Skip to main content
SpringerLink
Log in

Local recurrence in patients after radical cystectomy and orthotopic ileal neobladder: impact on function

  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Whether an orthotopic bladder substitute shouldbe constructed in patients with locallyadvanced or lymph node positive bladder cancerremains a subject of debate. These patients areat risk that local recurrence may impairreservoir function in orthotopic neobladders[1]. We retrospectively assessed reservoirfunction in 68 consecutive patients withlocally advanced bladder cancer. Tumor stagewas multifocal carcinoma in situ, multifocalpT1 disease, pT2, pT3a, pT3b, and pT4a in 3, 4,19, 11, 25, and 6 patients respectively. Lymphnodes were positive for carcinoma in 17patients. Out of the 68 patients, 65 could befollowed for at least three months.Within a median follow-up of 26 months (rangethree to 87 months), recurrence developed in 16of the 65 patients (25%). 7 patients (11%)had distant failure. 9 patients (14%) showedlocal and distant recurrence. In the six out ofthe nine patients with local recurrence locatedlateral, dorsal, or cranial of the neobladder,adequate neobladder function was retained untilthe last follow-up visit or until death. Onlythose three patients with local recurrenceinvolving the pelvic floor or urethra needed asuprapubic catheter due to urinary retentioncaused by tumor obstruction.Excluding pelvic floor and anterior urethraldisease, we recommend orthotopic bladdersubstitution even in locally advanced butresectable disease as far as the patient is ina good performance status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hautmann RE and 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.

    Google Scholar 

  2. Hollowell CMP, Christiano AP, Steinberg GD. Technique of Hautmann ileal neobladder with chimney modification: interim results in 50 patients. J Urol 2000; 163: 47-50.

    Google Scholar 

  3. Weijerman PC, Schurmans JR, Hop WC et al. Morbidity and quality of life in patients with orthotopic and heterotopic continent urinary diversion. Urology 1998; 51: 51-56.

    Google Scholar 

  4. Benson MC, Seaman BK, Olsson CA. The ileal neobladder is associated with a high success rate and a low complication rate. J Urol 1996; 155: 1585-1588.

    Google Scholar 

  5. Bjerre BD, Johansen C, Steven K. Health-related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey. Br J Urol 1995; 75: 200-205.

    Google Scholar 

  6. Boyd SD, Feinberg SM, Skinner DG et al. Quality of life survey of urinary diversion patterns: comparison of ileal conduits versus continent Kock ileal reservoirs. J Urol 1987; 138: 1386-1389.

    Google Scholar 

  7. Gerharz EW, Weingartner K, Dopatka T et al. Quality of life after cystectomy and urinary diversion: results of a retrospective interdisciplinary study. J Urol 1997; 158: 778-785.

    Google Scholar 

  8. Lebret T, Herve JM, Yonneau L et al. After cystectomy, is it justified to perform a bladder replacement for patients with lymph node positive bladder cancer? Eur Urol 2002; 42: 344-349.

    Google Scholar 

  9. Tefilli MV, Gheiler EL, Tiguert R et al. Urinary diversionrelated outcome in patients with pelvic recurrence after radical cystectomy for bladder cancer. Urology 1999; 53: 999-1004.

    Google Scholar 

  10. Jones J, Melchior SW, Gillitzer R et al. Urethral recurrence of transitional cell carcinoma in a female patient after cystectomy and orthotopic ileal neobladder. J Urol 2000; 164: 1646.

    Google Scholar 

  11. Freeman JA, Tarter TA, Esrig D et al. Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 1996; 156: 1615-1619.

    Google Scholar 

  12. Cancrini A, De Carli P, Pompeo V et al. Lower urinary tract reconstruction following cystectomy: experience and results in 96 patients using the orthotopic ileal bladder substitution of Studer et al. Eur Urol 1996; 29: 204-209.

    Google Scholar 

  13. Flohr P, Hefty R, Paiss T, Hautmann R. The ileal neobladder - updated experience with 306 patients. World J Urol 1996; 14: 22-26.

    Google Scholar 

  14. Hermanek P and Sobin LH. TNM Classification of Malignant Tumours. New York: Springer Verlag, 1992: 154.

    Google Scholar 

  15. Studer UE, Ackermann D, Casanova GA et al. A newer form of bladder substitute based on historical perspectives. Semin Urol 1988; 6: 57-65.

    Google Scholar 

  16. Brendler CB, Steinberg GD, Marshall TF et al. Local recurrence and survival following nerve-sparing radical cystoprostatectomy. J Urol 1990; 144: 1137-1140.

    Google Scholar 

  17. Cole CJ, Pollack A, Zagars GK et al. Local control of muscleinvasive bladder cancer: preoperative radiotherapy and cystectomy versus cystectomy alone. Int J Radiol Oncol 1995; 32: 331-340.

    Google Scholar 

  18. Westney OL, Pisters LL, Pettaway CA et al. Presentation, methods of diagnosis and therapy for pelvic recurrence following radical cystectomy for transitional cell carcinoma of the bladder. J Urol 1998; 159: 792-795.

    Google Scholar 

  19. Studer UE, Danuser H, Hochreiter W et al. Summary of 10 years+experience with an ileal low pressure substitute combined with an affrent tubular isoperistaltic segment. World J Urol 1996; 14: 29-39.

    Google Scholar 

  20. Skinner DG, Boyd SD, Lieskovsky G et al. Reconstruction of the lower urinary tract after cystectomy. Experiences and results in 126 patients with the Kock ileum reservoir in conjunction with bilateral ureteroileourethrostomy. Urologe [A] 1994; 33: 15-19.

    Google Scholar 

  21. Steven K and Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 200; 164: 288-295.

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

    Google Scholar 

  23. Turner WH, Danuser H, Moehrle K et al. The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. J Urol 1997; 158: 2118-2122.

    Google Scholar 

  24. Schoenberg MP, Walsh PC, Breazeale DR et al. Local recurrence and survival following nerve sparing radical cystoprostatectomy for bladder cancer. 10 year follow up. J Urol 1996; 155: 490-494.

    Google Scholar 

  25. Sengelow L, Kamby C and Von Der Maase H. Pattern of metastases in relation to characteristics of primary tumor and treatment in patients with disseminated urothelial carcinoma. J Urol 1996; 155: 111-114.

    Google Scholar 

  26. Whitmore WF and Batata M. Status of integrated irradiation and cystectomy for bladder cancer. Urol Clin N Amer 1984; 11:681-691.

    Google Scholar 

  27. Ghoneim MA, El-Mekresh MM, El-Baz MA et al. Radical cystectomy for carcinoma of the bladder: critical evaluation of results in 1,026 cases. J Urol 1997; 138: 393-399.

    Google Scholar 

  28. Freeman JA, Esrig D, Stein JP et al. Management of the patient with bladder cancer. Urol Clin N Amer 1994; 21: 645-651.

    Google Scholar 

  29. Tobisu K, Tanaka Y, Mizutani T et al. Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors. J Urol 1991; 146: 1551-1553.

    Google Scholar 

  30. Taggart DP, Imrie CW. A new pattern of histologic predominance and distribution of malignant diseases of the small intestine. Surg Gynec and Obstet 1987; 165: 515-518.

    Google Scholar 

  31. Lowenfels AB. Why are small-bowel tumours so rare? Lancet 1973; 1: 24.

    Google Scholar 

  32. Wattenberg LW. Studies of polycyclic hydrocarbon hydroxylases of the intestine possibly related to cancer. Effect of diet on benzopyrene hydroxylase activity. Cancer 1971; 28:99-102.

    Google Scholar 

  33. Stenzl A, Draxl H, Posch B et al. The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract? J Urol 1995; 153: 950-955.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Munich, Germany

    Ralph Oberneder, Stephan Staudte, Raphaela Waidelich, Nikolaus Schmeller & Alfons Hofstetter

Authors
  1. Ralph Oberneder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan Staudte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raphaela Waidelich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nikolaus Schmeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alfons Hofstetter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raphaela Waidelich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oberneder, R., Staudte, S., Waidelich, R. et al. Local recurrence in patients after radical cystectomy and orthotopic ileal neobladder: impact on function. Int Urol Nephrol 35, 175–179 (2003). https://doi.org/10.1023/B:UROL.0000020303.37190.95

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:UROL.0000020303.37190.95

Search

Navigation