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• W2027961305 abstract "No AccessJournal of UrologyClinical Urology: Original Articles1 Aug 1997Orthotopic Lower Urinary Tract Reconstruction in Women Using the Kock Ileal Neobladder: Updated Experience in 34 Patients John P. Stein, Gary D. Grossfeld, John A. Freeman, David Esrig, David A. Ginsberg, Richard J. Cote, Eila C. Skinner, Stuart D. Boyd, Gary Lieskovsky, and Donald G. Skinner John P. SteinJohn P. Stein More articles by this author , Gary D. GrossfeldGary D. Grossfeld More articles by this author , John A. FreemanJohn A. Freeman More articles by this author , David EsrigDavid Esrig More articles by this author , David A. GinsbergDavid A. Ginsberg More articles by this author , Richard J. CoteRichard J. Cote More articles by this author , Eila C. SkinnerEila C. Skinner More articles by this author , Stuart D. BoydStuart D. Boyd More articles by this author , Gary LieskovskyGary Lieskovsky More articles by this author , and Donald G. SkinnerDonald G. Skinner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64488-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Orthotopic lower urinary tract reconstruction has revolutionized urinary diversion following cystectomy. Initially performed solely in male patients, orthotopic diversion has now become a viable option in women. Currently, the orthotopic neobladder is the diversion of choice for women requiring lower urinary tract reconstruction at our institution. We evaluate and update our clinical and functional experience with orthotopic reconstruction in female patients. Materials and Methods: Since June 1990, 34 women 31 to 86 years old (median age 67) have undergone orthotopic lower urinary tract reconstruction following cystectomy. Indications for cystectomy included transitional cell carcinoma in 29 patients, urachal adenocarcinoma in 1, mesenchymal tumor of endometrial origin in 1, cervical carcinoma in 1 and a fibrotic radiated bladder in 1. In addition, 1 woman underwent undiversion to the native urethra following a previous simple cystectomy and cutaneous diversion for eosinophilic cystitis. Data were analyzed according to postoperative early and late complications, survival, tumor recurrence, pathological evaluation of the cystectomy specimen, continence status, voiding pattern and patient satisfaction. The median followup in this group of patients was 30 months (range 17 to 70). Results: There were no perioperative deaths, and 4 early (11%) and 3 (9%) late complications. Four patients died, none with a urethral recurrence, including 3 of metastatic bladder cancer and 1 of unrelated causes. In another patient with an extensive mesenchymal tumor of the uterus a sigmoid tumor recurred requiring conversion of the orthotopic reservoir to a cutaneous diversion. All of the remaining 29 patients are alive without evidence of disease. Intraoperative frozen section of the distal surgical margin (proximal urethra) accurately evaluated (confirmed by permanent section) the proximal urethra prospectively for tumor in all 29 specimens removed for transitional cell carcinoma, including 28 specimens (97%) without evidence of tumor and 1 specimen with carcinoma in situ. Complete daytime and nighttime continence was reported by 29 (88%) and 27 (82%) of 33 evaluable patients, respectively. A total of 28 patients (85%) void to completion, while 5 (15%) require some form of intermittent catheterization to empty the neobladder. Patient satisfaction is overwhelming. Conclusions: The excellent clinical and functional results demonstrated with further followup confirm our initial experience with orthotopic diversion in women. Careful selection of appropriate female candidates for orthotopic diversion is critical, and includes preoperative evaluation of the bladder neck and intraoperative frozen section analysis of the distal cystectomy margin. Furthermore, close monitoring of the retained urethra is mandatory in all women undergoing orthotopic diversion. We believe that the orthotopic neobladder is the urinary diversion of choice in women following cystectomy. References 1 : Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience.. J. Urol.1994; 152: 1404. Abstract, Google Scholar 2 : The Kock ileal neobladder.. Updated experience in 295 male patients. J. Urol.1996; 156: 920. 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Abstract, Google Scholar 8 : 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: 950. Abstract, Google Scholar 9 : Technique of radical cystectomy. In: Diagnosis and Management of Genitourinary Cancer. Philadelphia: W. B. Saunders, Co.1988: 607. chapt. 42. Google Scholar 10 Skinner D.G., Boyd S.D., Lieskovsky G. Technique of continent lower urinary tract reconstruction with Kock pouch urethrostomy following cystectomy. Videotape available from Marketing Communications, 3M Medical-Surgical Division, St. Paul, Minnesota. Google Scholar 11 : Continent and orthotopic urinary diversion following radical cystectomy. Should these reconstructive procedures now be considered standard of care? Surg.. Oncol. Clin. N. Amer.1995; 4: 277. Google Scholar 12 : Clinical assessment of urethral sphincter function.. J. Urol.1993; 150: 1452. Abstract, Google Scholar 13 : Urethral recurrence in patients with orthotopic ileal neobladders.. J. Urol.1996; 156: 1615. Link, Google Scholar 14 : Lower urinary tract reconstruction in the female using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: update of continence results and flurourodynamic findings.. Urology1996; 48: 383. Google Scholar 15 : Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women.. J. Urol.1995; 154: 2044. Abstract, Google Scholar 16 : Orthotopic ileal neobladder in female patients after radical cystectomy: 2-year experience. J. Urol., part 21995; 153: 956. Link, Google Scholar 17 : The ileal neobladder in women: 9 years of experience with 18 patients.. J. Urol.1996; 155: 76. Abstract, Google Scholar 18 Tanagho E.A. Personal communication, 1997. Google Scholar Departments of Urology and Pathology, University of Southern California, Los Angeles, California.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByBailey G, Blackburne A, Ziegelmann M and Lightner D (2018) Outcomes of Surgical Management in Patients with Stress Urinary Incontinence and/or Neovesicovaginal Fistula after Orthotopic Neobladder DiversionJournal of Urology, VOL. 196, NO. 5, (1478-1483), Online publication date: 1-Nov-2016.Finley D, Lee U, McDonough D, Raz S and deKernion J (2018) Urinary Retention After Orthotopic Neobladder Substitution in FemalesJournal of Urology, VOL. 186, NO. 4, (1364-1369), Online publication date: 1-Oct-2011.Ali-El-Dein B, Shaaban A, Abu-Eideh R, El-Azab M, Ashamallah A and Ghoneim M (2018) Surgical Complications Following Radical Cystectomy and Orthotopic Neobladders in WomenJournal of Urology, VOL. 180, NO. 1, (206-210), Online publication date: 1-Jul-2008.QUEK M, GINSBERG D, WILSON S, SKINNER E, STEIN J and SKINNER D (2018) PUBOVAGINAL SLINGS FOR STRESS URINARY INCONTINENCE FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMENJournal of Urology, VOL. 172, NO. 1, (219-221), Online publication date: 1-Jul-2004.WILSON S, QUEK M and GINSBERG D (2018) TRANSURETHRAL INJECTION OF BULKING AGENTS FOR STRESS URINARY INCONTINENCE FOLLOWING ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMENJournal of Urology, VOL. 172, NO. 1, (244-246), Online publication date: 1-Jul-2004.Ali-El-Dein B, Gomha M and Ghoneim M (2018) Critical Evaluation of the Problem of Chronic Urinary Retention After Orthotopic Bladder Substitution in WomenJournal of Urology, VOL. 168, NO. 2, (587-592), Online publication date: 1-Aug-2002.Steinberg G, Rinker-Schaeffer C, Sokoloff M and Brendler C (2018) Highlights Of The Society Of Urologic Oncology Meeting, June 2, 2001Journal of Urology, VOL. 168, NO. 2, (653-659), Online publication date: 1-Aug-2002.PRUTHI R, PETRUS C and BUNDRICK W (2018) NEW ONSET VESICOVAGINAL FISTULA AFTER TRANSURETHRAL COLLAGEN INJECTION IN WOMEN WHO UNDERWENT CYSTECTOMY AND ORTHOTOPIC NEOBLADDER CREATION: PRESENTATION AND DEFINITIVE TREATMENTJournal of Urology, VOL. 164, NO. 5, (1638-1639), Online publication date: 1-Nov-2000.JONES J, MELCHIOR S, GILLITZER R, FICHTNER J, EL-MEKRESH M and THÜROFF J (2018) URETHRAL RECURRENCE OF TRANSITIONAL CELL CARCINOMA IN A FEMALE PATIENT AFTER CYSTECTOMY AND ORTHOTOPIC ILEAL NEOBLADDERJournal of Urology, VOL. 164, NO. 5, (1646-1646), Online publication date: 1-Nov-2000.MILLS R and STUDER U (2018) FEMALE ORTHOTOPIC BLADDER SUBSTITUTION: A GOOD OPERATION IN THE RIGHT CIRCUMSTANCESJournal of Urology, VOL. 163, NO. 5, (1501-1504), Online publication date: 1-May-2000.FUJISAWA M, GOTOH A, MIYAZAKI S, NAKAMURA I, HARA I, OKADA H, ARAKAWA S and KAMIDONO S (2018) SIGMOID NEOBLADDER IN WOMEN AFTER RADICAL CYSTECTOMYJournal of Urology, VOL. 163, NO. 5, (1505-1509), Online publication date: 1-May-2000.TCHETGEN M, SANDA M, MONTIE J and FAERBER G (2018) COLLAGEN INJECTION FOR THE TREATMENT OF INCONTINENCE AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMENJournal of Urology, VOL. 163, NO. 1, (212-214), Online publication date: 1-Jan-2000.SCHOENBERG M, HORTOPAN S, SCHLOSSBERG L and MARSHALL F (2018) ANATOMICAL ANTERIOR EXENTERATION WITH URETHRAL AND VAGINAL PRESERVATION: ILLUSTRATED SURGICAL METHODJournal of Urology, VOL. 161, NO. 2, (569-572), Online publication date: 1-Feb-1999.SHIMOGAKI H, OKADA H, FUJISAWA M, ARAKAWA S, KAWABATA G, KAMIDONO S and YAMANAKA N (2018) LONG-TERM EXPERIENCE WITH ORTHOTOPIC RECONSTRUCTION OF THE LOWER URINARY TRACT IN WOMENJournal of Urology, VOL. 161, NO. 2, (573-577), Online publication date: 1-Feb-1999.ALI-EL-DEIN B, EL-SOBKY E, HOHENFELLNER M and GHONEIM M (2018) ORTHOTOPIC BLADDER SUBSTITUTION IN WOMEN: FUNCTIONAL EVALUATIONJournal of Urology, VOL. 161, NO. 6, (1875-1880), Online publication date: 1-Jun-1999.STEIN J, LIESKOVSKY G, GINSBERG D, BOCHNER B and SKINNER D (2018) THE T POUCH: AN ORTHOTOPIC ILEAL NEOBLADDER INCORPORATING A SEROSAL LINED ILEAL ANTIREFLUX TECHNIQUEJournal of Urology, VOL. 159, NO. 6, (1836-1842), Online publication date: 1-Jun-1998. Volume 158Issue 2August 1997Page: 400-405 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information John P. Stein More articles by this author Gary D. Grossfeld More articles by this author John A. Freeman More articles by this author David Esrig More articles by this author David A. Ginsberg More articles by this author Richard J. Cote More articles by this author Eila C. Skinner More articles by this author Stuart D. Boyd More articles by this author Gary Lieskovsky More articles by this author Donald G. Skinner More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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