Top

World Journal of Urology

Published in:

01-12-2012 | Original Article

Perugia ileal neobladder: functional results and complications

Authors: Massimo Porena, Luigi Mearini, Alessandro Zucchi, Michele Del Zingaro, Ettore Mearini, Antonella Giannantoni

Published in: World Journal of Urology | Issue 6/2012

Abstract

Purpose

To evaluate the long-term functional results and complications of an orthotopic ileal neobladder, defined as perugia ileal neobladder (PIN), in a group of patients with bladder cancer who underwent radical cystectomy (RC).

Methods

Between 1993 and 2009, 237 consecutive patients who underwent RC for non-metastatic bladder cancer and orthotopic ileal neobladder reconstruction were enrolled. The neobladder was created using a modified Camey-II technique and consisted of a detubularized ileal loop of 45 cm using a vertical “Y” shape. Complications (<90 days) were reviewed and staged according to Clavien–Dindo classification and evaluated at long-term follow-up. Standard monitoring for cancer recurrence (computerized tomography, bone scan), cystourethrography, urodynamics and frequency/volume charts were performed during follow-up.

Results

The median follow-up was 64 months, and the 5-year overall survival rate was 64 %. Early complications were mostly grade I and II; grade III and IV complications were observed in 27 patients. Perioperative mortality rate was 1.6 %. The most frequent late complications were neobladder–ureteral reflux, urolithiasis and urethral anastomotic stricture. Daytime and nighttime urinary continence were 93.5 and 83.9 %, respectively. All patients were able to completely empty neobladders. Twenty patients were followed up for at least 10 years and presented satisfactory functional results.

Conclusions

Surgical morbidity of RC and orthotopic neobladder was significant; however, the rate of grade III–IV complications was low. The long-term functional results of the PIN were interesting, confirming that appropriate patients’ selection, adequate surgical technique, accurate patients’ counseling and follow-up are essential.

Hautmann RE, Abol-Enein H, Hafez K et al (2007) Urinary diversion. Urology 6:17–49CrossRef

Gakis G, Stenzl A (2010) Ileal neobladder and its variants. Eur Urol Suppl 9:745–753CrossRef

Mearini E, Mearini L, Zucchi A, Porena M (2000) Modified Camey II technique. Eur Urol 37(suppl. 2):564

Porena M, Mearini L, Zucchi A, Mearini E (2000) Ureterointestinal anastomosis in orthotopic neobladders. Urol Int 64:181–184PubMedCrossRef

Stenzl A, Cowan NC, De Santis M et al (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 55:815–825PubMedCrossRef

Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655PubMedCrossRef

Skinner DG, Lieskovsky G (1987) Management of invasive high-grade bladder cancer. In: Skinner DG, Lieskovsky G (eds) Diagnoses and management of genitourinary cancer. Saunders, Philadelphia, pp 295–312

Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, Thalmann GN (2006) Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol 176(1):161–166

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef

10.

Aaronson NK, Ahmedzai S, Bergman B et al (1993) The european organization for research and treatment of cancer QLQC30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRef

11.

Lukacz ES, Whitcomb EL, Lawrence JM et al (2007) Are sexual activity and satisfaction affected by pelvic floor disorders? Analysis of a community-based survey. Am J Obstet Gynecol 197:88PubMedCrossRef

12.

Novara G, Ficarra V, Minja A, De Marco V, Artibani W (2010) Functional results following vescica ileale padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires. Eur Urol 57(6):1045-1051

13.

Kulkarni JN, Pramesh CS, Rathi S, Pantvaidya GH (2003) Long-term results of orthotopic neobladder reconstruction after radical cystectomy. BJU Int 91:485–488PubMedCrossRef

14.

Skolarikos A, Deliveliotis C, Alargof E et al (2004) Modified ileal neobladder for continent urinary diversion: functional results after 9 years of experience. J Urol 171:2298–2301PubMedCrossRef

15.

Granberg CF, Boorjian SA, Crispen PL et al (2008) Functional andoncological outcomes after orthotopic neobladder reconstruction in women. BJU Int 102:1551–1555PubMedCrossRef

16.

Stein JP, Lieskovsky G, Ginsberg DA et al (1998) The T pouch: an orthotopic ileal neobladder incorporating a serosal lined ilealantireflux technique. J Urol 159:1836–1842PubMedCrossRef

17.

Fontana D, Bellina M, Fasolis G, Frea B, Scarpa RM, Mari M, Rolle L, Destefanis P (2004) Y-neobladder: an easy, fast, and reliable procedure. Urology. 63:699–703PubMedCrossRef

18.

Hautmann RE, de Petriconi R, Gottfried HW et al (1999) The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 161:422–427PubMedCrossRef

19.

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

20.

Kassouf W, Hautmann RE, Bochner BH, Lerner SP, Colombo R, Zlotta A, Studer UE (2010) A critical analysis of orthotopic bladder substitutes in adult patients with bladder cancer: Is there a perfect solution? Eur Urol 58:374–383PubMedCrossRef

21.

Lantz AG (2010) Renal and functional outcomes following cystectomy and neobladder reconstruction. Can Urol Assoc J. 4:328–331PubMedCrossRef

22.

Gakis G, Stenzl A (2010) Ileal neobladder and its variants. Eur Urol Suppl 9:745–753CrossRef

23.

Thoeny HC, Sonnenschein MJ, Madersbacher S, Vock P, Studer UE (2002) Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term? J Urol 168:2030–2034PubMedCrossRef

24.

Thurairaja R, Studer UE (2008) How to avoid clean intermittent catheterization in men with ileal bladder substitution. J Urol 180:2504–2509PubMedCrossRef

25.

Porru D, Madeddu G, Campus G, Montisci I, Caddemi G, Scarpa RM et al (1999) Urodynamic analysis of voiding dysfunction in orthotopic ileal neobladder. World J Urol 17:285–289PubMedCrossRef

26.

Mikuma N, Hirose T, Yokoo A, Tsukamoto T (1997) Voiding dysfunction in ileal neobladder. J Urol 158:1365–1368PubMedCrossRef

27.

Parekh DJ, Gilbert WB, Smith JA Jr (2000) Functional lower urinary tract voiding outcomes after cystectomy and orthotopic neobladder. J Urol 163:56–58PubMedCrossRef

28.

Stein JP, Dunn MD, Quek ML, Miranda G, Skinner DG (2004) The orthotopic T pouch ileal bladder substitute: experience with 209 patients. J Urol 172:584–587PubMedCrossRef

29.

Hautmann RE, de Petriconi RC, Volkmer BG (2010) Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol 184(3):990–994PubMedCrossRef

30.

Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174PubMedCrossRef

Title: Perugia ileal neobladder: functional results and complications
Authors: Massimo Porena
Luigi Mearini
Alessandro Zucchi
Michele Del Zingaro
Ettore Mearini
Antonella Giannantoni
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 6/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0985-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perugia ileal neobladder: functional results and complications

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2012

High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment

Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results

The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome

Patterns of local recurrence after radical cystectomy in a contemporary series of patients with muscle-invasive bladder cancer

Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy

Positive urine cytology and carcinoma in situ prior to second transurethral resection of the bladder correlate with positive second resection histology and the need for subsequent cystectomy