Abstract
Over the past 20 years orthotopic urinary reconstruction with the techniques developed at Ulm and Bern has become a widely accepted form of urinary diversion. So far, both centers together have performed more than 1,300 orthotopic bladder substitutions with an overall rate of neobladder formation in 58% of all cystectomized patients. Today, the absolute contraindications for this procedure are urinary stress incontinence, damaged rhabdosphincter, severely impaired renal and liver function, severe intestinal diseases or an oncologic situation requiring urethrectomy. In patients treated for transitional cell carcinoma of the bladder, the rate of urethral recurrence in both centers was 1.5 and 5%, respectively, and the rate of upper urinary tract recurrence was 2–3%. Local tumor recurrence usually did not affect neobladder function. The rate of outlet obstruction by local recurrence was 2%, that of gross hematuria 1%, and of entero-reservoir fistulas 1–2%. Daytime continence at 12 months was 92%, while nighttime continence was lower around 80%. Transient or permanent urinary retention was seen in 11–12% of male patients. In both series, long-term upper urinary tract safety was good. The risk of stenoses of the uretero-intestinal anastomosis with consecutive loss of renal function decreased with the introduction of non-refluxing implantation techniques. The rate of long-term metabolic complications remains low when adequate substitution with sodium bicarbonate is guaranteed in patients with impaired renal function. Patient selection and meticulous postoperative follow-up contributed to achieve good long-term results after cystectomy and orthotopic ileal neobladder substitution of the two large series of patients from the Universities of Ulm and Bern.
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References
Abol-Enein H, Ghoneim MA (2001) Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J Urol 165(5):1427–1432
Aboseif SR, Borirakchanyavat S, Lue TF, Carroll PR (1998) Continence mechanism of the ileal neobladder in women: a urodynamics study. World J Urol 16(6):400–404
Ali-el-Dein B, el Sobky E, Hohenfellner M, Ghoneim MA (1999) Orthotopic bladder substitution in women: functional evaluation. J Urol 161(6):1875–1880
Ali-el-Dein B, Gomha M, Ghoneim MA (2002) Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women. J Urol 168(2):587–592
Arai Y, Okubo K, Konami T, Kin S, Kanba T, Okabe T et al (1999) Voiding function of orthotopic ileal neobladder in women. Urology 54(1):44–49
(6)Burkhard FC, Studer UE (2001) Orthotopic urinary diversion using an ileal low pressure bladder substitute with an afferent segment. Atlas of the Urol Clin North Am 9(2):57–73
Clark PE, Stein JP, Groshen SG, Miranda G, Cai J, Lieskovsky G et al (2004) The management of urethral transitional cell carcinoma after radical cystectomy for invasive bladder cancer. J Urol 172(4 Pt 1):1342–1347
Freeman JA, Esrig D, Stein JP, Skinner DG (1994) Management of the patient with bladder cancer. Urethral recurrence. Urol Clin North Am 21(4):645–651
Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC et al (1996) Urethral recurrence in patients with orthotopic ileal neobladders. J Urol 156(5):1615–1619
Gburek BM, Lieber MM, Blute ML (1998) Comparison of studer ileal neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications. J Urol 160(3 Pt 1):721–723
Ghoneim MA, Shaaban AA, Mahran MR, Kock NG (1992) Further experience with the urethral Kock pouch. J Urol 147(2):361–365
Giessing M, Turk I, Schoenberger B, Loening SA (2001) Orthotopic neobladder after kidney transplantation in a male patient with recurring urothelial carcinoma and renal cancer. J Urol 166(4):1383
Gschwend JE, Hautmann RE, Volkmer BG (2004) Radical cystectomy and urinary diversion in elderly patients with increased comorbidity. Urologe A 43(8):930–934
Gschwend JE, Volkmer BG, Liske P, Kleinschmidt K, Hautmann RE (2005) Type of ureteral anastomosis on the rate of Hydronephrosis and renal function. J Urol 173(4):481A
Hassan JM, Cookson MS, Smith JA Jr, Chang SS (2004) Urethral recurrence in patients following orthotopic urinary diversion. J Urol 172(4 Pt 1):1338–1341
Hautmann RE (2000) Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder? Curr Urol Rep 1(3):173–179
Hautmann RE (2001) 15 years experience with the ileal neobladder. What have we learned?. Urologe A 40(5):360–367
Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169(3):834–842
Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T (1999) The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol 161(2):422–427
Hautmann RE, de Petriconi R, Kleinschmidt K, Gottfried HW, Gschwend JE (2000) Orthotopic ileal neobladder in females: impact of the urethral resection line on functional results. Int Urogynecol J Pelvic Floor Dysfunct 11(4):224–229
Hautmann RE, Egghart G, Frohneberg D, Miller K (1987) The ileal neobladder. Urologe A 26(2):67–73
Hautmann RE, Egghart G, Frohneberg D, Miller K (1988) The ileal neobladder. J Urol 139(1):39–42
Hautmann RE, Simon J (1999) Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men. J Urol 162(6):1963–1966
Hugonnet CL, Danuser H, Springer JP, Studer UE (2001) Urethral sensitivity and the impact on urinary continence in patients with an ileal bladder substitute after cystectomy. J Urol 165(5):1502–1505
Huguet J, Palou J, Serrallach M, Sole Balcells FJ, Salvador J, Villavicencio H (2003) Management of urethral recurrence in patients with Studer ileal neobladder. Eur Urol 43(5):495–498
Jones J, Melchior SW, Gillitzer R, Fichtner J, El Mekresh M, Thuroff JW (2000) Urethral recurrence of transitional cell carcinoma in a female patient after cystectomy and orthotopic ileal neobladder. J Urol 164(5):1646
Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW, Studer UE (2004) Attempted nerve sparing surgery and age have a significant effent on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. J Urol 172(4 Pt 1):1323–1327
Lang H, de Petriconi R, Wenderoth U, Volkmer BG, Hautmann RE, Gschwend JE (2005) Orthotopic ileal neobladder reconstruction in patients with bladder cancer following renal transplantation. J Urol 173(3):881–884
Le Duc A, Camey M, Teillac P (1987) Antireflux uretero-ileal implantation via a mucosal sulcus. Ann Urol (Paris) 21(1):33–34
Lee KS, Montie JE, Dunn RL, Lee CT (2003) Hautmann and Studer orthotopic neobladders: a contemporary experience. J Urol 169(6):2188–2191
Light JK (1992) Continence mechanisms following orthotopic bladder substitution. Scand J Urol Nephrol Suppl 142:95–97
Madersbacher S, Mohrle K, Burkhard F, Studer UE (2002) Long-term voiding pattern of patients with ileal orthotopic bladder substitutes. J Urol 167(5):2052–2057
Miller K, Bachor R, Frohneberg D, Egghart G, Hautmann R (1990) Continent urinary diversion in the elderly patient. Results with an ileum neobladder. Urologe A 29(2):87–90
Mills RD, Studer UE (1999) Metabolic consequences of continent urinary diversion. J Urol 161:1057
Minowada S, Sasaki Y, Kano M, Okano Y (1995) Sling operation for male urinary incontinence after ileal neobladder reconstruction: a case report. Int J Urol 2(2):132–133
Montie JE (2005) Radical cystectomy in the elderly: comparison of survival between younger and older patients. J Urol 174(4 Pt 1):1254–1255
Montie JE, Park JM (1997) Orthotopic diversion in women. Semin Urol Oncol 15(3):184–188
Nimeh T, Ng CS, Goldfarb DA, Klein EA (2002) Orthotopic neobladder and subsequent renal transplantation. Urology 60(5):911
Pastor Guzman JM, Donate Moreno MJ, Gimenez Bachs JM, Pastor NH, Lorenzo RJ, Ruiz MR et al (2005) Entero-neobladder ileal fistula: two cases report. Actas Urol Esp 29(8):782–786
Quek ML, Ginsberg DA, Wilson S, Skinner EC, Stein JP, Skinner DG (2004) Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women. J Urol 172(1):219–221
Saika T, Manabe D, Suyama B (1999) Clinical study of radical cystectomy and urinary reconstruction in elderly patients with bladder cancer. Hinyokika Kiyo 45(1):19–23
Saika T, Suyama B, Murata T, Manabe D, Kurashige T, Nasu Y et al (2001) Orthotopic neobladder reconstruction in elderly bladder cancer patients. Int J Urol 8(10):533–538
Selli C, Boggi U, Travaglini F, Vistoli F, Del Chiaro M, Mosca F (2004) Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function. Transpl Int 17(2):97–100
Simon J, Gschwend JE, Volkmer BG (2005) Local recurrence following radical cystectomy for bladder cancer. Diagnostic and therapeutic options. Urologe A 44(4):375–381
Skinner DG, Studer UE, Okada K, Aso Y, Hautmann H, Koontz W et al (1995) Which patients are suitable for continent diversion or bladder substitution following cystectomy or other definitive local treatment? Int J Urol 2(Suppl 2):105–112
Stein JP, Clark P, Miranda G, Cai J, Groshen S, Skinner DG (2005) Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients. J Urol 173(4):1163–1168
Stein JP, Ginsberg DA, Skinner DG (2002) Indications and technique of the orthotopic neobladder in women. Urol Clin North Am 29(3):725–734, xi
Stenzl A, Colleselli K, Poisel S, Feichtinger H, Bartsch G (1996) The use of neobladders in women undergoing cystectomy for transitional-cell cancer. World J Urol 14(1):15–21
Stenzl A, Colleselli K, Poisel S, Feichtinger H, Pontasch H, Bartsch G (1995) Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J Urol 154(6):2044–2049
Steven K, Poulsen AL (2000) The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol 164(2):288–295
Studer UE, Ackermann D, Casanova GA, Zingg EJ (1988a) A newer form of bladder substitute based on historical perspectives. Semin Urol 6(1):57–65
Studer UE, Burkhard FC, Schumacher MC, 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
Studer UE, Casanova GA, Zingg EJ (1988b) Bladder substitution with an ileal low-pressure reservoir. Eur Urol 14(Suppl 1):36–40
Studer UE, Danuser H, Hochreiter W, Springer JP, Turner WH, Zingg EJ (1996a) Summary of 10 years’ experience with an ileal low-pressure bladder substitute combined with an afferent tubular isoperistaltic segment. World J Urol 14(1):29–39
Studer UE, Danuser H, Thalmann GN, Springer J, Turner H (1996b) Antireflux nipples or afferent tubular segments in 70 patients with ileal low pressure bladder substitutes: Long term results of a prospective randomized trial. J Urol 156: 1913
Studer UE, deKernion JB, Zimmern PE (1985) A model for a bladder replacement plasty by an ileal reservoir––an experimental study in dogs. Urol Res 13:243
Tchetgen MB, Sanda MG, Montie JE, Faerber GJ (2000) Collagen injection for the treatment of incontinence after cystectomy and orthotopic neobladder reconstruction in women. J Urol 163(1):212–214
Varol C, Studer UE (2004) Managing patients after an ileal orthotopic bladder substitution. BJU Int 93(3):266–270
Varol C, Thalmann GN, Burkhard FC, Studer UE (2004) Treatment of urethral recurrence following radical cystectomy and ileal bladder substitution. J Urol 172(3):937–942
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Hautmann, R.E., Volkmer, B.G., Schumacher, M.C. et al. Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 24, 305–314 (2006). https://doi.org/10.1007/s00345-006-0105-z
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DOI: https://doi.org/10.1007/s00345-006-0105-z