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Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder?

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Abstract

Bladder replacement has become a standard method of urinary diversion in adults undergoing cystectomy. When faced with a treatment decision, the patient and urologist are most comfortable if information is available on short- and long-term possible outcomes of the proposed intervention and on the magnitude of the expected effect. This article presents and discusses absolute and relative contraindications for orthotopic neobladders that may help optimize the clinical results with these procedures. As our own series has progressed, so has our philosophy regarding patients who are candidates for an orthotopic reconstruction. All men who require radical cystectomy as treatment for bladder cancer are initially thought to be appropriate candidates for orthotopic lower urinary tract reconstruction. Given the criteria presented in this article approximately, 80% of men are considered acceptable candidates for a neobladder. By these criteria, 65% of women are adequate candidates for an orthotopic bladder.

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References and Recommended Reading

  1. Studer UE, Hautmann RE, Hohenfellner M, et al.: Indications for continent diversion after cystectomy and factors affecting long-term results. Urol Oncol 1998, 4:172–182. A precise survey of the opinions and current practice of expert urologists from around the world reveals a high level of consensus. These are the proceedings of the Fifth International Consensus Conference on Bladder Cancer, November 6–8, 1997, Tokyo, Japan.

    Article  Google Scholar 

  2. Benson CM, Olsson CA: Continent urinary diversion. Urol Clin North Am 1999, 26:125–147.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Eisenberger CF, Schoenberg M, Fitter D, Marshall FF: Orthotopic ileocolic neobladder reconstruction following radical cystectomy: history, technique and results of the Johns Hopkins experience, 1986–1998. Urol Clin North Am 1999, 26:149–156.

    Article  PubMed  CAS  Google Scholar 

  5. Hautmann RE, 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. This paper, for the first time, describes in detail the likelihood of local recurrence and interference with neobladder function in a large series of patients with locally advanced transitional cell cancer of the bladder treated with cystectomy and ileal neobladder construction.

    Article  PubMed  CAS  Google Scholar 

  6. Mills RD, Studer UE: Review article: metabolic consequences of continent urinary diversion. J Urol 1999, 161:1057–1066. This is a comprehensive and clear review of the pertinent metabolic consequences when intestine is resected (malabsorption) and when urine is in contact with bowel (reabsorption).

    Article  PubMed  CAS  Google Scholar 

  7. Jonsson O, Fjalling M, Kilander A, et al.: Bile acid malabsorption after continent urinary diversion with an ileal reservoir [abstract]. J Urol 1997, 157:238.

    Google Scholar 

  8. Fillipas D, Fisch M, Abol Enein H, et al.: Chloride absorption in patients with a continent ileocaecal reservoir (Mainz pouch I). Br J Urol 1997, 79:588.

    Google Scholar 

  9. Davidsson T, Akerlund S, White T, et al.: Mucosal permeability of ileal and colonic reservoirs for urine. Br J Urol 1996, 78:64.

    PubMed  CAS  Google Scholar 

  10. Spitz A, Stein JP, Lieskovsky G, Skinner DG: Orthotopic urinary diversion with preservation of erectile and ejaculatory function in men requiring radical cystectomy for nonurothelial malignancy: a new technique. J Urol 1999, 161:1761–1764.

    Article  PubMed  CAS  Google Scholar 

  11. Kitamara H, Miyao N, Yanase M, et al.: Quality of life in patients having an ileal conduit, continent reservoir or orthotopic neobladder after cystectomy for bladder carcinoma. Int J Urol 1999, 6:393–399.

    Article  Google Scholar 

  12. Mansson A, Christensson P, Johnson G, Colleen S: Can preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction predict psychosocial adjustment after cystectomy in patients with bladder cancer? Br J Urol 1998, 82:348–356.

    PubMed  CAS  Google Scholar 

  13. Hobisch A, Tosun K, Kinzl J, et al.: Patient assessment of life after cystectomy and orthotopic neobladder versus ileum conduit [abstract]. J Urol 1999, 161:90. A comparison between patients undergoing ileal conduit versus ileal neobladder diversion found that no single item in the Quality of Life Questionnaire C30 indicated that ileal conduit was superior to neobladder. Neobladder patients adapted better to the new situation than conduit patients.

    Article  Google Scholar 

  14. Hautmann RE, de Petriconi R, Gottfried H-W, et al.: The ileal neobladder: complications and functional results in 363 patients after 11 years of follow-up. J Urol 1999, 161:422–428. The long-term complications and functional results in 363 ileal neobladders with a mean follow-up of 57 months are presented. This study demonstrates the safety and efficacy of ileal neobladder urinary diversion in experienced hands. The study had the longest follow-up and largest series; the complication rates were acceptable (but not negligible), and functional results were excellent.

    Article  PubMed  CAS  Google Scholar 

  15. Hautmann RE, Paiss T: Does the option of the ileal neobladder stimulate patient and physician decision toward earlier cystectomy? J Urol 1998, 159:1845–1850. This study suggests that bladder reconstruction may decrease the reticence to use cystectomy early in the disease process, thus raising the survival rate.

    Article  PubMed  CAS  Google Scholar 

  16. Chen ME, Pisters LL, Malpica A, et al.: Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M.D. Anderson Cancer Center. J Urol 1997, 157:2120.

    Article  PubMed  CAS  Google Scholar 

  17. Maralani S, Wood DP, Grignon D, et al.: Incidence of urethral involvement in female bladder cancer: an anatomic pathologic study. Urology 1997, 50:537–541.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Hautmann RE, Paiss T, de Petriconi R: The ileal neobladder in woman: 9 years of experience with 18 patients. J Urol 1996, 155:76.

    Article  PubMed  CAS  Google Scholar 

  20. Stein JP, Grossfeld GD, Freemann JA, et al.: Orthotopic lower urinary tract reconstruction in woman using the Kock ileal neobladder: updated experience in 34 patients. J Urol 1997, 158:400.

    Article  PubMed  CAS  Google Scholar 

  21. Barroso U Jr, Duel B, Spencer Barthold J, González R: Orthotopic urethral substitution in female patients using the Mitrofanoff principle. J Urol 1999, 161:251–253.

    Article  PubMed  Google Scholar 

  22. Bercovich E, Pirozzi F, Curreli A: Point of technique: lower urinary tract substitution after radical cystectomy with urethral mucosa and submucosa removal in females with trigonal and/or bladder neck involvement. Br J Urol 1998, 82:913–914.

    PubMed  CAS  Google Scholar 

  23. Aral Y, Okubo K, Konami T, et al.: Voiding function of orthotopic ileal neobladder in women. Urology 1999, 54:44–49.

    Article  Google Scholar 

  24. Shimogaki H, Okada H, Fujisawa M, et al.: Long-term experience with orthotopic reconstruction of the lower urinary tract in women. J Urol 1999; 161:573–577.

    Article  PubMed  CAS  Google Scholar 

  25. Ali-El-Dein B, El-Sobky E, Hohenfellner M, Ghoneim MA: Orthotopic bladder substitution in women: functional evaluation. J Urol 1999, 161:1875–1880. This article analyzes the functional results of orthotopic bladder substitution. Six of 43 women had difficulty emptying the pouch spontaneously, with concomitant residual urine due to acute angulation between urethra and pouch. Failure to complete emptying seems to be due to anatomic rather than functional reasons.

    Article  PubMed  CAS  Google Scholar 

  26. Stenzl A, Draxl B, 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 1996, 153:950.

    Article  Google Scholar 

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  1. Department of Urology, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany

    Richard E. Hautmann MD

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  1. Richard E. Hautmann MD
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Hautmann, R.E. Which patients with transitional cell carcinoma of the bladder or prostatic urethra are candidates for an orthotopic neobladder?. Curr Urol Rep 1, 173–179 (2000). https://doi.org/10.1007/s11934-000-0016-2

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  • DOI: https://doi.org/10.1007/s11934-000-0016-2

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