Archivos espanoles de urologia · 1995
[Substitutive orthotopic ileocystoplasty. The Studer's technique].
Клиническое исследованиеАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Gutiérrez Baños J L, Martín García B, Hernández Rodríguez R, Portillo Martín J A, Correas Gómez M A, del Valle Schaan J I, Monge Mirallas J M, Roca Edreira A
Аннотация
OBJECTIVES: The results of the Studer enterocystoplasty technique is analyzed, with special reference to the early and late complications and urinary continence.
METHODS: We reviewed the records of 20 patients that underwent bladder substitution according to the Studer technique due to bladder carcinoma from 1990-1993. Patient follow-up ranged from 6-36 months. The ureteroileal anastomosis was done by the single stitch technique onto a tubularized ileal chimney.
RESULTS: The median age was 57.2 +/- 11.86 yrs (range 33-73). The preoperative stay for intestinal preparation ranged from 1-29 days (median 4.4 +/- 5.84) and the postoperative stay ranged from 1-60 days (median 26 +/- 11.44). The average operating time was 5.30 +/- 0.7 hours (range 4.15-7). There were two postoperative deaths; one from acute myocardial infarction and the other from pulmonary embolism. Three patients died from tumor progression during follow-up and one from leg ischemia 17 months postoperatively. Early complications: 2 cases of prolonged ileus, 1 wound infection, 7 urinary infections, 1 low debit intestinal fistula which resolved with parenteral nutrition, 3 patients had leakage at the ileourethral anastomosis which resolved with prolonged catheter drainage of 3-15 days, 1 hemorrhage from acute lesions to the gastric mucosa, 3 fascial dehiscence and 1 ureteroileal fistula that required reimplantation into the neobladder. Late complications: 1 ureteroileal stenosis that progressed to renal atrophy, 1 enterourethral stenosis that resolved with internal urethrotomy and 2 cases of severe metabolic acidosis and dehydration that resolved with fluid therapy. No differences were observed between the creatinine, pH and ion levels preoperatively and during follow-up. Continence was assessed in 17 cases: 100% were continent during the day, 41.2% were continent during the night, 4 had occasional nocturnal leakage and 6 required collecting devices during the night.
CONCLUSIONS: The Studer technique provides good results and quality of life to patients undergoing cystectomy. Although it carries a high morbidity, conservative management will suffice in a high percentage of cases.
METHODS: We reviewed the records of 20 patients that underwent bladder substitution according to the Studer technique due to bladder carcinoma from 1990-1993. Patient follow-up ranged from 6-36 months. The ureteroileal anastomosis was done by the single stitch technique onto a tubularized ileal chimney.
RESULTS: The median age was 57.2 +/- 11.86 yrs (range 33-73). The preoperative stay for intestinal preparation ranged from 1-29 days (median 4.4 +/- 5.84) and the postoperative stay ranged from 1-60 days (median 26 +/- 11.44). The average operating time was 5.30 +/- 0.7 hours (range 4.15-7). There were two postoperative deaths; one from acute myocardial infarction and the other from pulmonary embolism. Three patients died from tumor progression during follow-up and one from leg ischemia 17 months postoperatively. Early complications: 2 cases of prolonged ileus, 1 wound infection, 7 urinary infections, 1 low debit intestinal fistula which resolved with parenteral nutrition, 3 patients had leakage at the ileourethral anastomosis which resolved with prolonged catheter drainage of 3-15 days, 1 hemorrhage from acute lesions to the gastric mucosa, 3 fascial dehiscence and 1 ureteroileal fistula that required reimplantation into the neobladder. Late complications: 1 ureteroileal stenosis that progressed to renal atrophy, 1 enterourethral stenosis that resolved with internal urethrotomy and 2 cases of severe metabolic acidosis and dehydration that resolved with fluid therapy. No differences were observed between the creatinine, pH and ion levels preoperatively and during follow-up. Continence was assessed in 17 cases: 100% were continent during the day, 41.2% were continent during the night, 4 had occasional nocturnal leakage and 6 required collecting devices during the night.
CONCLUSIONS: The Studer technique provides good results and quality of life to patients undergoing cystectomy. Although it carries a high morbidity, conservative management will suffice in a high percentage of cases.