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Query: UMLS:C0005684 (bladder cancer)
 16,431 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. From April 1986 through May 1989, 113 patients underwent this procedure at our institution. Of these patients 99 underwent simultaneous radical cystectomy for bladder cancer and 14 underwent bladder augmentation. The mean postoperative followup was 14.4 months, with a range of 1 to 36 months. There was no perioperative mortality. However, 7 patients died more than 2 months postoperatively: 5 of tumor progression, 1 of pneumonia and severe metabolic acidosis, and 1 of septicemia of unknown cause. Reoperation was necessary in only 13 patients; 10 patients required urethrotomy or dilation of urethral strictures. Day and night continence was preserved in 82.1% of all patients. Stress incontinence, which must be corrected by an artificial sphincter, was found in 4 patients (4.2%) and night-time incontinence that required an external device occurred in 5 (5.3%). Eight patients (8.4%) with mild stress incontinence required no further treatment. Pressure waves exceeding 22 cm. water seldom occurred and then only at maximum capacity. Our experience with this relatively simple system without a nipple is an overwhelming success. The need for reoperation is extraordinarily low and the high reservoir capacity results in continence from the beginning in most patients. The concept is sound and offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:The ileal neobladder: experience and results of more than 100 consecutive cases. 230 60

A group of 11 patients, 2 female and 9 male, underwent total bladder replacement using the ileocolonic segment (LeBag technique) with anastomosis of the bowel to the urethra. The diagnosis was invasive bladder cancer in 10 patients and severe intractable interstitial cystitis in 1. The surgical technique in the male patients was modified to simplify the procedure. The 2 female patients underwent insertion of an artificial sphincter around the bowel segment for a continence mechanism. One patient died 6 weeks post-operatively from a severe coagulopathy. Five of the 9 male patients are continent day and night, relying on their own residual sphincter mechanism, but the remaining 4 required insertion of the artificial urinary sphincter to achieve social continence. The surviving female patient is totally continent. All patients have voiding intervals of 4 to 6 h during the day and are thus continent both day and night, but in some cases the artificial sphincter was necessary to achieve this. Loss of the normal bladder-sphincter reflexes following cystectomy may account for the high incidence of nocturnal incontinence observed in most series. Total bladder replacement is now possible in both male and female patients, thus avoiding an abdominal stoma.
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PMID:Total bladder replacement in the male and female using the ileocolonic segment (LeBag). 235 12

The purpose of the study was to investigate to what extent ileal conduit urinary diversion influenced patients' capacity to work. Sixty-sex urostomy patients were interviewed. Forty-seven of those were employed before surgery. Sixteen of 47 patients (34%) made permanent changes in their working conditions immediately after surgery, i.e. they did not resume work or they changed from full-time to part-time work. The working conditions changed in similar ways for another 15 patients who initially had been able to resume. Bladder cancer patients were more likely to work less than patients with incontinence/bladder dysfunction. Nineteen patients obtained disability pension either immediately after surgery or later. Eight of those considered stoma related problems, mainly leakage, as the main reason for inability to work. Diagnosis, gender, and type of work did not seem to affect the frequency of disability pension.
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PMID:The impact on work ability of ileal conduit urinary diversion. 236 21

After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.
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PMID:Replacement of the bladder by the urethral Kock pouch: functional results, urodynamics and radiological features. 270 96

At the beginning of this century it was realised that peristalsis would cause incontinence if bowel was used for augmentation or substitution of the bladder. Trans-section of the antimesenteric border and cross-folding of the intestinal segments (Goodwin's cup-patch technique) is an efficient means of solving this problem and has been successfully used in the Kock pouch. We anastomosed the ileal low pressure reservoir to the membranous urethra in 22 male patients following radical cystoprostatectomy for bladder cancer. The mean observation time was 16 months (range 3-36). The capacity of the bladder substitute increased with time, the average being 450 ml after 6 months. In the first 4 patients with a short (2-5 cm) intestinal segment between the pouch and the urethra, micturition was prolonged, residual urine varied from 50 to 300 ml and bacteriuria was found. Occasional expulsions of several ml of urine were caused by peristalsis within this short tubular segment. In the following 18 patients, the low pressure reservoir was anastomosed directly to the membranous urethra. Micturition was good, with no notable residual urine, no bacteriuria and no paroxysmal urinary incontinence. However, a safety pad is used by half of the patients because once or twice a week, mainly at night, a few ml of urine may be lost. No significant changes in serum electrolytes, bicarbonate or creatinine were noted. With the three different antireflux techniques used, no obstructive or inflammatory changes in the upper urinary tracts were found, although no long-term antibiotic prophylaxis was given.
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PMID:Three years' experience with an ileal low pressure bladder substitute. 292 Feb 59

The Kock pouch has three major limitations at the present time: The efferent nipple valve remains by far the weakest link in the procedure. A 10 to 20 per cent failure rate is too high, and it remains to be seen whether further modifications will be successful in the long run. The long-term function is unproven, and it is possible that deleterious effects may be seen as additional follow-up is obtained. Theoretically, the low-pressure system afforded by the Kock pouch may be superior in long-term safety to that provided by reservoirs made from other bowel segments. A stoma is still necessary. In spite of the above, there is a need for this type of procedure. We cannot remain content with the ileal conduit and should continue to search for better functional diversions. It is a debatable issue relative to the superiority of an internal functional reservoir to the urethra, which may lead to night-time incontinence, versus a Kock pouch with a stoma, which must be intubated. Improvement in overall survival from bladder cancer may be hard to come by, unless effective systemic chemotherapy is available; one means is to perform the surgery without delay in patients with potentially lethal cancers. To do this on a large scale, we must make the surgery as safe as possible and provide the least disruption of lifestyle. In some patients an internal intestinal reservoir attached to the urethra will be possible. Other patients may elect for a Kock pouch, whereas others may even be best served by standard ileal conduit. The growth pains of the Kock pouch have been significant but not without a reward.
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PMID:Continent ileal urinary reservoir (Kock pouch). 396 27

Supravesical urinary diversion by ureterotransversopyelostomy (UTPS) with unilateral nephrostomy was performed in 57 patients. The age of the 33 women ranged between 42 and 86 (mean 65), of the 24 men between 39 and 77 (mean 62) years. With a single exception, the indication for diversion was palliative: 25 patients had advanced bladder cancer (T3/T4), and 19 had undergone irradiation; 24 patients showed vesico- (recto-) vaginal fistulas due to radiation for gynecological carcinomas. In 2 patients, the indication was urge-incontinence following former radiation therapy for uterine cancer, whereas 5 patients had advanced malignancies originating in the urethra, prostate, rectum or ovaries. The only case without malignant disease exhibited a contracted bladder of uncertain origin, together with an immunodeficiency syndrome. The approach used was an upper abdominal cross incision. In 35 patients, an anastomosis was done between the ureter and contralateral renal pelvis; in 22, a terminoterminal ureteral anastomosis was performed. For placement of the nephrostomy (49 terminal, 8 U-tube nephrostomies) we preferred the right side in 41 of 57 cases. The mean follow-up time in the 22 surviving patients was 36 months (range 2-108); the mean survival time in the 30 deceased patients was 12 months (range 0.5-87). With 4 exceptions, the cause of death was progression of the underlying tumors. Operative lethality was 1.75%, early surgical complication rate 7%, and rate of severe late complications 10.5%. The most frequent problems arose from the nephrostomy and from stenoses of the ureteropelvic or ureteral anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ureterotransversopyelostomy with unilateral nephrostomy]. 409 Jan 30

Orgotein efficacy in minimizing the local side effects induced by radiotherapy, administered to patients suffering from bladder or prostate cancer, was studied in 3 double-blind clinical trials. Assessment parameters such as efficacy, signs and symptoms of bladder disease were chosen as follows: incontinence, pain, dysuria, cystoscopic picture, maximal voiding volume, voiding frequency (day and night), diarrhoea, amount of anti-diarrhoea preparations consumed. In the first study orgotein was administered in a dose of 4 mg, 15-30 minutes after radiotherapy. Orgotein was found to be statistically significant superior to placebo when assessed according to the above mentioned criteria. Side effects that would have compelled stopping the orgotein therapy did not develop. In the second trial 50 patients suffering from prostatic carcinoma received after each radiotherapy (5,400 rad during 6 weeks) 8 mg orgotein or placebo. The radiotherapy-induced side effects were less common in the orgotein group than in the placebo group. The third clinical trial was conducted according to the same protocol as the two previous ones. Fifty patients with either prostate or bladder cancer were given orgotein or placebo in conjunction with radio-therapy. Only data of 26 out of 50 are yet available. These data show in agreement with two previous mentioned trials a significant superiority of orgotein compared to placebo.
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PMID:Orgotein efficacy in ameliorating side effects due to radiation therapy. 704 89

We have used a urethral colonic pouch for total bladder replacement in 6 bladder cancer patients after radical cystectomy. The distal ileum, cecum, ascending colon and the right third of the transverse colon were isolated. The cecum and colon were opened along the tenia and a detubulized pouch was created. The ureters were sutured to the terminal ileum. The maximum pressure wave measured ranged 22-58 cmH2O, and the amount of residual urine varied between 0 and 58 ml. All patients were completely continent during the day and slight incontinence at night was observed in 3. By amputating the right colonic artery, the pouch is easily moved to the urethral stump and serves as a low pressure neobladder after cystoprostatectomy.
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PMID:The colonic neobladder: a stoma-free bladder substitute after radical cystectomy--preliminary results in six patients. 761 82

Cystectomy with urinary diversion is the treatment for many patients with bladder cancer. The ileal conduit continues to be an effective solution to the diversion problem, but it brings with it problems related to management and body image. The development of the orthotopic neobladder to the urethra is a recent effort to return the body to the most natural structure and function. This development, however, brings its own set of problems to be overcome. The purpose of this exploratory study was to examine the adjustments reported by male patients with ileal conduits and neobladder replacements. A questionnaire was mailed 10 to 30 months after operation to 30 patients who underwent ileal conduit and neobladder surgery. The questionnaire explored sickness-related dysfunction and adjustments the patients had to make after operation. Twenty-three patients (12 with ileal conduits and 11 with neobladders) responded to the questionnaire. There were no statistically significant differences in sickness impact scores between the ileal conduit and neobladder groups. Few patients with ileal conduits reported problems with the device. All the patients with neobladders reported some continued incontinence, primarily at night. All the patients reported erectile dysfunction, but few had sought treatment for this problem. The patients with ileal conduits reported impact on their social activities more frequently. Future research with a larger sample is needed, but this pilot study suggests that health care workers can do more to facilitate the adjustment to loss of sexual function and social interaction.
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PMID:A comparison of adjustments to urinary diversions: a pilot study. 770 45


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