MP61-01 LONG TERM FUNCTIONAL OUTCOMES AND COMPLICATIONS OF STUDER ORTHOTOPIC NEOBLADDER
Bibliographic record
Abstract
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 ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.032 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".