Functional and clinicopathologic outcomes using a modified vescica ileale padovana technique

Chandra K. Flack, M. Francesca Monn, Hristos Kaimakliotis, Michael Koch

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the clinicopathologic and functional outcomes of a modified Vescica ileale Padovana (VIP) neobladder technique. Methods: Data for 160 patients at a single institution who underwent radical cystectomy and orthotopic VIP neobladder creation between 1998 and 2013 were analyzed. Modified VIP technique involved longitudinal opening of the small bowel close to the anterior mesenteric border instead of along the true anti-mesentery. This allowed for creation of a dependent neourethral funnel and a large serosal surface for ureteral anastomosis, distant from any suture lines. Results: Mean age for the entire cohort was 59.5, with 9% female and 64% with muscle invasive disease prior to cystectomy. Within 30 days of surgery, 16 patients (10%) developed a Clavien grade 3-4 complication and there were no deaths. Ninety-six percent reported minor or no daytime urinary leakage at 12 months, and 70% reported minor or no nighttime urinary leakage. Two- and five-year overall survival rates were 84.2% and 72.6%, respectively. Seven patients developed a ureteral stricture (4%), three (2%) had bladder neck contractures, two (1%) experienced urethral recurrence, and there were no vesicovaginal fistulas. Conclusions: This modified VIP neobladder technique achieves favorable functional, survival, and recurrence outcomes similar to other published orthotopic continent diversions. Its near spheroidal shape lowers internal pressure, allowing for improved continence at physiologic filling capacity, and its offset bowel opening helps prevent unnecessary stretch to the native urethra, even in large individuals. The widened uretero-enteric anastomosis site distant from bowel suture lines contributes to decreased stricture rates and its placement on the dome of the neobladder facilitates endoscopic access should strictures occur. Finally, lack of posterior overlapping suture lines also mitigates the risk of fistulae formation in females should anterior vaginal wall excision or entry be unavoidable.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalBladder Cancer
Volume1
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Sutures
Pathologic Constriction
Cystectomy
Vesicovaginal Fistula
Recurrence
Mesentery
Contracture
Urethra
Ambulatory Surgical Procedures
Fistula
Urinary Bladder
Survival Rate
Pressure
Muscles
Survival

Keywords

  • Continent
  • Cystectomy
  • Quality of life
  • Treatment outcome
  • Urinary bladder neoplasms
  • Urinary diversion
  • Urinary reservoirs

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Functional and clinicopathologic outcomes using a modified vescica ileale padovana technique. / Flack, Chandra K.; Monn, M. Francesca; Kaimakliotis, Hristos; Koch, Michael.

In: Bladder Cancer, Vol. 1, No. 1, 01.01.2015, p. 73-79.

Research output: Contribution to journalArticle

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abstract = "Objective: To evaluate the clinicopathologic and functional outcomes of a modified Vescica ileale Padovana (VIP) neobladder technique. Methods: Data for 160 patients at a single institution who underwent radical cystectomy and orthotopic VIP neobladder creation between 1998 and 2013 were analyzed. Modified VIP technique involved longitudinal opening of the small bowel close to the anterior mesenteric border instead of along the true anti-mesentery. This allowed for creation of a dependent neourethral funnel and a large serosal surface for ureteral anastomosis, distant from any suture lines. Results: Mean age for the entire cohort was 59.5, with 9{\%} female and 64{\%} with muscle invasive disease prior to cystectomy. Within 30 days of surgery, 16 patients (10{\%}) developed a Clavien grade 3-4 complication and there were no deaths. Ninety-six percent reported minor or no daytime urinary leakage at 12 months, and 70{\%} reported minor or no nighttime urinary leakage. Two- and five-year overall survival rates were 84.2{\%} and 72.6{\%}, respectively. Seven patients developed a ureteral stricture (4{\%}), three (2{\%}) had bladder neck contractures, two (1{\%}) experienced urethral recurrence, and there were no vesicovaginal fistulas. Conclusions: This modified VIP neobladder technique achieves favorable functional, survival, and recurrence outcomes similar to other published orthotopic continent diversions. Its near spheroidal shape lowers internal pressure, allowing for improved continence at physiologic filling capacity, and its offset bowel opening helps prevent unnecessary stretch to the native urethra, even in large individuals. The widened uretero-enteric anastomosis site distant from bowel suture lines contributes to decreased stricture rates and its placement on the dome of the neobladder facilitates endoscopic access should strictures occur. Finally, lack of posterior overlapping suture lines also mitigates the risk of fistulae formation in females should anterior vaginal wall excision or entry be unavoidable.",
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AB - Objective: To evaluate the clinicopathologic and functional outcomes of a modified Vescica ileale Padovana (VIP) neobladder technique. Methods: Data for 160 patients at a single institution who underwent radical cystectomy and orthotopic VIP neobladder creation between 1998 and 2013 were analyzed. Modified VIP technique involved longitudinal opening of the small bowel close to the anterior mesenteric border instead of along the true anti-mesentery. This allowed for creation of a dependent neourethral funnel and a large serosal surface for ureteral anastomosis, distant from any suture lines. Results: Mean age for the entire cohort was 59.5, with 9% female and 64% with muscle invasive disease prior to cystectomy. Within 30 days of surgery, 16 patients (10%) developed a Clavien grade 3-4 complication and there were no deaths. Ninety-six percent reported minor or no daytime urinary leakage at 12 months, and 70% reported minor or no nighttime urinary leakage. Two- and five-year overall survival rates were 84.2% and 72.6%, respectively. Seven patients developed a ureteral stricture (4%), three (2%) had bladder neck contractures, two (1%) experienced urethral recurrence, and there were no vesicovaginal fistulas. Conclusions: This modified VIP neobladder technique achieves favorable functional, survival, and recurrence outcomes similar to other published orthotopic continent diversions. Its near spheroidal shape lowers internal pressure, allowing for improved continence at physiologic filling capacity, and its offset bowel opening helps prevent unnecessary stretch to the native urethra, even in large individuals. The widened uretero-enteric anastomosis site distant from bowel suture lines contributes to decreased stricture rates and its placement on the dome of the neobladder facilitates endoscopic access should strictures occur. Finally, lack of posterior overlapping suture lines also mitigates the risk of fistulae formation in females should anterior vaginal wall excision or entry be unavoidable.

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KW - Treatment outcome

KW - Urinary bladder neoplasms

KW - Urinary diversion

KW - Urinary reservoirs

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