Articles

A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution? eulogo1

By: Wassim Kassoufa lowast , Richard E. Hautmannb, Bernard H. Bochnerc, Seth P. Lernerd, Renzo Colomboe, Alexandre Zlottaf and Urs E. Studerg

Published online: 01 September 2010

Keywords: Bladder cancer, Orthotopic bladder substitute, Neobladder, Continence, Functional results, Outcomes, Radical cystectomy

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Abstract

Context

Orthotopic bladder substitute (OBS) has been popularized over the past 2 decades as a diversion following radical cystectomy for invasive bladder cancer. Various reports, mostly single-center experiences, are published on patients with OBS.

Objective

This study reviews the literature regarding indications, postoperative care, complications, quality-of-life measures, as well as functional and oncologic outcomes that have been published on patients with OBS.

Evidence acquisition

An English-language literature review of the Medline database (1990 to January 2010) of published data on patients with OBS following radical cystectomy for bladder cancer was undertaken. Articles that included surgery for noncancer etiology were excluded.

Evidence synthesis

Indications and patient selection criteria have significantly widened over the past 2 decades. Comparable oncologic data have been reported between patients with OBS versus other diversions. Secondary urethral tumors seem less common in patients with OBS compared with those with conduits or continent cutaneous diversions. Durable daytime and nocturnal continence is achieved in 85–90% and 60–80%, respectively. Continence is inferior in elderly patients with OBS. Urinary retention remains significant in the female patients, ranging from 25% to 50%. Complications including electrolyte disturbances, altered sensorium and drug metabolism, mucus retention, rupture, urinary tract infections, and upper tract deterioration are reviewed.

Conclusions

Indications for OBS following radical cystectomy in patients with invasive bladder cancer have significantly widened over the past 2 decades. An OBS should be offered to both male and female patients in the absence of contraindications. Good long-term functional and oncologic outcomes can be achieved in patients with OBS treated in high-volume institutions by experienced surgeons with specific knowledge in the field. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.

Take Home Message

Orthotopic bladder substitutes should be offered to both genders in the absence of contraindications. Good long-term functional and oncologic outcomes can be achieved. Preoperative education, patient selection, surgical techniques, and careful postoperative follow-up are cornerstones to achieve good long-term results.

Keywords: Bladder cancer, Orthotopic bladder substitute, Neobladder, Continence, Functional results, Outcomes, Radical cystectomy.

Footnotes

a Division of Urology, McGill University Health Centre, Montreal, Canada

b Division of Urology, University of Ulm, Ulm, Germany

c Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

d Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

e Department of Urology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy

f Division of Urology, University of Toronto, Toronto, Canada

g Division of Urology, University of Bern, Bern, Switzerland

lowast Corresponding author. Division of Urology, Montreal General Hospital, 1650 Cedar Ave. L8–315, Montreal, Quebec, H3G 1A4, Canada. Tel. +1 514 934 8246; Fax: +1 514 934 8297.

z.star Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.