Document Detail


A new technique for creation of a sigmoid neobladder for urinary reconstruction: clinical outcome in 42 men.
MedLine Citation:
PMID:  12893329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To present the results of a new technique for construction of a sigmoid neobladder after radical cystectomy. METHODS: Forty-two men, 43 to 74 years of age (mean age 62 +/- 8), underwent radical cystectomy for invasive bladder cancer and had a sigmoid neobladder created using a modification of the standard ureterointestinal anastomosis with rotation of the reservoir. The mean follow-up of this retrospective study was 35 +/- 20 months (range 6 to 90). The blood chemistry was analyzed routinely during follow-up, and complications, continence, and voiding pattern were assessed at regular intervals. RESULTS: There were 21 early complications in 14 patients: persistent urinary leakage in 2; wound infection in 9; prolonged ileus in 4; leakage from the colonic anastomosis in 2; and pulmonary embolus in 2. One patient each had venous thrombus of the lower extremities and methicillin-resistant Staphylococcus aureus colitis. One patient died in the perioperative period of massive pulmonary embolus, yielding a mortality rate of 2.4%. Eleven late complications occurred in 9 patients. Stenosis of the ureterointestinal anastomosis developed in 2 of 82 anastomoses, stenosis of urethral anastomosis in 4, and neobladder-ureteral reflux in 1. A reservoir stone was found in 1 patient, and adenoma and adenocarcinoma of the reservoir occurred in 1 patient each. One patient developed symptomatic hyperchloremic metabolic acidosis, and routine electrolyte evaluation revealed a slight metabolic acidosis in 6 patients. Hypovitaminosis B(12) did not occur in any patients. Of the 42 patients, 40 could void volitionally without catheterization. Patient satisfaction on continence, by day and night, was 77.3% and 72.7%, respectively. The mean neobladder capacity and the mean residual urine volume was 375 +/- 116 mL (range 234 to 624) and 68 +/- 86 mL (range 4 to 365), respectively. CONCLUSIONS: The modified sigmoid neobladder provides satisfactory results after radical cystectomy.
Authors:
Masato Fujisawa; Atsushi Takenaka; Sadao Kamidono
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urology     Volume:  62     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-01     Completed Date:  2003-08-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  254-8     Citation Subset:  IM    
Affiliation:
Department of Urology, Kawasaki Medical School, Kurashiki, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Colon, Sigmoid / surgery*
Cystectomy / adverse effects,  methods*
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications / etiology
Reconstructive Surgical Procedures / adverse effects,  methods*
Recovery of Function / physiology
Retrospective Studies
Surgically-Created Structures / adverse effects,  physiology*
Treatment Outcome
Urinary Bladder / physiology,  surgery*
Urinary Bladder Neoplasms / surgery
Urinary Diversion / adverse effects,  methods*
Urinary Reservoirs, Continent / physiology
Urodynamics / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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