Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis (original) (raw)
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Studer Orthotopic Neobladder: a Modified Surgical Technique
Urology, 2015
OBJECTIVE A modified technique for orthotopic ileal neobladder preparation is described. The Studer technique is the method most frequently used worldwide and seems to be an ideal reconstructive solution after radical cystectomy. METHODS After radical cystectomy, urinary diversion is attained by means of a detubulized ileal segment. About 40 cm are used to create the reservoir and 15 cm for a tubular afferent limb. A spheroidal-shaped reservoir is then obtained with a conic distal part that will be anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the levator ani and psoas muscles respectively. Post-operative results on a series of 36 patients are reported. RESULTS The final shape of the reservoir was roughly spherical. A small amount of anastomotic strictures was registered. Renal function was not impaired after surgery, even at late follow-up. CONCLUSION Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion. Further cases are required to confirm possible advantages of the modified technique.
Management of Urethral Recurrence in Patients with Studer Ileal Neobladder
European Urology, 2003
Objective: The overall risk of urethral recurrence (UR) of transitional cell carcinoma (TCC) in patients with orthotopic neobladder ranges from 2% to 6%. We are presenting herein our experience in order to evaluate and define the management of these patients, since the cases with urethral recurrence in patients with orthotopic neobladder are very scarce. Materials and methods: Five hundred and sixteen radical cystectomies due to TCC were performed at our Centre between January 1990 and February 1998. One hundred and thirty-eight of them (26.7%) underwent an orthotopic neobladder procedure with the Studer's technique. We are reviewing five cases of UR in patients with orthotopic neobladder, the cystectomy indications and the differences between the clinical and the pathologic stages. We are also assessing its clinical presentation, diagnosis, treatment and evolution. Results: Five patients (3.6%) from 50 to 71 years old with Studer's orthotopic neobladder presented with UR. All of those neobladders were initially superficial TCC, mostly multifocal, and all had failed the endovesical treatment. Endoscopic treatment was administered in two cases with superficial UR. One patient with urethral CIS received intraurethral BCG instillations. One case because of multiplicity, and another due to the presence of an infiltrating urethral tumour, underwent urethrectomy and neobladder exeresis. In both cases, the intact 15-20 cm isoperistaltic proximal ileal limb of the Studer-type orthotopic neobladder was used as an ileal conduit. Conclusions: UR in patients with orthotopic bladder substitution is unusual. A conservative approach is possible when dealing with superficial recurrences. In cases of urethrectomy, the isoperistaltic proximal ileal limb of the Studer neobladder may be used as an ileal conduit. #
Asian Journal of Medical Sciences
Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery. Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed. Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diamet...
Long-term Functional Outcome and Late Complications of Studer's Ileal Neobladder
Japanese Journal of Clinical Oncology, 2005
The purpose of this study was to evaluate the long-term functional outcome and late complications of Studer's ileal neobladder. Methods: The study included 57 patients who underwent radical cystectomy and bladder reconstruction with Studer's ileal neobladder, and were followed-up for at least 3 months after surgery. The voiding and storage function, and late complications were evaluated. The times of evaluation after surgery were categorized into periods I (3-23 months), II (24-59 months), III (60-95 months) and IV (>96 months). Results: Daytime and night-time continence rates were 95.6 and 88.6%, respectively. The averages of functional capacity (439 ml), maximum flow rate (15.7 ml/s) and residual urine (35 ml) evaluated in period I were maintained in period IV. Of the 57 patients, intermittent selfcatheterization was needed in five (8.8%) due to incomplete emptying or urinary retention. Urethroileal anastomotic stricture was found in two patients (3.5%), who were successfully treated by transurethral intervention. Inguinal hernia was found in seven patients (12.8%), five of whom developed it within 2 years after surgery. Conclusions: Our results indicate that Studer's ileal neobladder had a favorable long-term functional outcome. Although late complication rates were low, the incidence of inguinal hernia was relatively high, and this was considered as a definite late complication in our study.
World Journal of Surgical Oncology, 2023
Background To explore a method of constructing an orthotopic ileal neobladder (ONB) in the Y-pouch configuration. We describe the steps followed to create the Y-pouch ileal orthotopic neobladder (ONB) and compared the perioperative, functional, and urodynamics outcomes with the Studer neobladder technique. Methods A retrospective cohort study of 90 bladder cancer patients, who received open radical cystectomy with the ONB performed at a hospital from June 2009 to May 2020. These patients were divided into two groupsthe Y-pouch and the Studer neobladder groups. Perioperative, functional outcome, complication, renal function data outcomes, and pressure-volume study were used to evaluate the treatment outcomes after a radical cystectomy. Results Ninety patients (54 Studer and 36 Y-pouch neobladder) were enrolled. The median patient age was 62.6 (± 11) years. The mean operative time for the Studer technique was 290 (242.5-350) min, and the Y-pouch technique was 300 (271.2-335) min) (p = 0.826). At 30 days postoperatively, the Clavien-Dindo classification of surgical complications revealed grade-2 urinary infections in two patients (5.6%) and six patients (11.1%) for the Y-pouch and Studer techniques, respectively. Intermediate complications (30-90 days) were reported in 4 (11.1%) and 18 patients (44.4%) in the Y-pouch and the Studer techniques, respectively (p = 0.062). In the urodynamics study (UDS), the Y-pouch group had a mean postvoid residual volume of 20 mL and Studer of 40 ml (p = 0.06). A mean capacity of 462 (380-600) mL compares to the Studer neobladder group with 495 (400-628) mL. The average mean compliance of the Studer group was 35.5 (28-52) ml/cm H 2 O and 33 (30-43) ml/cm H 2 O for Y pouch, and most patients had > 30 ml/cm H 2 O compliance (80/90 patients). Conclusions The Y-pouch neobladder technique in an RC with an orthotopic neobladder provides perioperative and functional outcomes compared to those of the Studer orthotopic neobladder resulting in similar intermediateterm. Therefore, the Y-pouch ileal neobladder is both feasible and safe to be used as a standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy and needs confirmation with long-term results.
Orthotopic neobladder: A 22-year experience
Acta chirurgica iugoslavica, 2007
Objective: To analyze the outcome of orthotopic ileal neobladder related to complications and quality of life. Patients and methods: From 1985 to 2006, 75 patients with mean age of 57 years, (41-75) underwent radical cystectomy and orthotopic ileal neobladder substitution. The mean follow up was 72 months (6-144). Mean operative time was 240 minutes. Results: Intraoperative blood loss ranged from 250 to 2810 ml. Ureteral stents were removed on 14th postoperative day, and patients were discharged at 21st day, average. Complications appeared in 23 patients. There were two recurrent TCC in the neobladder. Three patients died from pulmonary embolism. Vesicoureteral reflux appeared in three patients, and it was bilateral in two patients. Total of 98% patients have daytime continence. Conclusion: Continent urinary reservoirs represent the state of the art in urinary diversion. Surgeons who perform these operations are urgent to institute requirements for careful long-term follow-up of the...
Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction
International Journal of Urology, 2012
To date, various procedures for creating an orthotopic neobladder following radical cystectomy have been reported. 1 Although the type of neobladder that provides the best outcomes is disputed , the ileal neobladder (INB) may currently be the most frequently selected form of neobladder worldwide. 2 At our institution, however, sigmoid neobladder (SNB) has been preferred for patients undergoing radical cystectomy irrespective of their characteristics. As previously described , 3,4 we modified several steps of the original method to create SNB in order to minimize postoperative complications. 8 For example, rotation of the reservoir upside-down and 180°horizontally provides a tension-free enterourethral anastomosis and successfully prevents urethral ischemia , while the implantation of ureters to the upper edge of the reservoir facilitates the creation of a submucosal tunnel and allows precise ureterointestinal anastomosis ). In fact, the incidence of complications in our SNB series, including ureterointestinal strictures, enterourethral strictures and vesicoureteral reflux, were lower than that in other SNB series. Of the several problems associated with neobladder, voiding dysfunction probably has the most adverse impact on a patient's postoperative satisfaction. In general, despite an unfavorable continence status, particularly night-time continence, SNB is likely to acquire an adequate voiding status by emptying the reservoir. 7,9,10 Furthermore, in our series the favorable voiding status of SNB was confirmed; that is, more than 90% of the patients could void spontaneously, and their post-void residual urine was less than 25 mL . 5,6 Furthermore, daytime and night-time continence rates in SNB were approximately 85 and 60%, respectively, which appeared to be markedly superior to those in previously reported outcomes in SNB . Considering the low compliance of SNB due to the physiological features of the sigmoid colon characterized by a high pressure with powerful contraction of the thick wall, we used a longer sigmoid segment (35-40 cm) than used in other studies, resulting in an increase in the pouch volume and its compliance. In addition, a small post-void residual urine, which has been shown to influence continence with a neobladder, 10 may also have contributed to the favorable continence status in our SNB series.
Ureteroileal Implantation in Orthotopic Neobladder With The Le Duc-Camey Mucosal-Through Technique
The Journal of Urology, 1997
We determined the postoperative risk of nonneoplastic ureteroileal implantation stenosis using the Le Duc-Camey technique, and assessed the extent to which followup is mandatory. Between October 1980 and October 1989, after a cystoprostatectomy, 158 consecutive men underwent lower urinary tract reconstruction by means of a U-shaped orthotopic ileal neobladder. Of these cases 109 were tubularized and 49 were detubularized. The 313 ureteral implantations were performed according to the Le Duc-Camey mucosal-through technique. Followup studies in all patients consisted of excretory urography or renal sonography carried out before discharge home, at least every 6 months during the first year after surgery and once a year thereafter. Followup was more than 2 years for 123 patients. The study was conducted retrospectively. The rate of anastomotic stenosis was 4.9% among 123 patients who were followed a minimum of 2 years. No obstructions were detected after 2 years. The rates of ureteral reimplantation and nephrectomy for chronic kidney obstruction were 3.7% and 2%, respectively. All strictures were located at the anastomosed site, and retrograde catheterization was uncertain. Surgical reimplantation through an elective extraperitoneal approach was easy to perform and effective. The anastomotic stenosis rate after Le Duc-Camey ureteroileal implantation in orthotopic U-shaped neobladder was 4.9%. During the first year after surgery, the difference between true stenosis and temporary edema was not easy to assess. The U-shaped neobladder allows for the implantation of a minimally dissected iliac ureter, which could be a factor in minimizing the risk of obstruction.