A retrospective comparative analysis of two methods of orthotopic bladder substitute

Objective. Comparison of the immediate results of a radical cystectomy (RC) subsequent orthotopic bladder substitute (OBS) in patients with bladder cancer by a standard technique of Studer and by the modified Hautmann technique with an extraperitoneal arrangement of a neobladder.

Subjects and methods. One hundred and fifty-five patients were undergone RC subsequent OBS in department oncourology of Tyumen Region Oncology Despensery during the period 2001–2014 years. The patients were selected on two groups: one (n = 67) was undergone modified Hautmann»s technique and second (n = 88) was undergone standard technique of Studer. Among patients 1st group of men was 64 (95,5 %), women 3 (4,5 %). Middle age made them 56,4 ± 14,6 years. Among patients 2nd group of men was 78 (88,6 %), women 10 (11,4 %). Middle age made them 56,5±19,5 years. The rate and structure of postoperative complications, repeated operations and a 30‑day mortality was estimated and compared on both groups.

Results. The incidence of complications, repeated surgeries and postoperative mortality outcomes of the patients registered in the 2nd group was 63 (71,6 %), 37 (42,0 %) and 7 (7,9 %) respectively. Incidence in the 1st group was 40 (59,7 %) and 4 (5,9 %) respectively and mortality outcomes weren»t. In structure of complications at patients of both groups prevailed infectious and inflammatory, in 14 cases (35 %) in 1st group and in 19 cases (30,2 %) in the 2nd group. Repeated operations at patients of 1st group were connected with peritonitis in 1 case, urinary fistula in 1 case and bleeding in 2 cases. At patients of 2 groups of a reoperation were carried out for the reason: peritonitis in 8 cases, an eventrate in 13 cases, purulent pyelonephritis – 3 cases, bleeding – 3 cases.

Conclusions. Decrease of rate postoperative complications, repeated surgeries and hospital mortality was detected in 1st group patients. Our modified Hautmann technique with an extraperitoneal arrangement of a neobladder can considered as an alternative to existing methods.

1. Lee R.K., Abol-Enein H., Artibani W. et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJUI 2014;113:11–23.

2. Burkhard F.C., Studer U.E. Orthotopic bladder substitution. Curr Opin Urol 2000;10: 343–9.

3. Hollowel C.M., Christiano A.P., Steinberg G.D. Technique of Hautmann ilealneobladder with chimney modification: interim results in 50 patients. J Urol 2000;163:47–50.

4. Sevin G., Soyupek S., Armağan A. et al. Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: expirients and results. BJUI 2004;94(3):355–9.

5. Brausi M.A. The motion: radical cystectomy in the eldery is becoming a standart treatmentfor bladder cancer. Eur Urol 2007;51: 1435–6.

6. Hautmann R.E., Egghart G., Frohneberg D., Miller K. The ileal neobladder. J Urol 1988;(1):39–42.

7. Изгейм В.П., Лыков А.В., Купчин А.В. и др. Малоинвазивная экстраперитонеальная цистэктомия при инвазивном раке мочевого пузыря. Материалы IV Конгресса Российского общества онкоурологов. 1–2 октября 2009; с. 92–93.

8. Карпатовский В.И., Тилляшайхов И.С., Мудрая С.А. и др. Биологические аспекты выбора участка кишечника для пластики мочевого пузыря. Урология 2010;2:27–31.

9. Hautmann R.E. Urinary diversion: ileal conduit to neobladder. J Urol 2003;169(3): 834–42.

10. Studer U.E., Zinng E.J. Ileal orthotopic bladder substitutes. What we have learned from 12 years experience with 200 patients . Urol Clin North Am 1997;24:781–8.

11. Pitts W.R., Muecke E.S. A 20 years experience with ileal conduits the Fate of the kidneys. J Urol (Baltimore) 1979;107:37–45.

12. Richie J.P., Skinner D.J., Waisman L. The effect of reflux on the development of pyelonefritis in urinary diversion, an expiremental study. J Surg Res 1974;16: 256–61.

13. Даренков С.П., Оччархаджиев С.Б., Дзитиев В.К. Сравнительный анализ антирефлюксных и прямых методов имплантации мочеточников при кишечной континентной деривации мочи. Урология 2007;3:7–10.