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

Operative results of ileal neobladder by the Hautmann procedure were studied in the patients with bladder cancer. From 1990 to 1993, 23 patients underwent total cystoprostatectomy for transitional cell carcinomas of the bladder. In 12 of these patients, an ileal neobladder was constructed for total bladder replacement under the following criteria; patients 1) with cancer confined in the bladder (T3b, M0, N0 or less), 20 without carcinoma in situ extending to more than half of urothelium of the bladder, 3) without cancerous lesion in the bladder neck or the prostatic urethra, 4) with performance status of 0 and the age of 75 or less. Pathologically, the disease was grade 2 in 3 patients, grade 3 in 9, stage pT1b in 3, stage pT2 in 4, stage pT3a in 1 and stage pT3b in 4. Two of 3 patients with the disease of stage pT1b had multiple papillary tumors. The remaining one patient had microinvasive cancer that carcinoma in situ infiltrated into submucosal area. Radical cystoprostatectomy and total bladder replacement by Hautmann procedure was performed in all patients. The maximum neobladder capacity was 349.5 +/- 58.1 ml (mean +/- SD). The intravesical pressure at maximum capacity was 30.6 +/- 6.2 cmH2O. At half maximum capacity, the intravesical pressure was 17.1 +/- 6.8 cmH2O. the maximum urethral closure pressure and the functional urethral length were 89.2 +/- 38.1 cmH2O and 25.5 +/- 7.0 mm, respectively. One patient had stress urinary incontinence. Slight nocturnal incontinence was found in 2 patients and nocturia was 1.86 +/- 0.55 times.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Experience of ileal neobladder for bladder cancer by Hautmann procedure]. 780 69

To improve the outcome and patient acceptance of bladder substitution, five male patients underwent O-shaped ileal neobladder reconstruction, after radical cystoprostatectomy for invasive bladder cancer, with a mean follow-up of 11 months. With only 40 cm of ileal segment, an O-shaped neobladder was constructed after complete detubularization. Bilateral ureters were implanted using the Le Duc-Camey method. Six months after operation, all patients were totally continent during the day time, and one patient suffered from mild incontinence at night, which could be overcome by waking to void once or twice. The satisfactory continence levels are in agreement with a urodynamic study of the neobladder which showed a low pressure, high-capacity (mean, 456 mL) reservoir in the cystometric tracings. The mean maximal flow rate was 22.2 mL/sec, the mean residual urine was minimal (10 to 20 mL), the mean maximal urethral closing pressure was 74.4 cm H2O and the mean functional profile length was 2.9 cm. All renal units do not have neovesico-ureteral reflux. Two patients showed unilateral hydronephrosis which subsided later, one patient sustained bilateral hydronephrosis and died of jejunal perforation five months postoperatively. There were few perioperative complications and no patient expressed regret at having undergone the procedure. We consider bladder substitution to be the treatment of choice in male patients requiring radical cystoprostatectomy.
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PMID:Ileal neobladder reconstruction after radical cystoprostatectomy. 786 60

Urodynamic investigation was performed in 12 men, 3 to 8 months after cystoprostatectomy for bladder cancer and bladder substitution, using a detubularized ileal segment as described by Studer-Zingg. All patients underwent a standard urodynamic evaluation and extramural ambulatory urodynamic monitoring (e.a.m.). Ten patients were continent by day and 3 were incontinent during the night to a degree that necessitated use of a condom catheter. Three patients awakened every 3 hours to void and 6 had to void 1-2 times nightly. The residual urine was over 100 ml in 3 patients; it was low or absent in the remainder. Micturition was achieved by straining, with a maximum flow rate of 13 ml per second or greater, except in 2 patients. In 2 patients a urethral narrowing was found at the urethro-ileal anastomosis, and in 1 of them an incoordination between the neobladder and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehabilitation. The incidence of nocturnal incontinence was 56.6%. In 2 patients urethral pressure profile revealed hypotonia, with a maximum urethral closure pressure (MUCP) < 45 cm H2O. During e.a.m. study pressure values in the neobladder usually ranged below 15 cm H2O and exceeded 35 cm H2O in only 1 patient who complained of daytime and nocturnal incontinence. Neobladder compliance was normal in all cases. In order to achieve a complete rehabilitation after operation, the patient should be instructed to follow a careful training in order to prevent overdistention of the neobladder by voiding at regular intervals and to obtain continence.
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PMID:Orthotopic ileal bladder substitute after radical cystectomy: urodynamic features. 792 Jun 82

The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatectomy for bladder cancer and bladder substitution with a detubularized ileal segment as described by Studer-Zingg. Sixteen patients were continent by day and 3 were incontinent during the night so as to require the use of a condom catheter. The residual urine was over 100 ml in 3 patients, while it was low or absent in the remainder. Micturition was performed by straining, and maximal flow rates were normal, although the pattern was intermittent. The incidence of nocturnal incontinence was 55.5%. Measurement of the urethral pressure profile revealed a shortened functional length, and low pressure was found in 3 patients, with a maximum urethral closure pressure < 45 cm H2O. During extramural ambulatory urodynamic monitoring, pressure values in the neobladder usually ranged below 20 cm H2O and exceeded 34 cm H2O in only 2 patients who complained of daytime and nocturnal incontinence. The urodynamic features of the neobladder in patients who underwent radical cystoprostatectomy and bladder replacement with a detubularized ileal segment indicate low pressure at high-level filling.
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PMID:Behaviour and urodynamic properties of orthotopic ileal bladder substitute after radical cystectomy. 797 82

We constructed an ileal neobladder in three patients using Hautmann's technique. The patients were men 51 and 67 years old with invasive bladder cancer and a 45-year-old woman with intractable hemorrhagic cystitis induced by cyclophosphamide. The urethral catheter was removed on the 21st postoperative day. At 2 to 5 months following operation, 3 patients had a vesical capacity of 270 to 500 ml and the maximum volume of urine excreted at one voiding was 130 ml to 400 ml. Voiding cystography disclosed no vesico-ureteral reflux. Two patients required abdominal straining at urination and another patient complained of a slight degree of nocturnal incontinence. Intravesical pressure was retained below 10 cm in hydrostatic height in two patients. On the other hand, it gradually increased as the neobladder was extended in another one. No uninhibited contraction was demonstrated by cystometric examination. The serum chloride level indicated almost the maximum normal value in all patients. Neither hydronephrosis nor residual urine was seen on drip infusion pyelography. The postoperative results indicate that the ileal neobladder using Hautmann's technique may become a very useful way to reconstruct the urinary tract.
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PMID:[Bladder substitution using ileal neobladder after total cystectomy: report of three cases]. 810 71

Between April 1986 and October 1992, a total of 229 patients with invasive bladder cancer underwent radical cystectomy and lower urinary tract reconstruction by means of the ileal neobladder. The perioperative mortality was 2.4%. Subsequently 10.5% of the patients suffered from early complications that led to relaparotomy and 3.8% of the patients had bowel occlusion. Significant late complications were urethro-ileal strictures (6.7%) and stenosis of the ureteral anastomosis (3.3%). Despite a very strict definition of continence, only 2 patients with a follow up of more than 2 years had an incontinence grade 3. Most (77%) of the patients in this collective were perfectly continent day and night, while 11.5% had only occasional spotting and wore pads to be on the safe side. In conclusion, the medium-term results are now available (average follow up 41 months) and show that the ileal neobladder is the treatment of choice for male patients after radical cystectomy for the treatment of invasive bladder cancer.
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PMID:[Functional results and complications of the ileal neobladder in over 200 patients]. 814 32

Between April 1993 and August 1995, a Hautmann's ileal neobladder was created in 37 men after total cystectomy for bladder cancer. Ureteroileostomy was performed using a submucosal tunnel instead of the Le-Duc Camey procedure. There was no operative mortality and only a few early complications. The mean postoperative follow-up time was 16 months, with a range of 3 to 31 months. Hydronephrosis occurred in 3 patients, being caused by stenosis at the uretero-ileo anastomosis in 2 and by proximal stenosis in 1. Neobladder-ureteral reflux did not occur in any of the patients. Postoperative ileus developed in 3 patients, and one required laparotomy. Stenosis of the urethro-ileal anastomosis developed in 3 patients, who were successfully treated by transurethral incision. Thirty five patients achieved daytime continence, while 2 patients had slight incontinence. Twenty nine patients achieved nighttime continence, and most of the patients awoke 1-4 times to prevent overflow incontinence. The mean maximum flow rate, average flow rate and post-voiding residual urine volume were respectively 15.3 ml/sec, 5.5 ml/sec and 81 ml at 6 months postoperatively, and 14.9 ml/sec, 5.4 ml/sec and 76 ml at 12 months. Four patients with more than 100 ml of residual urine required sterile intermittent catheterization 2-4 times a day. Urethral recurrence was detected in 2 patients. One was treated with transurethral resection and cisplatinum-based systemic chemotherapy, and the other required urethrectomy and urinary diversion using a new continent efferent limb.
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PMID:[Hautmann's ileal neobladder: experience of 37 cases]. 874 Dec 95

Multimodality organ-sparing treatment has, during the last decade, become the standard of care for many common malignancies. In appropriately selected patients with muscle-invading bladder cancer, bladder-preserving treatment combining surgical transurethral resection (TUR) with chemoradiation therapy offers a chance for long-term cure and survival equal to cystectomy, while also affording a 60% to 70% chance of maintaining a normally functioning bladder. Selection criteria helpful in determining appropriate patients for bladder preservation include such variables as small tumor size, that a visibly complete TUR is possible, the absence of hydronephrosis and that a complete response (CR) to induction chemoradiotherapy was achieved. Selecting patients based on response to induction therapy allows for prompt cystectomy if residual disease is found or for prompt consolidation chemoradiotherapy if a CR with induction therapy is achieved. Bladder-preserving treatment usually results in a normally functioning bladder without incontinence or hematuria for stage T2 and T3a patients. Stage T3b-T4 patients are locally controlled less frequently using these techniques. However, no data exist to suggest that patients with more advanced disease are in any way disadvantaged by preoperative chemoradiotherapy as an attempt at bladder conservation. Patients require close urological surveillance as do any patients with superficial bladder cancer who are being treated conservatively. As studies addressing the possibility of organ preservation continue to show positive results, more patients will become informed about and will be offered selective bladder-sparing approaches as one-treatment option.
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PMID:Conservative surgery, patient selection, and chemoradiation as organ-preserving treatment for muscle-invading bladder cancer. 889 72

Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.
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PMID:Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer. 912 53

The Davis technique has been used in 42 male patients with invasive bladder cancer, node-negative, and no bladder neck or prostatic involvement with TCC. Patients were told before the operation that there might be occasional difficulties with voiding and nocturnal incontinence, and that catheterisation might sometimes be necessary. All had undergone cysto-prostatectomy and bilateral pelvic lymphadenectomy. A 40 cm segment of ileum with the most dependent mesentery was used to make the urethro-ileal anastomosis. It was placed in a U-shaped configuration and the back wall closed with absorbable staples. Using electro-cautery, the segment was opened to gain access to the anterior staples, which were then removed. The segment was then folded up to form a conventional Kock pouch, with two corners. Finally the anterior portion was closed with absorbable staples or sutures. After three months approximately 95% of patients remained dry during the daytime and 75% at night. A total of 90% of patients were highly satisfied with the outcome, dissatisfaction relating mainly to incontinence and the need to catheterize.
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PMID:[Orthotopic replacement of the bladder]. 942 11


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