Gastric neobladders: surgical outcomes of 91 cases using different techniques

Vol. 44 (5): 914-919, September – October, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0563


ORIGINAL ARTICLE

Aloysio Floriano de Toledo 1, Carlos Eduardo Bastian da Cunha 1, Christian Heinz Steppe 1, Daniel Weissbluth de Toledo 1, Jorge Antonio Pastro Noronha 1, Gustavo Carvalhal 1
1 Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul – PUC, Porto Alegre, RS, Brasil

ABSTRACT  

Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers.

Materials and Methods: We report on a retrospective case series of 91 patients who recei­ved gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neoblad­ders were employed from 1988 to 2013 at a university hospital in the South of Brazil.

Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) tech­nique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further devel­opments of these techniques, with the detubularized gastric neobladder and the “spheri­cal” gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of tech­niques using ileum or colon.

Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

Keywords: Surgical Procedures, Operative; Urinary Diversion; Cystectomy

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