Stapled W-shaped (Hautmann) Orthotopic Ileal Neobladder. Functional Results and Complications over a 13-year Period.

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2024-09-17 DOI:10.1016/j.euf.2024.09.002

Angelo Cormio,Nicola d'Altilia,Beppe Calò,Ugo Giovanni Falagario,Francesco Cinelli,Vito Mancini,Gian Maria Busetto,Carlo Bettocchi,Giuseppe Carrieri,Luigi Cormio

{"title":"Stapled W-shaped (Hautmann) Orthotopic Ileal Neobladder. Functional Results and Complications over a 13-year Period.","authors":"Angelo Cormio,Nicola d'Altilia,Beppe Calò,Ugo Giovanni Falagario,Francesco Cinelli,Vito Mancini,Gian Maria Busetto,Carlo Bettocchi,Giuseppe Carrieri,Luigi Cormio","doi":"10.1016/j.euf.2024.09.002","DOIUrl":null,"url":null,"abstract":"BACKGROUND AND OBJECTIVE\r\nThe preferable technique for orthotopic bladder substitution after radical cystectomy is debated. The aim of this study was to describe our technique of a stapled W-shaped ileal neobladder and assess the complications and functional results in 100 patients. treated from December 2009 to July 2022.\r\n\r\nMETHODS\r\nThe W-shaped ileal neobladder is created with lateral arms of 15 cm and central arms of 10 cm. Following an incision of the lower part of the two medial arms, a 10-cm GIA titanium stapler is used to detubularize the medial arms first and then the laterals to the medial arms. Urethral-neobladder anastomosis and end-to-end ureteroileal anastomosis are finally carried out. We reported on clinical data, complications, and urinary function outcomes assessed by the International Consultation on Incontinence Questionnaire (ICIQ)-Short Form and daytime/24-h pad test. Full urinary continence (UC) was defined as pad tests yielding 0 g.\r\n\r\nKEY FINDINGS AND LIMITATIONS\r\nThe median surgical time was 210 min. The early (up to 90 d) and late (>90 d) complication rates were 18% (2% grade ≥4) and 11.7% (2% grade ≥4), respectively. Two patients had \"late\" bladder stones due to chronic urinary retention, whereas none developed calcifications in the neobladder along the stapling lines. Daytime and 24-h UC rates were 74.7% and 72.4% at 12 mo, 82.7% and 72.4% at 36 mo, respectively. Median ICIQ scores were in line with pad test results, being 0 in patients with full UC.\r\n\r\nCONCLUSIONS AND CLINICAL IMPLICATIONS\r\nOur stapled W-shaped ileal neobladder technique was found to be simple and fast to shape, with a low complication rate, and yielded favorable long-term functional outcomes.\r\n\r\nPATIENT SUMMARY\r\nThis study details the surgical technique, complications, and functional outcomes of patients who underwent open cystectomy with a stapled W-shaped ileal neobladder. Our results indicate that this approach is safe and provides favorable long-term functional outcomes.","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8000,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European urology focus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.euf.2024.09.002","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

BACKGROUND AND OBJECTIVE The preferable technique for orthotopic bladder substitution after radical cystectomy is debated. The aim of this study was to describe our technique of a stapled W-shaped ileal neobladder and assess the complications and functional results in 100 patients. treated from December 2009 to July 2022. METHODS The W-shaped ileal neobladder is created with lateral arms of 15 cm and central arms of 10 cm. Following an incision of the lower part of the two medial arms, a 10-cm GIA titanium stapler is used to detubularize the medial arms first and then the laterals to the medial arms. Urethral-neobladder anastomosis and end-to-end ureteroileal anastomosis are finally carried out. We reported on clinical data, complications, and urinary function outcomes assessed by the International Consultation on Incontinence Questionnaire (ICIQ)-Short Form and daytime/24-h pad test. Full urinary continence (UC) was defined as pad tests yielding 0 g. KEY FINDINGS AND LIMITATIONS The median surgical time was 210 min. The early (up to 90 d) and late (>90 d) complication rates were 18% (2% grade ≥4) and 11.7% (2% grade ≥4), respectively. Two patients had "late" bladder stones due to chronic urinary retention, whereas none developed calcifications in the neobladder along the stapling lines. Daytime and 24-h UC rates were 74.7% and 72.4% at 12 mo, 82.7% and 72.4% at 36 mo, respectively. Median ICIQ scores were in line with pad test results, being 0 in patients with full UC. CONCLUSIONS AND CLINICAL IMPLICATIONS Our stapled W-shaped ileal neobladder technique was found to be simple and fast to shape, with a low complication rate, and yielded favorable long-term functional outcomes. PATIENT SUMMARY This study details the surgical technique, complications, and functional outcomes of patients who underwent open cystectomy with a stapled W-shaped ileal neobladder. Our results indicate that this approach is safe and provides favorable long-term functional outcomes.

查看原文本刊更多论文

缝合W形（Hautmann）正位回肠新膀胱。13年间的功能结果和并发症。

背景和目的对于根治性膀胱切除术后膀胱正位替代的优选技术存在争议。本研究的目的是描述我们的 W 型回肠新膀胱缝合技术，并评估 2009 年 12 月至 2022 年 7 月期间接受治疗的 100 例患者的并发症和功能效果。方法W 型回肠新膀胱的外侧臂长 15 厘米，中央臂长 10 厘米。切开两个内侧臂的下半部分后，使用 10 厘米的 GIA 钛订书机首先将内侧臂脱管，然后将外侧臂与内侧臂连接起来。最后进行尿道-膀胱吻合术和输尿管静脉端对端吻合术。我们报告了临床数据、并发症以及通过国际尿失禁咨询问卷（ICIQ）-简表和白天/24小时尿垫测试评估的排尿功能结果。中位手术时间为210分钟。早期（90 d以内）和晚期（90 d以上）并发症发生率分别为18%（2%≥4级）和11.7%（2%≥4级）。两名患者因慢性尿潴留而出现 "晚期 "膀胱结石，但没有人沿着缝合线在新膀胱内出现钙化。12个月时的日间和24小时尿失禁率分别为74.7%和72.4%，36个月时分别为82.7%和72.4%。中位 ICIQ 评分与 pad 测试结果一致，完全 UC 患者的中位 ICIQ 评分为 0.结论和临床意义研究发现，我们的订书机 W 型回肠新膀胱技术操作简单、成型快、并发症发生率低，并可获得良好的长期功能预后。患者摘要本研究详细介绍了使用订书机 W 型回肠新膀胱进行开放式膀胱切除术的患者的手术技术、并发症和功能预后。我们的研究结果表明，这种方法是安全的，并能提供良好的长期功能效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.