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Sadao Kamidono - One of the best experts on this subject based on the ideXlab platform.
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Significance of renal function in changes in acid-base metabolism after orthotopic bladder replacement: colon Neobladder compared with ileal Neobladder.
International journal of urology : official journal of the Japanese Urological Association, 2004Co-Authors: Hideaki Miyake, Sadao Kamidono, Soichi Arakawa, Hiroshi Eto, Shoji Hara, Isaco HaraAbstract:Background: The objective of this study was to determine whether renal function influences the acid–base metabolism in patients undergoing orthotopic bladder replacement using intestinal segment. Methods: Acid–base balance, serum electrolytes and renal function were studied in 30 patients with colon Neobladder and 18 patients with ileal Neobladder. Mean follow up was 51 months. Effects of renal function on acid–base metabolism in both types of bladder replacement were compared. Therapeutic efficacy of the sodium bicarbonate administration was also evaluated in cases with hyperchloremic acidosis. Results: No significant differences were observed in any of the variables examined between the colon and ileal Neobladder groups, except for potassium concentration. Although metabolic acidosis was detected using the Siggard–Anderson acid–base nomogram in eight (26.7%) and seven (38.9%) patients in the colon and ileal Neobladder groups, respectively, this difference was not significant. In both the colon and ileal Neobladder groups, the serum creatinine concentrations in patients diagnosed with metabolic acidosis were significantly higher than in those diagnosed with a normal metabolic status. Furthermore, as a result of severe metabolic acidosis, three (10.0%) and three (16.7%) patients in the colon and ileal Neobladder groups, respectively, were administered sodium bicarbonate and their metabolic status was fully normalized. Conclusions: Despite there being no statistical difference, patients with ileal Neobladder may more easily develop metabolic acidosis compared with those with colon Neobladder. In addition, a close association between the serum creatinine level and the degree of metabolic acidosis was observed in both groups. However, even if severe metabolic acidosis occurs, it is relatively easy to correct using sodium bicarbonate. These findings suggest that it might be safe to use a colon segment for orthotopic bladder reconstruction in patients with higher serum creatinine levels, despite no significant difference in acid–base metabolism and detection rates of metabolic acidosis between the colon and ileal Neobladder groups.
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carcinoma in situ spread to mucosa of sigmoid colon Neobladder
Urology, 2003Co-Authors: Isao Hara, Hiroshi Okada, Hideaki Miyake, Shoji Hara, Gaku Kawabata, Sadao KamidonoAbstract:Abstract This is the first case of carcinoma in situ (CIS) of a transitional cell carcinoma that had spread into a Neobladder constructed using a bowel segment associated with local recurrence at the ureteral-Neobladder anastomosis. Considering that the CIS lesion was found in macroscopically intact epithelium remote from the main tumor, this strongly suggests that CIS could arise from solid tumor by implantation. Although some studies have reported secondary malignancy occurring in the Neobladder, most have been adenocarcinoma that arose from the replaced bowel segment. To our knowledge, the present case is the first of widespread CIS of transitional cell carcinoma in an orthotopic Neobladder.
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An Evaluation of Quality of Life in Patients Who Underwent Orthotopic Bladder Replacement after Cystectomy: Comparison of Ileal Neobladder versus Colon Neobladder
Urologia internationalis, 2002Co-Authors: Hideaki Miyake, Akinobu Gotoh, Sadao Kamidono, Hiroshi Okada, Masato Fujisawa, Ichiro Nakamura, Soichi Arakawa, Hiroshi Eto, Isao HaraAbstract:Objective: The objective of this study was to determine whether the quality of life (QOL) in patients who underwent orthotopic bladder replacement after radical cystectomy was affected by the intestinal segment used for the creation of a Neobladder. Materials and Methods: A total of 52 patients who underwent radical cystectomy for bladder cancer were included in this study; i.e., 24 patients with an ileal Neobladder and 28 patients with a sigmoid Neobladder. QOL was evaluated using the SF-36 health-related QOL survey and a questionnaire designed to evaluate the continent status. Results: The mean follow-up periods for patients with an ileal and a sigmoid Neobladder was 40.2 and 43.1 months, respectively. The SF-36 survey revealed that patients with colon Neobladder had a significantly higher score for role-emotional functioning than those with ileal Neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon Neobladders; however, general health and social functioning in patients with both types of Neobladder appeared to be significantly lower than those in the general population in the United States. The results of the questionnaire analyzing the continent status were also similar between these two groups, including the desire to urinate, the incidence of both day- and nighttime urinary leakage, the frequency of pad exchange, and the concern of urine odor. Conclusions: Six of the eight scales concerning health-related QOL were favorable with both patients with ileal and colon Neobladders, and the health-related QOL in orthotopic Neobladder patients except for role-emotional functioning was not affected by the segment of the intestine used for Neobladder construction. Moreover, no significant differences were observed in the QOL associated with continent status between these two groups. Therefore, patients with both types of orthotopic Neobladder were generally satisfied with their health-related as well as disease-specific QOL.
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D -Xylose absorption after urinary orthotopic bladder replacement: colon Neobladder compared with ileal Neobladder
International journal of urology : official journal of the Japanese Urological Association, 2002Co-Authors: Shoji Hara, Sadao Kamidono, Hiroshi Okada, Soichi Arakawa, Hideaki Miyake, Isao HaraAbstract:Background : To evaluate the digestive and absorptive status using the D -xylose test in patients who underwent radical cystectomy and orthotopic bladder replacement either by colon or ileal segment. Methods : D -Xylose serum levels after an oral load, nutritional status, plasma vitamin B12 levels, and acid-base and electrolyte balances were studied in 18 patients with colon Neobladder and 12 patients with ileal Neobladder. Mean follow-up period was 51 months. Results of both types of bladder replacement and a healthy control group were compared. Results : Although no significant difference in the changes of plasma levels of D -xylose after oral load was observed between patients with colon Neobladder and healthy controls, plasma levels of D - xylose 90 min after oral load in patients with ileal Neobladder were significantly lower than those with colon Neobladder. In contrast, there was no significant difference in nutritional status, plasma levels of vitamin B12, and acid-base and electrolyte balances between patients with colon and ileal Neobladders. Conclusion : Despite acceptable nutritional status, intestinal malabsorption might be present in patients with ileal Neobladder, as indicated by the plasma levels of D -xylose, while the colon neo- bladder group showed no significant differences compared with normal controls. Therefore, absorp- tive and metabolic status should be carefully monitored after ileal Neobladder creation.
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Increased serum carcinoembryonic antigen level in patients undergoing colon Neobladder replacement compared with ileal Neobladder replacement.
Urology, 2002Co-Authors: Isao Hara, Hiroshi Okada, Masato Fujisawa, Soichi Arakawa, Hideaki Miyake, Hiroshi Eto, Shoji Hara, Yoshizumi Takechi, Sadao KamidonoAbstract:Abstract Objectives. To compare the serum and urinary carcinoembryonic antigen (CEA) levels for assessment of possible risk of malignant transformation in patients with orthotopic Neobladder. Methods. The serum and urinary levels of CEA, nutritional status, and acid-base and electrolyte balances were studied in 87 patients after radical cystectomy (22 with ileal Neobladder, 28 with colon Neobladder, and 37 with ileal conduit). The results of these groups were compared. Results. The serum CEA level in patients with colon Neobladder, ileal Neobladder, and ileal conduit was 5.4 ± 3.0, 3.7 ± 1.6, and 3.1 ± 1.5 ng/mL, respectively. The serum CEA level in the colon Neobladder group was significantly higher than the levels in the remaining two groups ( P P Conclusions. These findings suggest that colon bladder replacement caused significantly increased serum CEA values compared with ileal Neobladder or ileal conduit; however, the elevated serum CEA level correlated with the urinary CEA level, irrespective of other clinical factors. Therefore, the elevated serum CEA in the colon Neobladder group may have been due to reabsorption of CEA in urine rather than to an association with malignant changes in the bowel segments used for Neobladder creation.
Siamak Daneshmand - One of the best experts on this subject based on the ideXlab platform.
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Voiding Dysfunction After Neobladder Urinary Diversion
Current Bladder Dysfunction Reports, 2020Co-Authors: Saum Ghodoussipour, Siamak DaneshmandAbstract:Radical cystectomy and urinary diversion remains the gold standard treatment for patients with high risk or muscle invasive bladder cancer. Despite the fact that a majority of patients are eligible for orthotopic Neobladder, over 85% of patients receive incontinent urinary diversions, primarily over concerns for complications or postoperative voiding dysfunction. In this review, we explore the incidence, etiology, and treatment of voiding dysfunction after orthotopic Neobladder creation in male and female patients. Voiding dysfunction after orthotopic Neobladder consists of urinary incontinence and urinary retention. Both are well-recognized potential sequelae, but occur more commonly in female patients. Recent studies have characterized voiding dysfunction as a dynamic problem that improves with time. While treatment options are limited, several techniques exist to minimize the risks of voiding dysfunction after orthotopic Neobladder. Despite excellent functional outcomes in the majority of patients, concerns over voiding dysfunction after orthotopic Neobladder may in part explain the disparity in receipt of incontinent versus continent urinary diversions. More prospective and patient-reported studies of voiding outcomes are required and newer more effective treatment options for voiding dysfunction are needed.
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Orthotopic urinary diversion in the elderly
World Journal of Urology, 2016Co-Authors: Cory M. Hugen, Siamak DaneshmandAbstract:Introduction Age is an established risk factor for developing bladder cancer and is associated with increased stage and worse treatment outcomes. Furthermore, elderly patients who require radical cystectomy are more likely to undergo an incontinent urinary diversion compared with younger patients. Methods To evaluate whether evidence exists to support performing an orthotopic Neobladder in the elderly, we reviewed the literature to identify studies reporting outcomes, complications, patient-selection criteria, and quality-of-life data on elderly patients who underwent orthotopic Neobladder following radical cystectomy. Results While age was shown to be a risk factor for complications following orthotopic Neobladder, similar complication rates were reported between those who received either an orthotopic Neobladder or ileal conduit when compared within age groups. Additionally, in properly selected elderly patients, similar outcomes and quality of life can be expected when compared with younger patients. Conclusions It is appropriate to offer an orthotopic Neobladder to well-selected elderly patients following radical cystectomy.
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randomized trial of studer pouch versus t pouch orthotopic ileal Neobladder in patients with bladder cancer
The Journal of Urology, 2015Co-Authors: Eila C Skinner, Gus Miranda, Siamak Daneshmand, Adrian Fairey, Susan Groshen, Jie Cai, Donald G SkinnerAbstract:Purpose: The need to prevent reflux in the construction of an orthotopic ileal Neobladder is controversial. We designed the USC-STAR trial to determine whether the T-pouch Neobladder that included an antireflux mechanism was superior to the Studer pouch in patients with bladder cancer undergoing radical cystectomy.Materials and Methods: This single center, randomized, controlled trial recruited patients with clinically nonmetastatic bladder cancer scheduled to undergo radical cystectomy with Neobladder. Eligible patients were randomly assigned to undergo T-pouch or Studer ileal orthotopic Neobladder. Treatment assignment was not masked. The primary end point was change in renal function from baseline to 3 years. The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation was used to calculate the estimated glomerular filtration rate.Results: Between February 2002 and November 2009, 237 patients were randomly assigned to T-pouch ileal orthotopic Neobladder and 247 to Studer ileal orthotopic ne...
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Radiosensitivity of orthotopic ileal Neobladders.
Journal of Clinical Oncology, 2015Co-Authors: Leslie K. Ballas, Shelly X. Bian, Gus Miranda, Siamak DaneshmandAbstract:350 Background: A prior report from our institution documented that Kock ileal reservoirs can tolerate doses of 45-50.4Gy. This study provides retrospective information on the radiosensitivity of orthotopic Neobladders by reviewing the acute and late toxicity in patients who underwent post-operative radiotherapy following radical cystoprostatectomy with orthotopic ileal Neobladder reconstruction. Methods: The USC bladder cancer database was queried for all patients who underwent cystoprostatectomy and Neobladder reconstruction followed by adjuvant radiation therapy related to their bladder cancer. The original patient charts and radiation therapy records were reviewed to determine the dose of radiation received by the Neobladder. The patient charts were also reviewed to determine acute and late toxicity related to radiation. Results: From 1980 to 2013, 1,742 patients underwent radical cystoprostatectomy with orthotopic Neobladder reconstruction. Of those 1,742 patients, 10 patients met the criteria of the...
Michele Gallucci - One of the best experts on this subject based on the ideXlab platform.
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perioperative and mid term oncologic outcomes of robotic assisted radical cystectomy with totally intracorporeal Neobladder results of a propensity score matched comparison with open cohort from a single centre series
Ejso, 2018Co-Authors: Giuseppe Simone, Mariaconsiglia Ferriero, Salvatore Guaglianone, Gabriele Tuderti, Leonardo Misuraca, Umberto Anceschi, F Minisola, Michele GallucciAbstract:Abstract Aim In this study, we compared perioperative and oncologic outcomes of patients treated with either open or robot-assisted radical cystectomy and intracorporeal Neobladder at a tertiary care center. Methods The institutional prospective bladder cancer database was queried for “cystectomy with curative intent” and “Neobladder”. All patients underwent robot-assisted radical cystectomy and intracorporeal Neobladder or open radical cystectomy and orthotopic Neobladder for high-grade non-muscle invasive bladder cancer or muscle invasive bladder cancer with a follow-up length ≥2 years were included. A 1:1 propensity score matching analysis was used. Kaplan-Meier method was performed to compare oncologic outcomes of selected cohorts. Survival rates were computed at 1,2,3 and 4 years after surgery and the log rank test was applied to assess statistical significance between the matched groups. Results Overall, 363 patients (299 open and 64 robotic) were included. Open radical cystectomy patients were more frequently male (p = 0.08), with higher pT stages (p = 0.003), lower incidence of urothelial histologies (p = 0.05) and lesser adoption of neoadjuvant chemotherapy ( Conclusions Robot-assisted radical cystectomy and intracorporeal Neobladder provides comparable oncologic outcomes of open radical cystectomy and orthotopic Neobladder at intermediate term survival analysis.
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risk assessment of stone formation in stapled orthotopic ileal Neobladder
The Journal of Urology, 2015Co-Authors: Mariaconsiglia Ferriero, Salvatore Guaglianone, Rocco Papalia, Gian Luca Muto, Michele Gallucci, Giuseppe SimoneAbstract:Purpose: The increasing trend of performing radical cystectomy with a minimally invasive approach has made stapled Neobladders an attractive alternative to hand-sewn pouches. To date, data on the incidence and clinical impact of stone formation in long surviving Neobladder cases are scarce. We report a long-term, single-center experience of stapled orthotopic ileal Neobladder and identify predictors of stone formation.Materials and Methods: From May 2001 to October 2012, 445 consecutive patients (388 male, 57 female) underwent radical cystectomy and stapled orthotopic ileal Neobladder. Univariable and multivariable analyses were performed to identify independent predictors of an increased risk of stone formation.Results: At a median followup of 41 months (IQR 16–58) Neobladder stone formation occurred in 41 patients (9.2%). All of these patients successfully underwent endoscopic stone lithotripsy with 34 as outpatient procedures. On univariable Cox analysis only female gender (p = 0.001, HR 3.29, 95% CI 1...
Michael L. Blute - One of the best experts on this subject based on the ideXlab platform.
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Intracorporeal Neobladder reconstruction: pressure‐flow urodyamic studies in cadaveric orthotopic Neobladders
BJU international, 2011Co-Authors: Michael L. Blute, Arvin K. George, Amin S. Herati, Arun Srinivasian, Manish Vira, Louis R. Kavoussi, Lee RichstoneAbstract:Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To determine the pressure-flow characteristics of Neobladders created in various configurations that may be constructed intra-abdominally. Complete intracorporeal Neobladder construction has been previously described but is limited due to excessive operative time and the need for an advanced laparoscopic skill set. MATERIALS AND METHODS • Four Neobladder configurations were constructed, each using 20 cm of human cadaveric small intestine. The standard hand sewn Studer pouch was compared with a circular loop, W-pouch, and U-pouch with stapled anastamoses. • Pressure flow studies were completed using the Aquarius TT UDS system (Laborie Medical Technologies, Toronto, Ontario) and each Neobladder was filled to a pressure of 50 cm H2O. Neobladder change in pressure, capacity, and overall compliance were determined. RESULTS • The cystometric capacities of the stapled U-pouch, W-pouch, Circle pouch, and Studer pouch were 167.3 mL, 177.5 mL, 114 mL, and 145.2 mL respectively. The first increase in intravesical pressure was at 90.3 mL, 103 mL, 50 mL, and 85 mL. • The greatest compliance of 3.81 mL/cmH2O was demonstrated in the U-pouch, with the W-pouch revealing a compliance of 3.44 mL/cmH2O. • The least compliant Neobladder was the circle pouch (2.24 mL/cmH20) followed by the standard Studer pouch (2.94 mL/cmH2O). CONCLUSION • The construction of an orthotopic Neobladder must not only be technically feasible but maintain adequate capacity and compliance for optimal functioning. Pressure-flow studies demonstrated equivalent results in alternate Neobladder configurations. Additional data is needed to determine feasibility in vivo.
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comparison of studer ileal Neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications
The Journal of Urology, 1998Co-Authors: Bernard M Gburek, Michael M Lieber, Michael L. BluteAbstract:AbstractPurpose: We compare the perioperative and long-term morbidity of a cohort of patients who had undergone Studer ileal Neobladder urinary diversion with that of a similar cohort who had undergone ileal conduit urinary diversion during the same interval and by the same surgeons.Materials and Methods: Between 1990 and 1996 we performed Studer ileal Neobladder urinary diversion in 62 men and 4 women, and ileal conduit urinary diversion in 66 men. Mean age of the Neobladder and conduit patients was 62 and 69 years, and mean followup was 17 and 20 months, respectively.Results: Of 66 Neobladder cases (18%) 12 had a total of 16 perioperative complications and a 5% reoperation rate, whereas 12 of 66 conduit cases (18%) had a total of 17 perioperative complications and a 6% reoperation rate. Mean hospital stay was 13 days for each group. Of the Neobladder cases 14 (21%) had 14 late complications and an 11% reoperation rate, whereas 8 conduit cases (12%) had 9 late complications and an 8% reoperation rate.Con...
A Stenzl - One of the best experts on this subject based on the ideXlab platform.
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life after cystectomy and orthotopic Neobladder versus ileal conduit urinary diversion
Seminars in Urologic Oncology, 2001Co-Authors: Alfred Hobisch, Georg Bartsch, Kadir Tosun, Johann F Kinzl, Georg Kemmler, Lorenz Holtl, A StenzlAbstract:Patients frequently complain about changes in their everyday life after radical cystectomy and urinary diversion. The aim of this study was to compare subjective morbidity of ileal Neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent radical cystectomy due to a bladder malignancy were included in the study: 69 patients (67.6%) with an orthotopic Neobladder and 33 patients (32.4%) with an ileal conduit. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality-of-life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to elucidate specific items regarding urinary diversion. The questioning was performed by a nonurologist. The results obtained from the validated (QLQ-C30) and our self-designed questionnaire clearly demonstrate that patients with an orthotopic Neobladder better adapt to the new situation than patients with an ileal conduit. In addition, Neobladder to the urethra improves quality of life due to a better self-confidence, better rehabilitation as well as restoration of leisure, professional, traveling, and social activities, and reduced risk of inadvertent loss of urine. For example, 74.6% of Neobladder patients felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of Neobladder patients had wet clothes caused by urine leakage during day versus 48.5% of ileal conduit patients; 92.8% of Neobladder patients felt not handicapped at all; and 87% felt not sickly or ill in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Moreover, 97% of our Neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease in contrast to only 36% of ileal conduit patients. The results obtained by this study demonstrate that quality of life is preserved in a higher degree after orthotopic Neobladder than after ileal conduit urinary diversion.
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quality of life after cystectomy and orthotopic Neobladder versus ileal conduit urinary diversion
World Journal of Urology, 2000Co-Authors: Alfred Hobisch, Georg Bartsch, Kadir Tosun, Johann F Kinzl, Georg Kemmler, Lorenz Holtl, A StenzlAbstract:The impact of bladder removal and urinary diversion for patients' everyday life is largely unknown. The aims of this study were to compare subjective morbidity of ileal Neobladder to the urethra versus ileal conduit urinary diversion and to elucidate its influence on quality of life. A total of 102 patients who underwent cystectomy due to a bladder malignancy were included in the study. In 69 patients (67.6%) an orthotopic Neobladder and in 33 patients (32.4%) an ileal conduit was performed as urinary diversion. The compliance was 99% and mean follow-up was 37 months. All patients completed two retrospective quality of life questionnaires, namely the QLQ-C30 and a questionnaire developed at our institution to ask for urinary diversion specific items. The questioning and assessment was performed by non-urologists. The results obtained from the validated (QLQ-C30) and our own specially compiled questionnaire clearly demonstrate that patients with an orthotopic Neobladder are more able to adapt to the new situation than patients with an ileal conduit. In addition, Neobladder to the urethra improves the quality of life because it improves self-confidence, causes better rehabilitation as well as the restoration of leisure, professional, travelling, and social activities, and reduced risk of inadvertent loss of urine. For example, 92.8% of Neobladder patients did not feel handicapped at all, and 87% did not feel sick or ill, in contrast to 51.5% and 66.7% of ileal conduit patients, respectively. Of the Neobladder patients, 74.6% felt absolutely safe with the urinary diversion in contrast to 33.3% in the ileal conduit group. Only 1.5% of Neobladder patients had wet clothes caused by urine leakage during the day, versus 48.5% of ileal conduit patients. Moreover, 97% of our Neobladder patients would recommend the same urinary diversion to a friend suffering from the same disease, but only 36% of ileal conduit patients would do so. These results demonstrate that the quality of life is preserved to a higher degree after orthotopic Neobladder than after ileal conduit urinary diversion.
