ORTHOTOPIC BLADDER SUBSTITUTION IN WOMEN FOLLOWING CYSTECTOMY FOR BLADDER CANCER - 11/09/11

Doi : 10.1016/S0094-0143(05)70365-7

Mohamed A. Ghoneim, MD, MD (HON) ^{^{*
From the Department of Urology, University of Mansoura, and the Urology and Nephrology Center, Mansoura, Egypt}}

Resumen

As a result of the evolution of low-pressure reservoirs derived from various segments of the intestines,^{10 Kock N.G., Nilson A.E., Norlen L. , y al. Urinary diversion via a continent ileal reservoir clinical experience Scand J Urol Nephrol 1978 ; 49 (suppl) : 23-31

Haga clic aquí para ir a la sección de Referencias} orthotopic bladder substitution is now a feasible option. The procedure has gained an increasing popularity in men for whom cystectomy was indicated.^{5 Ghoneim M.A., Kock N.G., Lycke G. , y al. An appliance-free, sphincter controlled bladder substitute: The urethral Kock pouch J Urol 1987 ; 138 : 1150-1154

Haga clic aquí para ir a la sección de Referencias, 8 Hautmann R.E., Egghart G., Frohneberg D. , y al. The ileal neobladder J Urol 1988 ; 139 : 39-42

Haga clic aquí para ir a la sección de Referencias, 11 Skinner D.G., Boyd S.D., Lieskovsky G. , y al. Lower urinary tract reconstruction following cystectomy: Experience and results in 126 patients using the Kock ileal reservoir with bilateral uretero-ileal urethrostomy J Urol 1991 ; 146 : 756-760

Haga clic aquí para ir a la sección de Referencias, 15 Studer U.E., Ackermann D., Casanova G.A. , y al. Three years experience with an ileal low pressure bladder substitute Br J Urol 1989 ; 63 : 43-52 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} The employment of such procedures in women was lagging, however, because total urethrectomy was considered an integral part of the radical operation. Furthermore, the chances of continence in a woman in whom the bladder neck was removed during cystectomy was questionable. The first clinical attempt was reported by Tscholl et al^{16 Tscholl R., Leisinger H.J., Hauri D. The ileal S-pouch for bladder replacement after cystectomy: Preliminary report of 7 cases J Urol 1987 ; 138 : 344-347

Haga clic aquí para ir a la sección de Referencias} in 1987. Although their one female patient became continent, the authors were skeptical and stated that “from this case, one should not infer that the proximal urethra can ensure continence on its own.”

Three studies provided the scientific basis and paved the way for orthotopic substitution in selected cases in women. The functional study by Hubner et al^{9 Hubner W.A., Trigo-Rocha F., Plas E.G. , y al. Urethral function after cystectomy: A canine in vivo experiment Urol Res 1993 ; 21 : 45-48 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} outlined that the continuity of bladder and urethra in the dog is not required for the function of the urethral closure mechanism. The anatomic study by Colleselli and associates^{4 Colleselli K., Strasser H., Moriggl B. , y al. Hemi-Kock to the female urethra J Urol 1994 ; 151 (part 2) : 500A

Haga clic aquí para ir a la sección de Referencias} showed that the preservation of the musculature of the lower two thirds of urethra together with its nerve supply is important for urinary continence in women. Finally, the pathologic studies of Stenzl and coworkers^{14 Stenzl A., Draxl H., Posch B. , y al. The risk of urethral tumours in female bladder cancer: Can the urethra be used for orthotopic reconstruction of the the lower urinary tract? J Urol 1995 ; 153 : 950-955 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} identified the subpopulation of patients in whom the urethra may be preserved without an increased risk of local tumor recurrences.

As a result, an increasing number of clinical experiences with orthotopic bladder substitution in women were reported by several groups with uniformly good functional results.^{7 Hautmann R.E., Paiss T., Petriconi R. The ileal neobladder in women: 9 years of experience with 18 patients J Urol 1996 ; 155 : 76-81 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 12 Stein J.P., Stenzl A., Esrig D. , y al. Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral uretero-ileal urethrostomy: Initial clinical experience J Urol 1994 ; 152 : 1404-1408

Haga clic aquí para ir a la sección de Referencias} The author's first case was carried out late in 1994. Since then, the procedure has been employed for another 32 patients.