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Use and Complications of Neobladder and Continent Urinary Diversion in Female Pelvic Cancer

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Female Genitourinary and Pelvic Floor Reconstruction

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Abstract

Cancer of the female pelvis originates from organs of the three different pelvic compartments. The lower urinary tract is often also affected by the malignancy. Cystectomy is therefore part of treatment, especially in patients with extensive disease. Preservation of the urethra and the urethral sphincter complex is crucial for orthotopic neobladder placement. Various patient factors and disease-specific factors might lead to the decision of a heterotopic urinary diversion, either continent or incontinent. The current literature supports the use of orthotopic neobladders in female patients based on the oncological and functional outcomes. Over time, many different forms of neobladders have been described and modified by surgeons. To date, the use of the ileum is the most commonly accepted approach. If a patient is not eligible to receive an orthotopic urinary diversion, a continent cutaneous heterotopic reservoir is a useful option, to avoid an incontinent diversion and its negative effects on body image. Heterotopic pouches need regular catheterization by the patient and have a higher complication rate compared to other diversions. Furthermore, there are fewer and fewer centers that have surgical knowledge of the construction and the postoperative care of heterotopic pouches, including management of complications. This chapter reviews the indications for and different forms of urinary diversions, the surgical aspects of the ablative and reconstructive part of the surgery, and the complications and their management in female pelvic cancer patients.

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Author information

Authors and Affiliations

  1. Department of Urology, University Hospital of Tuebingen; Eberhard Karls University, Tuebingen, Germany

    Bastian Amend, Kathrin Meisterhofer, Jens Bedke & Arnulf Stenzl

Authors
  1. Bastian Amend
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  2. Kathrin Meisterhofer
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  3. Jens Bedke
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  4. Arnulf Stenzl
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Corresponding author

Correspondence to Arnulf Stenzl .

Editor information

Editors and Affiliations

  1. University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. University of Oslo, Oslo, Norway

    Henriette Veiby Holm

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jaspreet Sandhu

  4. Eastern Virginia Medical School, Norfolk, VA, USA

    Kurt A McCammon

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Amend, B., Meisterhofer, K., Bedke, J., Stenzl, A. (2023). Use and Complications of Neobladder and Continent Urinary Diversion in Female Pelvic Cancer. In: Martins, F.E., Holm, H.V., Sandhu, J., McCammon, K.A. (eds) Female Genitourinary and Pelvic Floor Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-71112-2_60-1

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  • DOI: https://doi.org/10.1007/978-3-030-71112-2_60-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71112-2

  • Online ISBN: 978-3-030-71112-2

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