Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center

No AccessJournal of UrologyAdult Urology1 Jan 2021Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single CenterThis article is commented on by the following:Editorial CommentEditorial Comment Richard E. Hautmann, Björn Volkmer, Günther Egghart, Detlef Frohneberg, Hans-Werner Gottfried, Jürgen Gschwend, Robert Hefty, Klaus Kleinschmidt, Rainer Küfer, Kurt Miller, Robert de Petriconi, Jörg Simon, and Ulrich Wenderoth Richard E. HautmannRichard E. Hautmann †Correspondence: Department of Urology, University of Ulm, Boschstrasse 4a, 89231Neu-Ulm, Germany telephone: +49 731 1538750; FAX: +49 731 1538752; E-mail Address: [email protected] Department of Urology, University of Ulm, Neu-Ulm, Germany , Björn VolkmerBjörn Volkmer Department of Urology, Klinikum Kassel, Kassel, Germany , Günther EgghartGünther Egghart Department of Urology, Kreiskrankenhaus Sigmaringen, Sigmaringen, Germany , Detlef FrohnebergDetlef Frohneberg Department of Urology, Klinikum Karlsruhe, Karlsruhe, Germany , Hans-Werner GottfriedHans-Werner Gottfried Department of Urology, Evangelisches Krankenhaus, Göttingen-Weende, Germany , Jürgen GschwendJürgen Gschwend Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany , Robert HeftyRobert Hefty Department of Urology, Klinikum Heidenheim, Heidenheim, Germany , Klaus KleinschmidtKlaus Kleinschmidt Department of Urology Helios Dr.-Horst-Schmidt Kliniken, Wiesbaden, Germany , Rainer KüferRainer Küfer Department of Urology, Klinik am Eichert Göppingen, Göppingen, Germany , Kurt MillerKurt Miller Department of Urology, Charité University Berlin, Berlin, Germany , Robert de PetriconiRobert de Petriconi Department of Urology, University of Ulm, Neu-Ulm, Germany , Jörg SimonJörg Simon Department of Urology, Ortenau Klinikum Offenburg, Offenburg, Germany , and Ulrich WenderothUlrich Wenderoth Department of Urology, Klinikum Heidenheim, Heidenheim, Germany View All Author Informationhttps://doi.org/10.1097/JU.0000000000001345AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience. Materials and Methods: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included. Results: Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p <0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p <0.05). Conclusions: The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate. References 1. : Patients with an orthotopic low pressure bladder substitute enjoy long-term good function. J Urol 2016; 196: 1172. Link, Google Scholar 2. : 25 Years of experience with 1,000 neobladders: long-term complications. J Urol 2011; 185: 2207. Link, Google Scholar 3. : Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol 2006; 176: 161. Link, Google Scholar 4. : Radical cystectomy for carcinoma of the bladder: 2,270 consecutive cases 5 years later. J Urol 2008; 180: 121. Link, Google Scholar 5. : The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 2012; 30: 733. Google Scholar 6. : Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009; 55: 164. Google Scholar 7. : The ileal neobladder. Urol Clin North Am 2001; 9: 85. Google Scholar 8. : Surgery illustrated—surgical atlas ileal neobladder. BJU Int 2010; 105: 1024. Google Scholar 9. : Radiology and follow-up of the neobladder. In: Radiology and Follow-up of Urologic Surgery. Edited by . Hoboken, New Jersey: Wiley & Sons Ltd. 2018; chpt 10, p 125. Google Scholar 10. : The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 1999; 161: 422. Link, Google Scholar 11. : Metabolic long-term follow-up of the ileal neobladder. Eur Urol 1993; 24: 197. Google Scholar 12. : Prognostic features for objectively defined urinary continence after radical cystectomy and ileal orthotopic neobladder in a contemporary cohort. J Urol 2017; 197: 210. Link, Google Scholar 13. : Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol 2013; 189: 1782. Link, Google Scholar 14. : Prospective evaluation of continence following radical cystectomy and orthotopic urinary diversion using a validated questionnaire. J Urol 2016; 196: 1685. Link, Google Scholar 15. : Continence after total bladder replacement: urodynamic analysis of the ileal neobladder. Br J Urol 1990; 65: 462. Google Scholar 16. : The standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs. Br J Urol 1996; 78: 516. Google Scholar 17. : Urinary diversion after radical cystectomy for bladder cancer: comparing trends in the US and Germany from 2006 to 2014. Ann Surg Oncol 2019; 102: 284. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 1, (1-3), Online publication date: 1-Jan-2021.Related articlesJournal of Urology28 Oct 2020Editorial CommentJournal of Urology28 Oct 2020Editorial Comment Volume 205Issue 1January 2021Page: 174-182 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsurinary diversioncystectomytreatment outcomeurinary bladder neoplasmsAcknowledgmentsHildegunde Kreitmeier provided graphic support and editorial assistance.MetricsAuthor Information Richard E. Hautmann Department of Urology, University of Ulm, Neu-Ulm, Germany †Correspondence: Department of Urology, University of Ulm, Boschstrasse 4a, 89231Neu-Ulm, Germany telephone: +49 731 1538750; FAX: +49 731 1538752; E-mail Address: [email protected] Equal study contribution. More articles by this author Björn Volkmer Department of Urology, Klinikum Kassel, Kassel, Germany Equal study contribution. More articles by this author Günther Egghart Department of Urology, Kreiskrankenhaus Sigmaringen, Sigmaringen, Germany Deceased. More articles by this author Detlef Frohneberg Department of Urology, Klinikum Karlsruhe, Karlsruhe, Germany More articles by this author Hans-Werner Gottfried Department of Urology, Evangelisches Krankenhaus, Göttingen-Weende, Germany More articles by this author Jürgen Gschwend Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany More articles by this author Robert Hefty Department of Urology, Klinikum Heidenheim, Heidenheim, Germany More articles by this author Klaus Kleinschmidt Department of Urology Helios Dr.-Horst-Schmidt Kliniken, Wiesbaden, Germany More articles by this author Rainer Küfer Department of Urology, Klinik am Eichert Göppingen, Göppingen, Germany More articles by this author Kurt Miller Department of Urology, Charité University Berlin, Berlin, Germany More articles by this author Robert de Petriconi Department of Urology, University of Ulm, Neu-Ulm, Germany More articles by this author Jörg Simon Department of Urology, Ortenau Klinikum Offenburg, Offenburg, Germany More articles by this author Ulrich Wenderoth Department of Urology, Klinikum Heidenheim, Heidenheim, Germany More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...