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Continent urinary tract reconstruction - the Lund experience.

W Månsson1, T Davidsson, J Könyves

  • 1Department of Urology, University Hospital and Department of Nursing, Lund University, Lund, Sweden.

BJU International
|July 31, 2003
PubMed
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Continent urinary tract reconstruction, including orthotopic bladder substitution (OBS) and continent cutaneous diversion (CCD), has high complication rates. The Lundiana pouch demonstrated superior storage and emptying compared to the Goldwasser neobladder.

Area of Science:

  • Urology
  • Surgical Innovation
  • Reconstructive Surgery

Background:

  • The Department of Urology in Lund has a history of innovation in reconstructive urology.
  • This study reviews long-term experience with orthotopic bladder substitution (OBS) and continent cutaneous urinary diversion (CCD).

Purpose of the Study:

  • To assess early and late complications and functional outcomes of OBS and CCD.
  • To compare the efficacy of the Goldwasser neobladder and the Lundiana pouch for urinary tract reconstruction.

Main Methods:

  • Retrospective review of medical records for patients undergoing OBS (Goldwasser technique) or CCD (Lundiana technique) between 1987 and 1999.
  • Follow-up extended to December 2001, including patients with malignant and benign diseases.

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Main Results:

  • High incidence of early (10-12%) and late (22-23%) complications requiring reoperation for both OBS and CCD.
  • Stone formation occurred in 10-12% of patients; pouch perforation in four patients.
  • The Lundiana pouch showed better functional outcomes for storage and emptying compared to the Goldwasser neobladder, with low rates of incontinence.

Conclusions:

  • Continent urinary tract reconstruction is associated with significant early and late complications.
  • The Lundiana pouch (CCD) is superior to the Goldwasser neobladder (OBS) for urinary storage and emptying.
  • Despite complications, renal function was generally preserved, and continence was achieved in most patients with the Lundiana pouch.