Research and Reports in Urology (Dec 2019)
Orthotopic Neobladder Reconstruction: Patient Selection And Perspectives
Abstract
Liang G Qu,1 Nathan Lawrentschuk1–4 1Department of Urology, Austin Health, Heidelberg, VIC, Australia; 2Department of Surgery, University of Melbourne, Heidelberg, VIC, Australia; 3Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; 4EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC, AustraliaCorrespondence: Nathan LawrentschukDepartment of Surgery, University of Melbourne, Austin Hospital Suite 5, 210 Burgundy Street, Heidelberg, VIC 3084, AustraliaTel +61 3 9496 5000 Email [email protected]: Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure that may be performed in a patient with bladder cancer following a radical cystectomy. The selection of a patient for an ONB reconstruction is strict as not everyone may be suitable to undergo this complex surgery. Patients must be not only mentally competent but also physically dexterous enough to allow for appropriate neobladder training post-procedure, to achieve best urinary function. However, even with a carefully chosen patient population, various complications specific to ONB reconstruction may result. Metabolic acidosis may result from electrolyte shifts, resulting in secondary complications such as bone demineralization and urinary calculi. In addition, nutritional deficiencies may result from the use of a transposed intestinal segment for the fashioning of the reservoir. A widely used outcome measure when assessing for ONB reconstruction is continence. With a strict neobladder training regimen, daytime continence may be achieved in roughly 70% of patients post-ONB procedure. This number may increase over the course of several years, although may decrease in up to 20 years of follow-up. Similarly, quality of life (QoL) measures have been widely studied, and current literature suggests slightly better QoL achieved with ONB compared to other urinary diversion procedures. Of note, the tools used to assess continence and QoL vary between studies, limiting the interpretability of the summarized data. Nevertheless, ONB reconstruction is a procedure that is still evolving, with ongoing modifications that can reduce complications and improve patient urinary function.Keywords: neobladder, urinary diversion, bladder cancer
