MP61-01 LONG TERM FUNCTIONAL OUTCOMES AND COMPLICATIONS OF STUDER ORTHOTOPIC NEOBLADDER
Notice bibliographique
Résumé
You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP61)1 Apr 2019MP61-01 LONG TERM FUNCTIONAL OUTCOMES AND COMPLICATIONS OF STUDER ORTHOTOPIC NEOBLADDER Ernest Chan*, Khalil Hetou, Shiva Nair, Emily Stephenson, Jonathan Izawa, and Joseph Chin Ernest Chan*Ernest Chan* More articles by this author , Khalil HetouKhalil Hetou More articles by this author , Shiva NairShiva Nair More articles by this author , Emily StephensonEmily Stephenson More articles by this author , Jonathan IzawaJonathan Izawa More articles by this author , and Joseph ChinJoseph Chin More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556803.20663.98AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Orthotopic neobladder (NB) offers patients distinct advantages over an ileal conduit for urinary diversion following radical cystectomy. These include the potential for near-normal voiding function, continence and a more acceptable body image. Long-term patient satisfaction, however, may be compromised by urinary functional outcomes and complications. This study aims to assess the long-term functional outcomes and complication rates of those undergoing orthotopic Studer NB urinary diversion. METHODS: Out of 721 patients from 1995 to 2017 who underwent cystectomy by 2 surgeons at our institution for bladder malignancy, 104 patients with orthotopic NB were identified. Our inclusion criteria were those who had > 1 year post-operative follow-up with sufficient data for analysis. The outcomes collected retrospectively were: post-operative complications, prevalence of long-term voiding dysfunction, anatomical, metabolic and functional outcomes related to NBs. RESULTS: 66 patients with complete data were used for in-depth analysis. Median follow-up was 6 years. 25 (37.9%) postoperative complications occurred: 2 (3%) Clavien III, and 1 (1.5%) Clavien IV. 30 (43.5%) patients reported nocturnal urinary incontinence (UI), 9 (13%) reported daytime UI requiring pads, 16 (23.2%) were utilizing clean intermittent catheterization and 3 had permanent drainage (4%; 1 suprapubic and 2 with indwelling urethral catheter). NB patients with greater than 5 years follow-up were more likely to have nocturnal UI (p=0.02). Moreover, 22 (31.9%) had recurrent UTIs, 12 (17.4%) had urolithiasis, 4 (6.1%) had vitamin B12 deficiency, and 3 (4.5%) required oral bicarbonate therapy. 1 (1.5%) patient developed end stage renal failure while 12 (18.8%) had milder degrees of renal insufficiency. Of the 12 (18.8%) uretero-NB stenosis, 7 underwent balloon dilation, of which 2 failed and required reimplantation; 2 were due to tumor recurrence and managed with palliative nephrostomy. All of the 5 (7.2%) NB-urethral contractures were managed endoscopically. CONCLUSIONS: At our center, orthotopic NB is a safe option (low Clavien >III complication rate) with acceptable long-term functional outcomes. Although, this study lacks detailed urodynamic assessment, it can be assumed that chronic over-distension leading to NB hypotonia was the main problem. Risk of nocturnal UI increases with time (>5 years), and may be mitigated by frequent micturition. These long-term functional outcomes findings should be part of the pre-operative counselling for orthotopic NB. Source of Funding: None London, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e877-e877 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ernest Chan* More articles by this author Khalil Hetou More articles by this author Shiva Nair More articles by this author Emily Stephenson More articles by this author Jonathan Izawa More articles by this author Joseph Chin More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,032 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».