Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center
| Autor: | Hans-Werner Gottfried, R. Hefty, Ulrich Wenderoth, R. Küfer, Richard E. Hautmann, G. Egghart, Kurt Miller, Jörg Simon, Robert de Petriconi, Klaus Kleinschmidt, Detlef Frohneberg, Jürgen E. Gschwend, Björn Volkmer |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology medicine.medical_treatment Urinary Bladder Urinary Diversion Cystectomy Single Center Severity of Illness Index Outcome (game theory) Young Adult chemistry.chemical_compound Postoperative Complications Ileum Incontinence Pads medicine Humans Bladder substitution Intermittent Urethral Catheterization Prospective Studies Aged Aged 80 and over business.industry Incidence Urinary Reservoirs Continent Urinary diversion Age Factors Meth Middle Aged Tumor recurrence Surgery Treatment Outcome Urinary Incontinence Urinary Bladder Neoplasms chemistry Male patient Female business Follow-Up Studies |
| Zdroj: | Journal of Urology. 205:174-182 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1097/ju.0000000000001345 |
| Popis: | There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience.Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included.Median age at radical cystectomy and at survey was 63 (range 23-81) and 75 (range 43-92) years, respectively. Overall 87% of patients voided spontaneously and residual-free. This rate decreased with increasing age at the time of surgery (less than 50 years old 94%, 70 years old or older 82%). Overall day/nighttime continence rates were 90%/82%. These rates decreased with increasing age at the time of surgery from 100%/88% to 87%/80%. The overall pad-free rate was 71%/47%. Bicarbonate use decreased from 51% (5 years) to 19% (25 years). Patients with a followup of more than 20 years had the lowest rate of residual urine and clean intermittent catheterization (0.0%) as well as use of more than 1 pad at daytime/nighttime (6.3%/12.5%) and mucus obstruction (0.0%). Serum creatinine showed only the age related increase. The surgical complication rate was 27% and correlated inversely with functional results (chi-squared 11.227, p0.005), even when the younger age at the time of surgery (younger than 60 years) was related to higher rates of surgical complications (chi-squared 6.80, p0.05).The ileal neobladder represents an excellent long-term option for urinary diversion with an acceptable complication rate. |
| Databáze: | OpenAIRE |
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