Summary
Since June 1990, 21 women aged from 31 to 78 years (mean, 62 years) have undergone lower urinary tract reconstruction by means of an orthotopic Kock ileal reservoir following cystectomy. The indication for cystectomy included 15 patients with transitional-cell carcinoma of the bladder, 2 patients with urachal adenocarcinoma, 1 patient with cervical carcinoma, 1 patient with a mesenchymal tumor of endometrial origin, 1 patient with interstitial cystitis, and 1 patient with a fibrotic irradiated bladder. A total of four complications (two early and two late) have occurred in this group of patients. Excellent continence has been achieved during the day and night in 95% and 89% of the patients, respectively. In all, 16 of 20 patients void volitionally per urethra without a residual urine volume, whereas 4 patients require intermittent catheterization to empty the neobladder. All patients are completely satisfied. One patient died of metastatic transitional-cell carcinoma without a pelvic recurrence. Of the remaining 20 patients, 18 are currently alive without evidence of recurrent disease. Tumor recurrence has occurred in two patients: one patient with an extensive mesenchymal tumor developed a sigmoid recurrence necessitating conversion to a continent cutaneous diversion, and one patient developed a right iliac recurrence. This initial experience with lower urinary tract reconstruction in women has yielded extraordinary results, and we feel that the option of orthotopic reconstruction following cystectomy can safely be offered to selected female patients.
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Bricker EM (1950) Symposium on clinical surgery, bladder substitution after pelvic evisceration. Surg Clin North Am 30:1511
Camey M, Le Duc A (1979) L'enterocystoplastic avec cystoprostatectomie totale pour cancer de la vessie. Ann Urol 13:114
Colleselli K, Strasser H, Moriggl B, Stenzl A, Poisel S, Bartsch G (1994) Hemi-Kock to the female urethra: anatomical approach to the continence mechanism to the female urethra (abstract 1089). J Urol 151:500A
Gilchrist RK, Merricks JW, Hamlin HH, Rieger IT (1950) Construction of a substitute bladder and urethra. Surg Gynecol Obstet 90:752
Kock NG (1971) Ileostomy without external appliances: a survey of 25 patients with intra-abdominal intestinal reservoir. Ann Surg 173:545
McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanzordenker J, Ritchey M, Gorley EA (1993) Clinical assessment of urethral sphincter function. J Urol 150:1452
Norlen L, Trasti H (1978) Functional behavior of the continent ileum reservoir for urinary diversion: an experimental and clinical study. Scand J Urol Nephrol [Suppl]49:33
Richie JP, Skinner DG, Waisman J (1974) The effect of reflux on the development of pyelonephritis in urinary diversion: an experimental study. J Surg Res 16:256
Shapiro SR, Lebowitz R, Colodney H (1975) Fate of 90 children with ileal conduit urinary diversion a decade later: analysis of complications, pyelography, renal function and bacteriology. J Urol 114:289
Skinner DG, Lieskovsky G (1988) Technique of radical cystectomy. In: Skinner DG, Lieskovsky G (eds) Diagnosis and management of genitourinary cancer. W. B. Saunders, Philadelphia, p 607
Skinner DG, Boyd SD, Lieskovsky G (1984) Clinical experience with the Kock continent ileal reservoir for urinary diversion. J Urol 132:1101
Skinner DG, Lieskovsky G, Boyd SD (1984) Technique of creation of a continent internal ilea reservoir (Kock pouch) for urinary diversion. Urol Clin North Am 11:741
Skinner DG, Boyd SD, Lieskovsky G, Bennett C, Hopwood B (1991) Lower urinary tract reconstruction following cystectomy: experinece and results in 126 patients using the Kock ileal reservoir with bilateral ureteroileal urethrostomy. J Urol 146:756
Skinner DG, Boyd SD, Lieskovsky G (1987) Technique of continent lower urinary tract reconstruction with Kock pouch urethrostomy following cystectomy (videotape). Marketing communications, 3M Medical-Surgical Division, St. Paul, Minnesota
Stein JP, Cote RJ, Freeman JA, Esrig D, Skinner EC, Boyd SD, Lieskovsky G, Skinner DG (1995) Lower urinary tract reconstruction in women following cystectomy for pelvic malignancy; a pathological review of female cystectomy specimens. J Urol 154:1325
Stein JP, Stenzl A, Esrig D, Freeman JA, Boyd SD, Lieskovsky G, Cote RJ, Bennett C, Colleselli K, Draxl H, Janetschek G, Poisel S, Bartsch G, Skinner DG (1994) Lower urinary tract reconstruction following cystectomy in women using the Kock ileal reservoir with bilateral ureteroileal urethrostomy: initial clinical experience. J Urol 152:1404
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Stein, J.P., Stenzl, A., Grossfeld, G.D. et al. The use of orthotopic neobladders in women undergoing cystectomy for pelvic malignancy. World J Urol 14, 9–14 (1996). https://doi.org/10.1007/BF01836338
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DOI: https://doi.org/10.1007/BF01836338