Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
Department of Urology, San Giuseppe Hospital, Multimedica Group, Milan, Italy.
Urologia. 2020 Nov;87(4):167-169. doi: 10.1177/0391560320930115. Epub 2020 Jun 20.
In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively.
In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the .
We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4-1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease.
The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.
本研究报道了根据 Bianchi G 等人描述的 Studer 改良技术行原位新膀胱转流术的 2 年结果。该技术提高了储尿囊的稳定性和储尿能力。根治性膀胱切除术后，采用 40cm 去管化回肠段和 15cm 管状输入段，形成一个球形储尿囊，并进行 Wallace 输尿管吻合术，创建球形储尿囊。将新膀胱的锥形远端与尿道残端吻合。重建完成后，新膀胱和输入段分别与提肛肌和腰大肌附着。
共有 18 例患者在 S. Giuseppe 医院接受了根治性膀胱切除术和改良 Studer 原位新膀胱转流术。我们研究了术后随访年数，特别是下尿路病史、轴向计算机断层扫描和血液检查，以评估术后并发症。
我们通过 CT 发现 2 例双侧轻度积水，同时肌酐水平略有升高（1.4-1.8mg/dL）。未发现新膀胱-尿道吻合口狭窄。3 例患者白天有尿失禁，仅 2 例患者夜间有尿失禁。1 例患者因结石行输尿管镜检查，1 例患者因非肿瘤泌尿科疾病死亡。
我们对 Studer-Neobladder 的改良似乎改善了尿路重建，可能降低了长期并发症的风险，如与输尿管吻合口狭窄相关的肾积水（文献报道为 11.1%比 16.9%）和尿潴留（文献报道为 0%比 12%）。然而，我们发现与经典 Studer Neobladder 相同的日间和夜间尿失禁风险。
