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Selecting Patients for Continent or Incontinent, Heterotopic or Orthotopic Diversion

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Functional Urologic Surgery in Neurogenic and Oncologic Diseases

Abstract

Radical cystectomy (RC) and urinary diversions (UDs) are difficult procedures in urology, especially when RC is performed by mini-invasive technique (laparoscopic/robotic) and UDs are tailored intracorporeally. However, RC remains the best treatment option for muscle-invasive bladder cancer (MIBC) or high-risk noninvasive bladder cancer (NIBC) [1, 2]. Different UD procedures have their own indications and may present specific problems. In experienced hands and high-volume centers with rigorous standardized preoperative selection and systematic long-term follow-up, major complications can be avoided and excellent long-term results can be achieved.

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References

  1. Goossens-Laan CA, Visser O, Hulshof MC, et al. Survival after treatment for carcinoma invading bladder muscle: a Dutch population-based study on the impact of hospital volume. BJUInt. 2012;110:226–32.

    Article  Google Scholar 

  2. Babjuk M, Burger M, Zigeuner R, Shariat SF, Van Rhijn BW, Compérat E, Sylvester RJ, Kaasinen E, Böhle A, Palou Redorta J, Rouprêt M. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. European Association of Urology. Eur Urol. 2013;64(4):639–53. doi: 10.1016/j.eururo.2013.06.003. Epub 2013 Jun 12. Review.

    Google Scholar 

  3. Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, Montie JD, Sagalowsky AI, Stein JP, Stenzl A, Studer UE, Volkmer BG. World Health Organization (WHO) consensus conference in bladder cancer, urinary diversion. Urology. 2007;69(1 Suppl):17–49.

    Article  PubMed  Google Scholar 

  4. Lebret T, Herve JM, Yonneau L, et al. After cystectomy, is it justified to perform a bladder replacement for patients with lymph node positive bladder cancer? Eur Urol. 2002;42(4):344–9.

    Article  PubMed  Google Scholar 

  5. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666–75.

    CAS  PubMed  Google Scholar 

  6. Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, Ribal MJ, Van der Heijden AG, Sherif A. European Association of Urology. Eur Urol. 2014;65(4):778–92. doi: 10.1016/j.eururo.2013.11.046. Epub 2013 Dec 12.

    Google Scholar 

  7. Miller DC, Taub DA, Dunn RL, et al. The impact of co-morbid disease on cancer control and survival following radical cystectomy. J Urol. 2003;169(1):105–9.

    Article  PubMed  Google Scholar 

  8. Extermann M, Overcash J, Lyman GH, et al. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16(4):1582–7.

    CAS  PubMed  Google Scholar 

  9. Ashworth A. Papillomatosis of the urethra. Br J Urol. 1956;28(1):3–13.

    Article  CAS  PubMed  Google Scholar 

  10. Raz S, Mclorie G, Johnson S, Skinner DG. Management of the urethra in patients undergoing radical cystectomy for bladder carcinoma. J Urol. 1978;120(3):298–300.

    CAS  PubMed  Google Scholar 

  11. Faysal MH. Urethrectomy in men with transitional cell carcinoma of bladder. Urology. 1980;16(1):23–6.

    Article  CAS  PubMed  Google Scholar 

  12. Hardeman SW, Soloway MS. Urethral recurrence following radical cystectomy. J Urol. 1990;144(3):666–9.

    CAS  PubMed  Google Scholar 

  13. Levinson AK, Johnson DE, Wishnow KI. Indications for urethrectomy in an era of continent urinary diversion. J Urol. 1990;144(1):73–5.

    CAS  PubMed  Google Scholar 

  14. Tobisu K, Tanaka Y, Mizutani T, Kakizoe T. Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors. J Urol. 1991;146(6):1551–3; discussion 1553-4.

    CAS  PubMed  Google Scholar 

  15. Nieder AM, Sved PD, Gomez P, Kim SS, Manoharan M, Soloway MS. Urethral recurrence after cystoprostatectomy: implications for urinary diversion and monitoring. Urology. 2004;64(5):950–4.

    Article  PubMed  Google Scholar 

  16. Stein JP, Clark P, Miranda G, Cai J, Groshen S, Skinner DG. Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients. J Urol. 2005;173(4):1163–8.

    Article  PubMed  Google Scholar 

  17. Stenzl A, Draxl H, Posch B, Colleselli K, Falk M, Bartsch G. The risk of urethral tumors in female bladder cancer: can the urethra be used for orthotopic reconstruction of the lower urinary tract? J Urol. 1995;153(3 Pt 2):950–5.

    CAS  PubMed  Google Scholar 

  18. Freeman JA, Tarter TA, Esrig D, Stein JP, Elmajian DA, Chen SC, Groshen S, Lieskovsky G, Skinner DG. Urethral recurrence in patients with orthotopic ileal neobladders. J Urol. 1996;156(5):1615–9.

    Article  CAS  PubMed  Google Scholar 

  19. Hassan JM, Cookson MS, Smith Jr JA, Chang SS. Urethral recurrence in patients following orthotopic urinary diversion. J Urol. 2004;172(4 Pt 1):1338–41.

    Article  PubMed  Google Scholar 

  20. Wood Jr DP, Montie JE, Pontes JE, Levin HS. Identification of transitional cell carcinoma of the prostate in bladder cancer patients: a prospective study. J Urol. 1989;142(1):83–5.

    PubMed  Google Scholar 

  21. Sakamoto N, Tsuneyoshi M, Naito S, Kumazawa J. An adequate sampling of the prostate to identify prostatic involvement by urothelial carcinoma in bladder cancer patients. J Urol. 1993;149(2):318–21.

    CAS  PubMed  Google Scholar 

  22. Lebret T, Hervé JM, Barré P, Gaudez F, Lugagne PM, Barbagelatta M, Botto H. Urethral recurrence of transitional cell carcinoma of the bladder. Predictive value of preoperative latero-montanal biopsies and urethral frozen sections during prostatocystectomy. Eur Urol. 1998;33(2):170–4.

    Article  CAS  PubMed  Google Scholar 

  23. Donat SM, Wei DC, McGuire MS, Herr HW. The efficacy of transurethral biopsy for predicting the long-term clinical impact of prostatic invasive bladder cancer. J Urol. 2001;165(5):1580–4.

    Article  CAS  PubMed  Google Scholar 

  24. Azimuddin K, Khubchandani IT, Stasik JJ, et al. Neoplasia after ureterosigmoidostomy. Dis Colon Rectum. 1999;42(12):1632–8.

    Article  CAS  PubMed  Google Scholar 

  25. Stein JP, Cote RJ, Freeman JA, Esrig D, Elmajian DA, Groshen S, Skinner EC, Boyd SD, Lieskovsky G, Skinner DG. Indications for lower urinary tract reconstruction in women after cystectomy for bladder cancer: a pathological review of female cystectomy specimens. J Urol. 1995;154(4):1329–33.

    Article  CAS  PubMed  Google Scholar 

  26. Maralani S, Wood Jr DP, Grignon D, Banerjee M, Sakr W, Pontes JE. Incidence of urethral involvement in female bladder cancer: an anatomic pathologic study. Urology. 1997;50(4):537–41.

    Article  CAS  PubMed  Google Scholar 

  27. Stein JP, Esrig D, Freeman JA, Grossfeld GD, Ginsberg DA, Cote RJ, Groshen S, Boyd SD, Lieskovsky G, Skinner DG. Prospective pathologic analysis of female cystectomy specimens: risk factors for orthotopic diversion in women. Urology. 1998;51(6):951–5.

    Article  CAS  PubMed  Google Scholar 

  28. Stein JP, Ginsberg DA, Skinner DG. Indications and technique of the orthotopic neobladder in women. Urol Clin North Am. 2002;29(3):725–34, xi.

    Article  PubMed  Google Scholar 

  29. Lance RS, Dinney CP, Swanson D, Babaian RJ, Pisters LL, Palmer LJ, Grossman HB. Radical cystectomy for invasive bladder cancer in the octogenarian. Oncol Rep. 2001;8(4):723–6.

    CAS  PubMed  Google Scholar 

  30. Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, Skinner DG. Radical cystectomy in the elderly: comparison of clinical outcomes between younger and older patients. Cancer. 2005;104(1):36–43.

    Article  PubMed  Google Scholar 

  31. Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, Gontero P. Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology. 2008;71(5):919–23. doi:10.1016/j.urology.2007.11.125. Epub 2008 Mar 20.

    Article  PubMed  Google Scholar 

  32. Elmajian DA, Stein JP, Skinner DG. Orthotopic urinary diversion: the Kock ileal neobladder. World J Urol. 1996;14(1):40–6.

    Article  CAS  PubMed  Google Scholar 

  33. Dutta SC, Chang SC, Coffey CS, Smith Jr JA, Jack G, Cookson MS. Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder. J Urol. 2002;168:164–7.

    Article  PubMed  Google Scholar 

  34. Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol. 2005;173:1318–22.

    Article  PubMed  Google Scholar 

  35. Siracusano S, Niero M, Lonardi C, Cerruto MA, Ciciliato S, Toffoli L, Visalli F, Massidda D, Iafrate M, Artibani W, Bassi P, Imbimbo C, Racioppi M, Talamini R, D’Elia C, Cacciamani G, De Marchi D, Silvestri T, Verze P, Belgrano E. Development of a questionnaire specifically for patients with ileal orthotopic neobladder (IONB). Health Qual Life Outcomes. 2014;12:135.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Imbimbo C, Mirone V, Siracusano S, Niero M, Cerruto MA, Lonardi C, Artibani W, Bassi P, Iafrate M, Racioppi M, Talamini R, Ciciliato S, Toffoli L, Visalli F, Massidda D, D’Elia C, Cacciamani G, De Marchi D, Silvestri T, Creta M, Belgrano E, Verze P. Urology. 2015 Aug 17. Quality of life assessment with orthotopic ileal neobladder reconstruction after radical cystectomy: results from a prospective Italian multicenter observational study].

    Google Scholar 

  37. Hautmann RE. Urinary diversion: ileal conduit to neobladder. J Urol. 2003;169(3):834–42.

    Article  PubMed  Google Scholar 

  38. Abbas F, Biyabani SR, Talati J. Orthotopic bladder replacement to the urethra following salvage radical cystoprostatectomy in men with failed radiation therapy. Tech Urol. 2001;7(1):20–6.

    CAS  PubMed  Google Scholar 

  39. Ahlering TE, Kanellos A, Boyd SD, Lieskovsky G, Skinner DG, Bernstein L. A comparative study of perioperative complications with Kock pouch urinary diversion in highly irradiated versus nonirradiated patients. J Urol. 1988;139(6):1202–4.

    CAS  PubMed  Google Scholar 

  40. Gschwend JE, May F, Paiss T, Gottfried HW, Hautmann RE. High-dose pelvic irradiation followed by ileal neobladder urinary diversion: complications and long-term results. Br J Urol. 1996;77(5):680–3.

    Article  CAS  PubMed  Google Scholar 

  41. Bochner BH, Figueroa AJ, Skinner EC, Lieskovsky G, Petrovich Z, Boyd SD, Skinner DG. Salvage radical cystoprostatectomy and orthotopic urinary diversion following radiation failure. J Urol. 1998;160(1):29–33.

    Article  CAS  PubMed  Google Scholar 

  42. Nieuwenhuijzen JA, Horenblas S, Meinhardt W, van Tinteren H, Moonen LM. Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer. BJU Int. 2004;94(6):793–7.

    Article  PubMed  Google Scholar 

  43. Huang EY, Skinner EC, Boyd SD, Cai J, Miranda G, Daneshmand S. Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy. World J Urol. 2012;30(6):741–5. doi:10.1007/s00345-012-0861-x. Epub 2012 Mar 29.

    Article  PubMed  Google Scholar 

  44. Urs E Studer, Richard E. Hautmann, M Hohenfellner, Robert D Mills, Yusaku Okada, Randall G. Rowland, Kenichi Tobisu, Taiji Tsukamoto. Indications for continent diversion after cystectomy and factors affecting long-term results Received: February 5, 1999.

    Google Scholar 

  45. Pastore AL, Palleschi G, Silvestri L, Cavallaro G, Rizzello M, Silecchia G, de Nunzio C, Al-Rawashdah SF, Petrozza V, Carbone A. Pure intracorporeal laparoscopic radical cystectomy with orthotopic “U” shaped ileal neobladder. BMC Urol. 2014;14:89. doi:10.1186/1471-2490-14-89.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Porpiglia F, Renard J, Billia M, Scoffone C, Cracco A, Terrone C, Scarpa RM. Open versus laparoscopy assisted radical cystectomy: results of a prospective study. J Endourol. 2007;21:325–9. doi:10.1089/end.2006.0224.

    Article  PubMed  Google Scholar 

  47. Huang J, Lin T, Xu K, Huang H, Jiang C, Han J, Yao Y, Guo Z, Xie W, Yin X, Zhang C. Laparoscopic radical cystectomy with orthotopic ileal neobladder: a report of 85 cases. J Endourol. 2008;22:939–46. doi:10.1089/end.2007.0298.

    Article  PubMed  Google Scholar 

  48. Parra RO, Andrus CH, Jones JP, Boullier JA. Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol. 1992;148:1140–4.

    CAS  PubMed  Google Scholar 

  49. Pastore AL, Palleschi G, Silvestri L, Leto A, Sacchi K, Pacini L, Petrozza V, Carbone A. Prospective randomized study of radiofrequency versus ultrasound scalpels on functional outcomes of laparoscopic radical prostatectomy. J Endourol. 2013;27:989–93. doi:10.1089/end.2013.0033.

    Article  PubMed  Google Scholar 

  50. Gill IS, Fergany A, Klein EA, Kaouk JH, Sung GT, Meraney AM, Savage SJ, Ulchaker JC, Novick AC. Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology. 2000;56:26–9. doi:10.1016/S0090-4295(00)00598-7.

    Article  CAS  PubMed  Google Scholar 

  51. Wang GJ, Barocas DA, Raman JD, Scherr DS. Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy. BJU Int. 2008;101:89–93.

    PubMed  Google Scholar 

  52. Pruthi RS, Wallen EM. Robotic assisted laparoscopic radical cystoprostatectomy: operative and pathological outcomes. J Urol. 2007;178:814–8. doi:10.1016/j.juro.2007.05.040.

    Article  PubMed  Google Scholar 

  53. Hasson HM, Rotman C, Rana N, Kumari NA. Open laparoscopy: 29-year experience. Obstet Gynecol. 2000;96:763–6. doi:10.1016/S0029-7844(00)01026-7.

    CAS  PubMed  Google Scholar 

  54. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003;61:699–702. doi:10.1016/S0090-4295(02)02543-8.

    Article  PubMed  Google Scholar 

  55. Spinelli MG, Cozzi G, Grasso A, Talso M, Varisco D, Abed El Rahman D, Acquati P, Albo G, Rocco B, Maggioni A, Rocco F. Ralp and Rocco stitch: original technique. Urologia. 2011;18(78 Suppl):35–8. doi:10.5301/RU.2011.8773.

    Article  Google Scholar 

  56. Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am. 1950;30:1511–21.

    CAS  PubMed  Google Scholar 

  57. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 1953;39:368–76. doi:10.3109/00016925309136722.

    Article  CAS  PubMed  Google Scholar 

  58. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Palleschi G, Pastore AL, Ripoli A, Silvestri L, Petrozza V, Carbone A. Videourodynamic evaluation of intracorporeally reconstructed orthotopic U-shaped ileal neobladders. Urology. 2015;85(4):883–9.

    Article  PubMed  Google Scholar 

  60. Puppo P, Naselli A. Laparoscopic radical cystectomy. Where do we stand? Arch Esp Urol. 2010;63:508–19. doi:10.4321/S0004-06142010000700005.

    Article  PubMed  Google Scholar 

  61. Aboumarzouk OM, Drewa T, Olejniczak P, Chlosta PL. Laparoscopic versus open radical cystectomy for muscle-invasive bladder cancer: a single institute comparative analysis. Urol Int. 2013;91(1):109–12. doi:10.1159/000350237.

    Article  PubMed  Google Scholar 

  62. Abraham JB, Young JL, Box GN, Lee HJ, Deane LA, Ornstein DK. Comparative analysis of laparoscopic and robot-assisted radical cystectomy with ileal conduit urinary diversion. J Endourol. 2007;21(12):1473–80. doi:10.1089/end.2007.0095.

    Article  PubMed  Google Scholar 

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Carbone, A., Fuschi, A. (2016). Selecting Patients for Continent or Incontinent, Heterotopic or Orthotopic Diversion. In: Carbone, A., Palleschi, G., Pastore, A., Messas, A. (eds) Functional Urologic Surgery in Neurogenic and Oncologic Diseases. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-29191-8_4

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