Neo Bladder

8/10/2019 Neo Bladder

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Urinary Diversions:


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1851- Ureteroproctostomy (Simon)

1878- Ureterosigmoidostomy (Smith)

1950s- Ileal loop (Bricker)

1959- Ileal neobladder (Camay)

1970s to early 80s- Koch and Indiana

Late 80s- Orthotopic diversion

History of Diversion Surgery


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What Necessitates Urinary

Diversions?

Invasive bladder cancer

Hostile neurogenic bladder

Interstitial or radiation cystitis

Congenital abnormalities

Intractable incontinence


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6th most common cancer in U.S.

New cases: 73,510

Deaths: 14,880

3x more common in men

Bladder Cancer Facts

National Cancer Institute, 2012


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Urostomy (ileal conduit)

Continent Cutaneous Urostomy

Orthotopic Neobladder

Urinary Diversion Options


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Non-continent

Ureterostomy

Ileal Conduit

Continent

Indiana Pouch (continent cutaneous)


Non-continent vs. Continent


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Surgical Selection Factors

Availability of surgeon and O.R.

Age of patient

Comorbidities

Renal function


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Location of tumor

Sphincter competence

Hx of pelvic radiation

Hx of bowel disease



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Manual dexterity

Mental status

Weight

Patient preference



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Duke: 60% ileal conduits, 40% internal

continent pouches (2012)

Prevalence of Continent

Diversions


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Ileal pouch in native anatomical

location

AKA

Studer diversion



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Cons

Delayed continence

Urinary retention

Metabolic acidosis

Catheterize

Pros

Cosmesis

No stoma

Independentlyvoid

Cost effective



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Orthotopic Neobladder Pouchogram


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Symptoms: Prevention:

Fever Irrigation

Bacteriuria Fluid intakePouch pain

Treatment:

Antibiotics (Flagyl)

Pouchitis


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Voiding

Q2hr day and Q3hr at night

Ultimately Q 4hr day & Q 8hr night

Valsalva, Cred method, sit on toilet

Measure and record output

Activation Teaching: NB


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Crede Maneuver


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Kaufman DS, Shipley WU, & Feldman AS. Bladder Cancer.Lancet. 2009;374(9685):239-247.

Hautmann RE, Abol-Enein H, Hafez K, et al. Urinary diversion.

Urology. 2007; 69(suppl):1749, 2007.

Somani BK, Gimlin D, Fayers P, et.al. Quality of life and bodyimage for bladder cancer patients undergoing radical

cystectomy and urinary diversion. Urology. 2009; 74(5):1138-43.

Nabil G, Cody JD, Dublin N, et.al. Urinary diversion and bladder

reconstruction/replacement using intestinal segments for

intractable incontinence or following cystectomy. 2009 TheCochrane Collaboration/JohnWiley & Sons, Ltd.

References


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Gray M & Beitz JM. Counseling patients undergoing urinarydiversion: does the type of diversion influence quality of life?

JWOCN.2005. Jan-Feb;32(1):7-15.

Gemmill R et al. Going with the flow: quality of life outcomes of

cancer survivors with urinary diversion. JWOCN 2010. Jan-

Feb;37(1):65-72.

Dutta SC et al. HRQOL assessment after radical cystectomy:

comparison of IC and ON. J Urol 2002;168(1):164-167

Gerharz EW et al. QOL in patients with bladder cancer. Urol

Oncol 2005;23(3):201-207.

References


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Kikuchi E et al. Assessment of Long-Term Quality of Life Usingthe FACT-BL Questionnaire in Patients with an IC, CR, or ON.

JJCO2006; 36(11)712716

References


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http://www.uoaa.org/ostomy_info/

http://www.uoaa.org/ostomy_info/

http://bcan.org

http://www.wocn.org

http://www.ostomysecrets.com

http://www.options-ostomy.com

http://www.trianglebcs.org

Patient Resources
http://www.uoaa.org/ostomy_info/http://www.uoaa.org/ostomy_info/http://bcan.org/http://www.wocn.org/http://www.ostomysecrets.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.options-ostomy.com/http://www.ostomysecrets.com/http://www.wocn.org/http://bcan.org/http://www.uoaa.org/ostomy_info/http://www.uoaa.org/ostomy_info/

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