Neobladder formation after pelvic irradiation
Richard E Hautmann1, Robert de Petriconi, Bjoern G Volkmer
1Department of Urology, Faculty of Medicine, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany. richard.hautmann@uniklinik-ulm.de
World Journal of Urology
|November 21, 2008
Summary
Ileal neobladder reconstruction after pelvic radiation is a safe and effective salvage surgery for select patients. While early complications occurred more frequently, severe complications and incontinence were manageable, offering good functional outcomes.
Area of Science:
- Urology
- Surgical Oncology
- Radiation Oncology
Background:
- Pelvic irradiation can compromise bladder function, necessitating advanced reconstructive techniques.
- Radical cystectomy with ileal neobladder is a complex procedure with potential complications.
Purpose of the Study:
- To evaluate the outcomes of ileal neobladder reconstruction in patients previously treated with pelvic radiation.
- To assess complication rates and functional results in this specific patient cohort.
Main Methods:
- Retrospective analysis of 1,570 radical cystectomies and 1,002 ileal neobladders.
- Identification of 25 patients with prior pelvic irradiation who underwent ileal neobladder construction.
- Complications graded using a modified Clavien system; functional and late outcomes were reported.
Main Results:
- 76% of neobladder patients experienced early complications vs. 52% of non-neobladder patients.
- Severe (grade 3-5) early complications were less frequent in the neobladder group.
- 19/25 neobladder patients achieved excellent daytime and nighttime continence; some experienced severe stress incontinence or hypercontinence.
Conclusions:
- Orthotopic lower urinary tract reconstruction with ileal neobladder is a safe and effective salvage option for selected patients with radiation-compromised bladders.
- Key prerequisites include good renal function, preoperative continence, absence of recurrent tumors, and no severe bowel damage.
- This procedure can restore a well-functioning lower urinary tract in patients with bladder cancer after radiation therapy.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
Voiding Cystourethrography (VCUG) and Cystography are specialized radiographic procedures used to examine the structure and function of the bladder and urethra.Voiding Cystourethrography (VCUG)A Voiding Cystourethrogram (VCUG) is a diagnostic imaging procedure that assesses the anatomy and function of the lower urinary tract. It focuses on the bladder, bladder neck, and urethra, helping detect abnormalities such as vesicoureteral reflux (VUR)—the backward or reverse flow of urine into the...
01:23Urinary Bladder
The urinary bladder is a hollow, muscular sac that temporarily stores urine before it is expelled from the body. It can hold approximately 600 mL of urine prior to micturition. The bladder is retroperitoneal and located behind the pubic symphysis in the pelvic floor.
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
01:19Anatomy of the Genitourinary System II: Bladder and Urethra
The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
01:28Imaging Studies I: Kidney, Ureter, and Bladder Studies
Kidney, Ureter, and Bladder (KUB) StudiesKidney, Ureter, and Bladder (KUB) studies are standard diagnostic imaging procedures used to assess the anatomy of the urinary system. They are commonly utilized for patients experiencing abdominal pain or urinary symptoms. By using a simple X-ray of the abdomen, KUB studies can reveal structural and pathological abnormalities within the kidneys, ureters, and bladder. These studies are particularly valuable in diagnosing kidney stones, urinary...