Functional Evaluation of Modified Studer and Modified Spiral Orthotopic Ileal Neobladders After Radical Cystectomy.
Study Details
Study Description
Brief Summary
Bladder cancer is the most common malignant neoplasm of the urinary system. Neoadjuvant chemotherapy followed by radical cystectomy (RC) is the standard treatment for Muscle invasive bladder cancer.
Studer neobladder is one of the commonly used techniques for orthotopic reconstruction, originally utilizing 60-65 cm of the ileum. However, this leads to formation of a flaccid reservoir.
Nowadays, most techniques use 40-45 cm ileal segment only due to the proven increased reservoir capacity over time. So Moeen et al developed a modified Studer ileal neobladder by using a shorter ileal segment (40 cm only).
Upper urinary tract protection is important in neobladder reconstruction. One of the proposed anti-reflux techniques is using an isoperistaltic limp which was about 20 cm. This segment will be compressed by the elevated intra-abdominal pressure during Valsalva voiding to prevent reflux. However, this length was subjected to multiple reductions in multiple studies. Moeen et al used an 8 cm straight isoperistaltic ileal chimney.
In spiral neobladder the ureters are implanted into the reservoir using a non-refluxing split-cuff nipple technique. It has good functional and urodynamic parameters. Moeen et al added 8 cm as RT sided angled chimney over the neobladder. The ureters were implanted directly in an end to side manner. They assumed that adding this angulation to this short chimney decreases reflux and protect the UUT, without adding time to develop an anti-reflux technique.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: modified Studer ileal neobladder the segment of the iso-peristaltic segment is 8 cm and the total length of the ileum used is 40 cm instead of 60 cm. |
Procedure: modified Studer ileal neobladder
orthotopic ileal neobladders
Other Names:
|
| Experimental: modified spiral ileal neobladder the chimney of the spiral neobladder will be an angled one instead of straight. |
Procedure: modified Studer ileal neobladder
orthotopic ileal neobladders
Other Names:
|
Outcome Measures
Primary Outcome Measures
- The assessment of the reservoir capacity [At 3rd month post operative]
Assessment of reservoir capacity by pouch size in urodynamics
- The assessment of the reservoir capacity [At 6th month post operative]
Assessment of reservoir capacity by pouch size in urodynamics
- The assessment of the reservoir capacity [At 12th month post operative]
Assessment of reservoir capacity by pouch size in urodynamics
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients with muscle invasive bladder cancer (T2-3N0-1M0).
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Patients with T1 high grade bladder cancer with failed intravesical immunotherapy.
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Bladder neck area including the trigone free from cancerous involvement.
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Patients accepting the operation who are medically fit.
Exclusion Criteria:
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Patients with serum creatinine ≥ 1.8 mg/dl.
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Patients with intestinal disorders including previous bowel resections, severe diverticulosis or inflammatory bowel disease.
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Inability to do perform clean intermittent catheterization (CIC) due to physical or mental impairment.
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Sphincteric deficiency or urethral stricture disease causing voiding dysfunction.
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Positive prostatic urethral biopsy.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Assuit university | Assiut | Assuit | Egypt | 71511 |
Sponsors and Collaborators
- Assiut University
Investigators
- Study Director: Diaa Eldin hameed Sayed, PhD, cheif of urological oncology department
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Assuituro