Orthotopic Neobladder Formation

Chapter

Abstract

Robotic orthotopic neobladder formation is one of the most challenging procedures in urological surgery and to date performed only in a few specialized centres. In recent years, the principles of open bladder reconstruction have been successfully translated to robotic-assisted surgery. Several techniques of reservoir formation have been described, with most of them creating a low-pressure bladder using a cross folded segment of ileum.

With progress in surgical technique and experience, operating times are now routinely equivalent to open procedures in high-volume centres. Complication rates are comparable to open surgery and in carefully selected patients, robotic-assisted reconstruction has become extremely successful. The key aspects in preventing complications include patient selection, meticulous preparation of the procedure, careful positioning and adherence to sound surgical principles. Post-operative care following the guidelines of enhanced recovery and close follow-up are further pre-requisites of a successful programme.

This chapter will focus on patient selection and preparation, technical details of the procedure and post-operative care necessary to minimize complications after robotic orthotopic neobladder formation.

Keywords

Orthotopic Neobladder Complications Robotic Intra-corporeal Cystectomyad Urinary diversion 

References

  1. 1.
    Menon M, et al. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003;92:232–6.CrossRefPubMedGoogle Scholar
  2. 2.
    National Institute for Clinical Excellence. Improving outcomes in urological cancers. www.nice.org.uk. Guidance on cancer, 2002.
  3. 3.
    Balaji KC, Yohannes P, McBride CL, Oleynikov D, Hemstreet GP. Feasibility of robot-assisted totally intracorporeal laparoscopic ileal conduit urinary diversion: initial results of a single institutional pilot study. Urology. 2004;63:51–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Goh AC, et al. Robotic intracorporeal continent cutaneous urinary diversion: primary description. J Endourol. 2015;29:1217–20.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Beecken W-D, et al. Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol. 2003;44:337–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Ahmed K, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. Eur Urol. 2014;65:340–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Koupparis A, et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion: impact on an established enhanced recovery protocol. BJU Int. 2015;116:924–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Tan WS, Lamb BW, Kelly JD. Evolution of the neobladder: a critical review of open and intracorporeal neobladder reconstruction techniques. Scand J Urol. 2016;50:95–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Ali AS, Hayes MC, Birch B, Dudderidge T, Somani BK. Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion. Eur J Surg Oncol. 2015;41:295–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee RK, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113:11–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Cody JD, et al. Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. Cochrane Database Syst Rev. 2012;73:CD003306.Google Scholar
  12. 12.
    Cerruto MA, et al. Systematic review and meta-analysis of non RCT's on health related quality of life after radical cystectomy using validated questionnaires: better results with orthotopic neobladder versus ileal conduit. Eur J Surg Oncol. 2016;42:343–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Fahmy O, Asri K, Schwentner C, Stenzl A, Gakis G. Current status of robotic assisted radical cystectomy with intracorporeal ileal neobladder for bladder cancer. J Surg Oncol. 2015;112:427–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Chopra S, et al. Evolution of robot-assisted orthotopic ileal neobladder formation: a step-by-step update to the University of Southern California (USC) technique. BJU Int. 2017;119:185–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–37.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Leow JJ, et al. Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis. BJU Int. 2015;115:713–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Shabsigh A, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.CrossRefPubMedGoogle Scholar
  18. 18.
    Sogni F, et al. Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology. 2008;71:919–23.CrossRefPubMedGoogle Scholar
  19. 19.
    McDermott WV. Metabolism and toxicity of ammonia. N Engl J Med. 1957;257:1076–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol. 1999;161:1057–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Studer UE, et al. Indications for continent diversion after cystectomy and factors affecting long-term results. Urol Oncol. 1998;4:172–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Von Meyenfeldt MF, Meijerink WJ, Rouflart MM, Builmaassen MT, Soeters PB. Perioperative nutritional support: a randomised clinical trial. Clin Nutr. 1992;11:180–6.CrossRefGoogle Scholar
  23. 23.
    Mohler JL, Flanigan RC. The effect of nutritional status and support on morbidity and mortality of bladder cancer patients treated by radical cystectomy. J Urol. 1987;137:404–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5:342–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Noblett SE, et al. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Color Dis. 2006;8:563–9.CrossRefGoogle Scholar
  26. 26.
    Goh AC, et al. Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol. 2012;62:891–901.CrossRefPubMedGoogle Scholar
  27. 27.
    Tyritzis SI, et al. Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol. 2013;64:734–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Studer UE, et al. Ileal bladder substitute: antireflux nipple or afferent tubular segment? Eur Urol. 1991;20:315–26.CrossRefPubMedGoogle Scholar
  29. 29.
    Davis NF, et al. Bricker versus Wallace anastomosis: a meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc J. 2015;9:E284–90.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol. 2008;179:582–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Hautmann RE, de Petriconi RC, Volkmer BG. Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol. 2010;184:990–4. quiz 1235.CrossRefPubMedGoogle Scholar
  32. 32.
    Pruthi RS, et al. Robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol. 2010;57:1013–21.CrossRefPubMedGoogle Scholar
  33. 33.
    Sim A, et al. Y pouch neobladder-a simplified method of intracorporeal neobladder after robotic cystectomy. J Endourol. 2015;29:387–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Tan WS, et al. Robot-assisted intracorporeal pyramid neobladder. BJU Int. 2015;116:771–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Shah HN, Nayyar R, Rajamahanty S, Hemal AK. Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience. Int Urol Nephrol. 2012;44:775–85.CrossRefPubMedGoogle Scholar
  36. 36.
    Ferriero M, et al. Risk assessment of stone formation in stapled orthotopic ileal neobladder. J Urol. 2015;193:891–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Simone G, et al. Robotic Intracorporeal Padua Ileal Bladder: surgical technique, perioperative, oncologic and functional outcomes. Eur Urol. 2016; doi: 10.1016/j.eururo.2016.10.018.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of UrologyUniversity Hospital AachenAachenGermany
  2. 2.Bristol Urological Institute, North Bristol NHS Trust, Southmead HospitalBristolUK

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