Orthotopic Ileal Neobladder Construction Using Non-Absorbable Staples: Is It Safe?
*Rafael Siqueira Rocha Vidal Department Of Urology, Brazil
*Corresponding Author: Rafael Siqueira Rocha Vidal
Department Of Urology, Brazil Email:email@example.com
Published on: 2015-05-12
Objective: Approximately 30% of bladder cancer patients present with muscle-invasive disease at the time of diagnosis and the standard treatment is radical cystectomy. The challenge for surgeons has been selecting an ideal urinary diversion technique for these patients. The main objective of this paper is to evaluate the post-surgical complications, resulting from the use of non-absorbable titanium staples in Orthotopic Ileal Neobladder (OIN) construction. Materials and Methods: We performed a retrospective analysis of all patients subjected to radical cystectomy with OIN construction at a single institution between 2006 and 2012. During this period, 18 patients underwent this surgery; imaging analyses and kidney function tests were performed as part of the follow-up to identify disease recurrence or the presence of complications. Results: The patients were followed for an average period of 20.8 months (range, 1–68 months) and had a mean 6-year overall survival rate of 75%. Two patients developed deep vein thrombosis (DVT) and 1 patient developed a urinary fistula (uretero-neobladder anastomosis). These complications developed early and were resolved after treatment. We observed 3 late complications, including a rupture of the OIN (6.2%) in 1 patient and reservoir calculus formation in 2 patients (12.5%). These complications developed late and were not related to the use of non-absorbable staples. Conclusions: The long follow-up period in patients subjected to OIN with the use of titanium staples demonstrated the safety and simple reproducibility of this technique. Prospective, comparative, and randomized studies should be performed to confirm these findings.
Bladder cancer is the ninth most frequent cause of cancer worldwide and is the fourth most frequent cause of cancer in men in the United States, where it is responsible for 130,000 deaths per year . According to the Ministry of Health, the incidence of bladder cancer in Brazil is estimated to be 3.7 cases per 100,000 individuals . Approximately 30% of bladder cancer patients present with muscle-invasive disease at the time of diagnosis . The standard treatment for these patients comprises radical cystectomy combined with pelvic lymphadenectomy; this combination provides disease-free survival rates of approximately 70% and 66% after 5 and 10 years, respectively .