Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur Urol Focus. 2021 May;7(3):629-637. doi: 10.1016/j.euf.2020.06.009. Epub 2020 Jul 9.
The crossfolded ileal reservoir combined with an afferent tubular isoperistaltic segment for heterotopic continent urinary diversion has been performed on a regular basis for over 20 years. Yet data on long-term-outcomes remain sparse.
To report long-term functional and oncological outcomes, gastrointestinal and metabolic disturbances, urinary tract infections (UTIs), and quality of life.
DESIGN, SETTING, AND PARTICIPANTS: Long-term functional and oncological outcomes of a consecutive series of 118 patients undergoing cystectomy and construction of a continent cutaneous crossfolded ileal reservoir from 2000 to 2018 were evaluated.
Patients underwent cystectomy and construction of a continent cutaneous crossfolded ileal reservoir according to the Studer technique for bladder reconstruction.
Pre- and postoperative data until last follow-up appointment were entered prospectively in the departmental database. Self-reported questionnaires regarding quality of life, patient satisfaction, and difficulty in catheterisation were sent to patients preoperatively; after 3, 6, 12, and 24 mo; and at last follow-up, and were then manually entered in the departmental database.
The median follow-up was 7.8 (interquartile range 3-12.7) yr. Patient satisfaction was high in 77.4% and moderate in 16.9%. Serum creatinine and estimated glomerular filtration rate remained stable during follow-up. Of all patients, 81% (96/118) had at least one UTI during follow-up. Recurrent UTIs occurred in 67% (79/118) of patients. Urolithiasis was found in 12% (14/118), with 6% (7/118) having a single and 6% a recurrent event. Of all stone formers, 79% (11/14) had recurrent UTIs. In oncological patients, 12.5% (10/79) developed a local recurrence. Cancer-specific survival and overall survival were 90% and 88%, and 68% and 56% after 1 and 10 yr, respectively. A limitations is the retrospective analysis from prospectively assessed data.
A high satisfaction level, stability of kidney function, and low rates of urolithiasis in patients with a heterotopic continent ileal reservoir can be achieved, provided that close attention is paid to intra- and postoperative details. Regular lifelong follow-up is essential for timely detection and treatment of complications. Oncological outcome is not affected by the urinary diversion.
In patients with a continent cutaneous ileal reservoir, good quality of life and a high satisfaction rate are possible provided that patients adhere to regular lifelong follow-up.
带输入直管的横褶回肠储尿囊联合同种异体间位可控性尿流改道术已常规应用 20 余年。但长期结果数据仍较少。
报告长期功能和肿瘤学结果、胃肠道和代谢紊乱、尿路感染（UTI）和生活质量。
设计、地点和参与者：评估 2000 年至 2018 年间连续 118 例接受膀胱切除术和构建可控性皮表横褶回肠储尿囊的患者的长期功能和肿瘤学结果。
患者根据 Studer 技术接受膀胱切除术和构建可控性皮表横褶回肠储尿囊。
在部门数据库中前瞻性地输入术前和随访期间的预术后数据。在术前、术后 3、6、12 和 24 个月以及最后一次随访时，向患者发送关于生活质量、患者满意度和置管困难的自我报告问卷，然后手动输入部门数据库。
中位随访时间为 7.8 年（四分位距 3-12.7）。77.4%的患者满意度高，16.9%的患者满意度中等。血清肌酐和估计肾小球滤过率在随访期间保持稳定。所有患者中有 81%（96/118）在随访期间至少发生一次 UTI。67%（79/118）的患者出现复发性 UTI。12%（14/118）的患者发现尿路结石，其中 6%（7/118）为单发，6%（7/118）为复发性。所有结石形成者中有 79%（11/14）有复发性 UTI。在肿瘤患者中，12.5%（10/79）出现局部复发。癌症特异性生存率和总生存率分别为 90%和 88%，1 年和 10 年后分别为 68%和 56%。局限性在于对前瞻性评估数据的回顾性分析。
如果密切关注围手术期细节，可实现同种异体间位可控性回肠储尿囊患者的高满意度、肾功能稳定和较低的尿路结石发生率。定期终生随访对于及时发现和治疗并发症至关重要。肿瘤学结果不受尿流改道的影响。
在可控性皮表回肠储尿囊患者中，如果患者坚持定期终生随访，可能获得良好的生活质量和高满意度。
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