Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, Montie JD, Sagalowsky AI, Stein JP, Stenzl A, Studer UE, Volkmer BG. (2007) Urinary diversion. In: World Health Organization (WHO) consensus conference on bladder cancer urinary diversion. Urology 69:17–49

The Federation of Swedish County Councils (2005) Annual Report of the Swedish National Bladder Cancer Registry Stockholm: The Federation of Swedish County Councils

Shariat SF, Milowsky M, Droller MJ (2009) Bladder cancer in the elderly. Urol Oncol 27:653–667PubMedPubMedCentralCrossRef

Leveridge MJ, Siemens DR, Mackillop WJ, Peng Y, Tannock IF, Berman DM, Booth CM (2015) Radical cystectomy and adjuvant chemotherapy for bladder cancer in the elderly: a population-based study. Urology 85:791–798. doi:10.1016/j.urology.2014.12.027 PubMedCrossRef

Butcher HR Jr, Sugg WL, McAfee CA, Bricker EM (1962) Ileal conduit method of ureteral urinary diversion. Ann Surg 156:682–691PubMedPubMedCentralCrossRef

Garde H, Ciappara M, Galante I, Fuentes Ferrer M, Gómez A, Blazquez J, Moreno J (2015) Radical cystectomy in octogenarian patients: a difficult decision to take. Urol Int 94:390–393. doi:10.1159/000371556 PubMedCrossRef

10.

Nazmy M, Yuh B, Kawachi M, Lau CS, Linehan J, Ruel NH, Torrey RR, Yamzon J, Wilson TG, Chan KG (2013) Early and late complications of robot-assisted radical cystectomy: a standardized analysis by urinary diversion type. J Urol 191:681–687. doi:10.1016/j.juro.2013.10.022 PubMedCrossRef

11.

Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, Fritsche HM et al (2011) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66:156–163. doi:10.1016/j.eururo.2013.12.018 CrossRef

12.

Schiffmann J, Gandaglia G, Larcher A, Sun M, Tian Z, Shariat SF et al (2014) Contemporary 90-day mortality rates after radical cystectomy in the elderly. Eur J Surg Oncol 40:1738–1745. doi:10.1016/j.ejso.2014.10.004 PubMedCrossRef

13.

Lavallée LT, Schramm D, Witiuk K, Mallick R, Fergusson D, Morash C et al (2014) Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals. PLoS ONE 9(10):e111281. doi:10.1371/journal.pone.0111281 PubMedPubMedCentralCrossRef

14.

Gore JL, Litwin MS (2009) Urologic Diseases in America Project. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27:45–50. doi:10.1007/s00345-008-0348-y PubMedPubMedCentralCrossRef

15.

Gudjónsson S, Davidsson T, Månsson W (2008) Incontinent urinary diversion. BJU Int 102:1320–1325. doi:10.1111/j.1464-410X.2008.07977 PubMedCrossRef

16.

Muhlberg W, Platt D (1999) Age-dependent changes of the kidneys: pharmacological implications. Gerontology 45:243–253PubMedCrossRef

17.

Advanced Bladder Cancer (ABC) (2005) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 48(2):202–205 (discussion 205-6) CrossRef

18.

Nishikawa M, Miyake H, Yamashita M, Inoue T, Fujisawa M (2014) Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol 19(6):1105–11111PubMedCrossRef

19.

Kristjánsson A, Bajc M, Wallin L, Willner J, Månsson W (1995) Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria. Br J Urol 76:546–550PubMedCrossRef

20.

Fehrman-Ekholm I, Skeppholm L (2004) Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol 38:73–77PubMedCrossRef

21.

Minervini A, Boni G, Salinitri G, Mariani G, Minervini R (2005) Evaluation of renal function and upper urinary tract morphology in the ileal orthotopic neobladder with no antireflux mechanism. J Urol 173:144–147PubMedCrossRef

22.

Joniau S, Benijts J, Van Kampen M, De Waele M, Ooms J, Van Cleynenbreugel B, Van Poppel H (2005) Clinical experience with the N-shaped ileal neobladder: assessment of complications, voiding patterns, and quality of life in our series of 58 patients. Eur Urol 47:666–672PubMedCrossRef

23.

Chang SS, Alberts GL, Smith JA Jr, Cookson MS (2004) Ileal conduit urinary diversion in patients with previous history of abdominal/pelvic irradiation. World J Urol 22(4):272–276PubMedCrossRef

24.

Hautmann RE, de Petriconi R, Volkmer BG (2009) Neobladder formation after pelvic irradiation. World J Urol 27:57–62. doi:10.1007/s00345-008-0346-0 PubMedCrossRef

25.

Santos F, Zakaria AS, Kassouf W, Tanguay S, Aprikian A (2015) High hospital and surgeon volume and its impact on overall survival after radical cystectomy among patients with bladder cancer in Quebec. World J Urol 33(9):1323–1330. doi:10.1007/s00345-014-1457-4 PubMedCrossRef

26.

Leow JJ, Reese S, Trinh QD, Bellmunt J, Chung BI, Kibel AS, Chang SL (2015) Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis. BJU Int 115(5):713–721PubMedCrossRef

27.

Barbieri CE, Lee B, Cookson MS, Bingham J, Clark PE, Smith JA, Chang SS (2007) Association of procedure volume with radical cystectomy outcomes in a nationwide database. J Urol 178(4):1418–1422PubMedCrossRef

28.

Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 18:CD004929

29.

Parnaby CN, MacDonald AJ, Jenkins JT (2009) Sham feed or sham? A meta-analysis of randomized clinical trials assessing the effect of gum chewing on gut function after elective colorectal surgery. Int J Colorectal Dis 24:585–592. doi:10.1007/s00384-009-0661-y PubMedCrossRef

30.

Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 6:773–776CrossRef

31.

Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209. doi:10.1097/SLA.0b013e318193425a PubMedCrossRef

32.

Karl A, Buchner A, Becker A, Staehler M, Seitz M, Khoder W et al (2014) A new concept for early recovery after surgery for patients undergoing radical cystectomy for bladder cancer: results of a prospective randomized study. J Urol 191(2):335–340. doi:10.1016/j.juro.2013.08.019 PubMedCrossRef

33.

Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I (2011) Long-term complications of conduit urinary diversion. J Urol 185:562–567. doi:10.1016/j.juro.2010.09.096 PubMedCrossRef

34.

Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J et al (2015) Ureteroenteric strictures after open radical cystectomy and urinary diversion: The University of Southern California experience. Urology 86:87–91. doi:10.1016/j.urology.2015.03.014 PubMedCrossRef

35.

Davis NF, Burke JP, McDermott T, Flynn R, Manecksha RP, Thornhill JA (2015) Bricker versus Wallace anastomosis: a meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc J 9:284–290. doi:10.5489/cuaj.2692 CrossRef

36.

Terai A, Arai Y, Kawakita M, Okada Y, Yoshida O (1995) Effect of urinary intestinal diversion on urinary risk factors for urolithiasis. J Urol 153:37–41PubMedCrossRef

37.

Kälble T, Hofmann I, Riedmiller H, Vergho D (2011) Tumor growth in urinary diversion: a multicenter analysis. Eur Urol 60:1081–1086. doi:10.1016/j.eururo.2011.07.006 PubMedCrossRef

38.

Gerharz EW (2007) Is there any evidence that one continent diversion is any better than any other or than ileal conduit? Curr Opin Urol 17:402–407PubMedCrossRef

39.

Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV et al (2013) ICUD-EAU international consultation on bladder cancer 2012: urinary diversion. Eur Urol 63:67–80. doi:10.1016/j.eururo.2012.08.050 PubMedCrossRef

40.

Anderson CB, Feurer ID, Large MC, Steinberg GD, Barocas DA, Cookson MS et al (2012) Psychometric characteristics of a condition-specific, health-related quality-of-life survey: the FACT-Vanderbilt Cystectomy Index. Urology 80:77–83PubMedCrossRef

41.

Kulaksizoglu H, Toktas G, Kulaksizoglu IB, Aglamis E, Unlüer E (2002) When should quality of life be measured after radical cystectomy? Eur Urol 42:350–355PubMedCrossRef

42.

Madersbacher S, Möhrle K, Burkhard F, Studer UE (2002) Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol 167:2052–2057PubMedCrossRef

Title: Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy
Authors: Khurram M. Siddiqui
Jonathan I. Izawa
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 1/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1706-1

At a glance: The STEP trials

Springer Medicine

Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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