Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality

doi:10.1016/S0090-4295(99)00619-6

Urology

Volume 55, Issue 6, June 2000, Pages 852-855

This study was presented at the 1999 Annual Meeting of the American Urological Association Dallas, May 1999.

https://doi.org/10.1016/S0090-4295(99)00619-6 Get rights and content

Abstract

Objectives. To compare postoperative morbidity and mortality in a concurrent and contemporary series of patients who underwent radical cystectomy with ileal conduit versus orthotopic neobladder.

Methods. The data of 198 patients were reviewed, 117 with orthotopic reconstruction and 81 with ileal conduit during a 5-year time frame. Thirty-day morbidity, mortality, reoperative rates, and parameters associated with the surgical procedures were obtained from chart review.

Results. No perioperative or postoperative deaths occurred in either group. The median operative time for the ileal conduit was 201 minutes (range 140 to 373), and for the orthotopic neobladder, it was 270 minutes (range 230 to 425). The median blood loss was 389 and 474 mL, respectively. The median length of hospitalization was 8 days for the ileal conduit group and 7 days for the orthotopic neobladder group. Diversion-related complications recognized within 30 days that ultimately required a return to the operating room occurred in 3.4% of those with a neobladder and 1.2% of those with an ileal conduit.

Conclusions. The orthotopic neobladder is a longer and technically more complex procedure than the ileal conduit procedure. However, no demonstrable difference in morbidity or perioperative complications were found between the two procedures in our review.

Section snippets

Material and methods

We reviewed 198 patients who underwent radical cystectomy and urinary reconstruction during a 5-year period ending in March 1999. One hundred seventeen patients underwent orthotopic CUR (group 1) and 81 patients underwent ileal conduit diversion (group 2). In group 1, 97 patients were men, and 20 were women; in group 2, 48 patients were men, and 33 were women. All the patients in both groups underwent radical cystectomy for muscle invasive carcinoma of the bladder, rapidly recurring high-grade

Results

No perioperative or postoperative deaths occurred in either group. In group 1, the median operative time was 270 minutes (range 230 to 425) compared with 201 minutes (range 140 to 373) in group 2. The median blood loss in group 1 was 474 mL (range 150 to 1700) and 389 mL (range 100 to 1400) in group 2. Patients in group 1 who received an orthotopic neobladder had a median length of hospitalization of 7 days (range 5 to 28) compared with 8 days (range 5 to 60) for patients in group 2 who

Comment

In some patients, an orthotopic neobladder after radical cystectomy provides an improved quality of life compared with an ileal conduit.2, 3 Certain patients are highly motivated to avoid an abdominal stoma. The functional voiding outcome with the neobladder is excellent, and almost all our patients achieved total daytime control. Fifteen percent required no more than a single pad to remain dry at night.

Despite these advantages, there is a general perception among urologists that the ileal

Conclusions

The orthotopic neobladder is technically a more complex procedure than the ileal conduit and requires a longer operative time. In our study, this did not translate into any identifiable increase in perioperative morbidity. The duration of hospitalization after the two procedures was comparable. Complications requiring a return to the operating room occurred with equal frequency with both procedures. For properly motivated patients, the orthotopic neobladder can be offered as a procedure with no

References (13)

O Williams et al.
Noncontinent urinary diversion
Urol Clin North Am
(1997)
P.C Weijerman et al.
Morbidity and quality of life in patients with orthotopic and heterotopic continent urinary diversion
Urology
(1998)
U.E Studer et al.
Ileal orthotopic bladder substitutes
Urol Clin North Am
(1997)
W.S McDougal
The continent urinary diversion
J Urol
(1987)
B.M Gburek et al.
Comparison of Studer ileal conduit urinary diversion with respect to perioperative outcome and late complications
J Urol
(1998)
H.A Frazier et al.
Complications of radical cystectomy and urinary diversiona retrospective review of 675 cases in 2 decades
J Urol
(1992)

There are more references available in the full text version of this article.

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Urinary Tract Infections After Urinary Diversion—Different Occurrence Patterns in Patients With Ileal Conduit and Orthotopic Neobladder
2018, Urology
To compare the incidence rate of urinary tract infections (UTIs) and associated pathogens between patients with ileal conduit and patients with orthotopic neobladder urinary diversion.
The medical records of 179 patients treated with radical cystectomy between 2006 and 2011 were reviewed and data pertaining to postoperative UTI were collected. UTI incidence was reported at 3 months' intervals and compared by diversion type. Preoperative predictors of UTI were evaluated with Cox regression analyses.
The study cohort included 130 patients with ileal conduit and 49 patients with orthotopic neobladder. Patients with a neobladder were younger (P <.001). Median follow-up was 38 months (IQR [interquartile range], 11-63). Median time from surgery to first infection was 1.5 months (IQR, 1-12.5) for patients with a neobladder and 11 months (IQR, 2.5-27) for patients with a conduit (P = .04). During the first 3 months after surgery, 29% of the patients with a neobladder and 8% of the patients with ileal conduit had a UTI episode (P = .001). Rates of UTI did not differ during subsequent follow-up. Diversion type was not associated with UTI on multivariable analysis. Escherichia coli was the most common pathogen in patients with a conduit (58%), and Klebsiella spp. in patients with a neobladder (29%).
The risk of UTI is significantly higher in patients with a neobladder during the first 3 months after surgery and comparable to patients with ileal conduit during subsequent follow-up. These findings may facilitate preoperative counseling regarding the expected risk of UTI after urinary diversion.
Urinary diversion in the genitourinary cancer survivor
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Urinary diversion has been in the scope of practice of Gynecologic Oncologists since the inception of the sub-specialty. However, many fewer urinary diversions are performed currently than in the past due to improved prevention of cervical cancer. The intent of this article is to provide a state of the art review for Gynecologic Oncologists. Surgeons performing these complex procedures must be knowledgeable about the differences between various types of continent and non-continent urinary diversions, and the principles of pre and post-operative care.
This includes the indications for surgery and pre-operative considerations, types of urinary diversion including continent and non-continent diversions, and the need for long-term follow-up with patients who undergo urinary diversion requiring lifelong follow up and testing for surveillance of the upper urinary tracts and to monitor for nutritional and metabolic alterations.
Comparison of Perioperative Morbidity of Radical Cystectomy with Neobladder Versus Ileal Conduit: A Matched Pair Analysis of 170 Patients
2016, Clinical Genitourinary Cancer
The objective of this study was to evaluate if use of an ileal conduit (IC) versus a neobladder (NB) during radical cystectomy (RC) can play a role in the morbidity of the surgical procedure.
Since 2001 our institution has prospectively maintained a database of more than 500 patients who have undergone RC. The records of 258 patients who received an RC and IC and 121 who received an RC and NB were reviewed for the present study. Using a binary logistic regression model a propensity score was generated for the following factors: sex, age, smoking habit, Charlson score, American Society of Anesthesiology score, preoperative hydronephrosis, and pathologic T stage. Two groups of patients with similar propensity scores were created with a ratio of 1:1, one group who received an IC and another who received an NB. The following features were compared between the 2 groups: blood loss, intraoperative complication rate, time to oral intake resumption, postoperative complication rate (overall, Clavien classification 1-2, Clavien classification 3-5, related to RC, related to urinary reconstruction).
In total, 170 patients were selected; 85 with NB, 85 with IC, and the 2 groups were well matched according to the desired features. No differences were noted for all of the compared features.
The morbidity of RC does not seem to be affected by the choice of IC versus NB.
Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: A systematic review
2013, European Urology
Postoperative paralytic ileus (POI) has profound clinical consequences because it represents a substantial burden on both patients and health care resources.
To determine the knowledge base regarding POI in the radical cystectomy (RC) population with an emphasis on preventive measures and risk factors.
A systematic literature search of Medline (1966 to February 2011) and a study review were conducted. Eligible studies explicitly reported the incidence of POI and/or at least two quantitative measures of gastrointestinal recovery.
The search identified 727 relevant articles; 77 met eligibility criteria, comprising 13 793 patients. Of these, 21 used explicit definitions of POI, and they varied widely. Across studies, the incidence of POI ranged from 1.58% to 23.5%. Possible risk factors for POI included increasing age and body mass index. Seventeen studies reported effects of an intervention on POI: 3 randomized controlled studies, 11 observational cohort studies with concurrent comparison, and 3 observational cohort studies with nonconcurrent comparison. Gum chewing was associated with shortened times to flatus (2.4 vs 2.9 d; p < 0.0001) and bowel movement (BM) (3.2 vs 3.9 d; p < 0.001) in one observational cohort study (n = 102); omission of a postoperative nasogastric tube (NGT) was associated with shorter time to flatus (4.21 vs 5.33 d; p = 0.0001) and shorter length of stay (14.4 vs 19.1 d; p = 0.001) in one observational cohort study (n = 430); and the routine use of bowel preparation was associated with an increased incidence of POI (5% vs 19%) in another series (n = 86). Additionally, readaptation of the dorsolateral peritoneal layer was shown to shorten times to flatus (p = 0.016) and times to BM (p = 0.011) in one randomized controlled study (n = 200).
The incidence/definition of POI after RC is highly variable. An improved reporting strategy is needed to identify true incidence and risk factors, and to guide future research for both potential preventive and therapeutic interventions.
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2022, Frontiers in Oncology

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¹: Dr. Koch is currently at the Department of Urology, Indiana University, Indianapolis, Indiana

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Adult urologyContinent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality

Abstract

Section snippets

Material and methods

Results

Comment

Conclusions

Urol Clin North Am

Urology

Urol Clin North Am

J Urol

J Urol

J Urol

Adult urology
Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality