LONG-TERM FUNCTIONAL AND URODYNAMIC RESULTS OF 50 PATIENTS RECEIVING A MODIFIED SIGMOID NEOBLADDER CREATED WITH A SHORT DISTAL SEGMENT

Modified S-ileal neobladder for continent urinary diversion: functional and urodynamic results after 20 years of follow-up

OBJECTIVE

To report continence and urodynamic findings after radical cystectomy and urinary diversion with modified S-ileal neobladder between January 1993 and January 2013.

PATIENTS AND METHODS

181 patients were enrolled. Continence status, reservoir sensation, compliance, capacity and activity were assessed.

RESULTS

Daytime continence was reported by 88.0, 98.4 and 99.2%, while nighttime continence was reported by 70.2, 94.0 and 95.8% of our patients at 6 months, 5 years and 20 years, respectively. Enterocystometric capacity and maximum reservoir pressure were 366 vs. 405 ml and 502 ml, and 29 vs. 18 and 11 cm H2O, at 6 months, 5 years and 20 years, respectively. Median post-void residual urine volume was 32 ml at 6 months, 50 ml at 5 years and 120 ml at 20 years.

CONCLUSIONS

The modified S-ileal neobladder technique has a very good long-lasting functional outcome, with high day- and nighttime continence levels as well as high acceptability rates from our patients.

Sleep disturbances decrease self-assessed quality of life in individuals who have undergone cystectomy

PURPOSE

The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer.

MATERIALS AND METHODS

All patients 30 to 80 years old who had undergone cystectomy with urinary diversion at 7 urological centers in Sweden were included in the study. Sleep disturbances, nocturnal urinary leakage and urine evacuation frequency, as well as their effect on self-assessed quality of life variables were measured with a study specific questionnaire. We received the questionnaire from 452 (92%) of 491 identified individuals. Outcome variables were dichotomized and the results are presented as relative risks.

RESULTS

Those individuals with an orthotopic neobladder had an increased risk of nocturnal urinary leakage and/or urine evacuation frequency compared to those with a noncontinent urostomy or cutaneous continent reservoir. Of the patients with an orthotopic neobladder 37% reported negative effects on nocturnal sleep compared to 22% and 14% of those with a noncontinent or continent urostomy, respectively. Of those patients reporting that the urinary diversion had a negative effect on nocturnal sleep 88% had a decreased quality of life vs 65% of those who stated that the urinary diversion had no or little influence on nocturnal sleep.

CONCLUSIONS

Nocturnal urinary problems are of great concern for individuals with urinary diversion, especially those with an orthotopic neobladder. Regular disruption of sleep decreases quality of life.

Voiding symptoms and urodynamic findings in patients with modified ileal neobladde

The aim of our study was to find the cause of urinary incontinence and voiding dysfunction in patients undergoing radical cystectomy and orthotopic bladder replacement with modified ileal neobladder (Reddy). Twenty-eight incontinent patients (operated on between 1988 and 2004) were involved in our examination. Based on the complaints of the patients, continence status was evaluated and divided into two groups: group I: partially incontinent (only night-time incontinence) n = 11 (39.3%) and group II: totally incontinent (night-time and daytime incontinence) n = 17 (60.7%). Detailed urodynamic examination (enterocystometry and urethral pressure profile) in addition to involuntary neobladder contractions and capacity detection were carried out on all patients. Furthermore resting pressure and maximal voluntary contraction ability of the sphincter were determined and statistically analyzed in both groups. Significant difference was noticed in resting pressure and maximal voluntary contraction ability of the sphincter among the partially incontinent and totally incontinent patients. Frequency, intensity and duration of involuntary neobladder contractions also showed significant differences between the two groups. Incontinence of neobladder depends not only on the destruction of resting and contraction capability of the urethral sphincter, but also on the presence or absence of involuntary contractions in the wall of the neobladder and decreased capacity of the neobladder.

Long-term functional outcomes in patients with various types of orthotopic intestinal neobladder

OBJECTIVES

To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB).

METHODS

Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively.

RESULTS

Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups.

CONCLUSIONS

Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based.

Quality of life after therapy for muscle-invasive bladder cancer

PURPOSE OF REVIEW

Therapy for invasive bladder cancer should aim at cure, and besides radical organ-removing surgery, bladder-sparing alternatives are available. Here I report the current status on quality-of-life issues after therapy for invasive bladder cancer.

RECENT FINDINGS

Consensus has not been reached on the definition of the concept 'quality of life', resulting in numerous ways of measuring it. It is reasonable to believe that the individually self-assessed level of quality of life is affected by the total post-therapeutic symptom burden, that is, the long-term side effects of a therapy are predictors for quality of life. The affection on quality of life by a symptom on an individual can never be predicted because of differences in symptom tolerance. On the group level, however, some symptoms are generally highly distressful, whereas others are generally low distressors. A new area of quality-of-life research is evolving, measuring symptoms, symptom distress and effects on quality of life.

SUMMARY

Cystectomy followed by orthotopic bladder replacement seems to keep a high level of quality of life in select cases; however, ileal conduit is still an excellent option in other patients. Bladder-sparing alternatives are available. An individual pre-therapeutic consultation will aid in determining the radical therapeutic method in each individual patient.