Document Type

Article

Department

Urology

Abstract

OBJECTIVE:

To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy.

STUDY DESIGN:

Case series.

PLACE AND DURATION OF STUDY:

Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010.

METHODOLOGY:

Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients.

RESULTS:

A total of 29 patients (23 males and 6 females) with mean age of 59 ± 12 years were included for the final analysis. The mean duration of surgery (both radical cystectomy and urinary diversion) was 520 ± 70 minutes. Perioperative complication rate was 24% (n=7) with surgical site infection in 4 patients, sepsis in 1 patient and 2 had ureteroileal leak. At 6 months follow-up, 22 patients were fully continent while 7 patients had minimal stress / nocturnal incontinence. The continence rate was 93% (n=27) at one year follow-up. The mean capacity of neo-bladder at 6 months was 384 ± 66 mLs. The late complication rate was 17% (n=5). Three patients developed anastomotic stricture requiring transurethral incision of neo bladder neck, one formed stone in neo-bladder and one developed incision hernia. All patients had preserved renal functions on follow-up. The survival rate was 80% (n=23) at a median follow-up of 66.4 ± 36 months. Two patients developed local recurrence and four developed distant metastasis.

CONCLUSION:

Studer ileal neo-bladder is a safe and effective option for urinary diversion in select patients with good oncological and functionaloutcomes comparable to contemporary literature, even in a low volume center.

Publication

Journal of The College of Physicians and Surgeons Pakistan

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