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1420 RETROGRADE URETEROSCOPY IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER RECONSTRUCTION FOR BLADDER CANCER: A 17-YEAR EXPERIENCE
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
RESULTS: We included 540 patients (Ulm: 471, Kassel: 69). The 5- and 10-year overall survival was 27.6% and 16.2%, respectively. 284 patients had an ileal neobladder (NBL), 256 other forms of urinary diversion (OTH). The rates of lymph-node metastases and distant metastases were: NBL: 63% and 6%, OTH: 56% and 13%. After 10 years the overall survival was better in the NBL group for pT3b-4b pN0/1 tumors (28.6% vs. 17.6%) and for pN2-3 or M1 tumors (8.0% vs. 3.7%).The rate of local recurrence was 17.3% in the NBL-group, but only 18/49 patients developed tumor-related neobladder complications (6.3% of all neobladder patients in this group): hydronephrosis (n⫽8), subneovesical obstruction (n⫽4), hematuria (n⫽4), neovesico-intestinal fistula (n⫽5). In all cases the storage function of the neobladder could be maintained. No neobladder was removed. In the cases with a fistula, the affected intestinal segment was bypassed. In subneovesical obstruction, a TUR-BT was successfull in 2, chemotherapy in 1 case. 1 patient had an undiversion to a continent pouch. CONCLUSIONS: Patients with ileal neobladders were younger, had a lower comorbidity and better tumor stages than patients with other forms of urinary diversion. The risk of tumor-related neobladder complications remained low and could be handled with preservation of the neobladder in almost all cases. Ileal neobladders can be safely offered to patients even with advanced tumor stages, as long as there is no residual tumor visible in the true pelvis at the end of cystectomy. Source of Funding: None
1419 COMPARING HEALTH RELATED QUALITY OF LIFE OUTCOMES AFTER INTRA-CORPOREAL AND EXTRA-CORPOREAL URINARY DIVERSION AFTER RADICAL CYSTECTOMY: A MULTI INSTITUTIONAL STUDY Ahmed Aboumohamed*, Buffalo, NY; Kristopher Tallman, Alon Weizer, Ann Arbor, MI; Aabroo Khan, Rakeeba Din, Ali Al-Daghmin, Diana Mehedint, Terry Creighton, Buffalo, NY; Stephen Dailey, Ann Arbor, MI; Yi Shi, Mohamed Sharif, Gregory Wilding, Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: With the increase in robot-assisted approach for radical cystectomy, Intra-corporeal urinary diversion (IUD) is now gaining wider acceptance. We compared healthrelated quality of life (HRQL) outcomes utilizing the validated bladderspecific Bladder Cancer Index (BCI) and European Organization for Research and Treatment of Cancer (EORTC) Body Image Scale (BIS) between IUD and Extra-corporeal urinary diversion (EUD). METHODS: Patients undergoing radical cystectomy at Roswell Park Cancer Institute (RPCI) and University of Michigan (UofM) were enrolled in the study; patients who had IUD following robot-assisted radical cystectomy (RARC) at RPCI were compared to patients who underwent EUD (following either open radical cystectomy or RARC) at both centers. All patients completed the validated questionnaires (BCI and BIS), preoperatively, and at standardized postoperative intervals (at least twice postoperatively). The primary outcome measure was difference in interval and baseline BCI and BIS scores in both categories. RESULTS: 107 patients were included in the study; 57 and 50 underwent IUD and EUD, respectively after radical cystectomy; all were ileal conduits. Age, American Society of Anesthesiology (ASA) score, and Pathological tumor stage were similar in both groups. Baseline urinary function, bowel habits, sexual function, and Body image based on the two HRQL questionnaires were not statistically different between both groups. Postoperative analysis at 1, 3, 6, 12, 18, and 24 months revealed statistically significant differences between both groups in overall return of sexual function in favor of the EUD group (pvalue⫽0.039). Bowel function was better for EUD at 12 months (pvalue⫽0.04), meanwhile the overall Bowel function over time was not statistically different between the two groups (p-value⫽0.068). Urinary function and body image did not show statistically significant differences between the two groups (p-value⫽0.93 and 0.81, respectively).
THE JOURNAL OF UROLOGY姞
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CONCLUSIONS: Based on BCI and BIS scores, no differences were seen between IUD and EUD in terms of urinary function, bowel habits, and body image. Source of Funding: None
1420 RETROGRADE URETEROSCOPY IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER RECONSTRUCTION FOR BLADDER CANCER: A 17-YEAR EXPERIENCE Nirmish Singla*, James E. Montie, Cheryl T. Lee, J. Stuart Wolf, Jr., Gary J. Faerber, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: To further assess the feasibility, technique, complications, and outcomes of retrograde ureteroscopy in patients with orthotopic neobladder. METHODS: We retrospectively reviewed our ureteroscopy experience in patients who underwent cystectomy with orthotopic ileal neobladder urinary diversion. Procedures were reviewed and data collected regarding patient characteristics, indications for ureteroscopy, surgical technique, success, and complications. RESULTS: Between 1995-2012, 45 patients (37 male, 8 female) with neobladder diversion underwent 77 sessions of attempted retrograde ureteroscopy on 97 renal units for filling defect (47 cases), urothelial thickening (9 cases), calculi (4 cases), positive cytology (27 cases), and/or positive FISH (15 cases) on follow-up. The ureter and renal pelvis were successfully instrumented in 78 of 97 units (80.4%), with 85.3% success in Hautmann-type (n⫽75 renal units attempted), 50% in Studer-type (n⫽8), and 71.4% in unascertained-type (n⫽14) neobladders. Causes of failure included inability to locate the ureteral orifice (8 cases), inability to cannulate the orifice (6 cases), or inability to advance the ureteroscope due to tortuosity (5 cases). Among successful attempts with appropriately documented findings, 35.9% of cases with filling defects (n⫽39) were confirmed malignant and 61.5% benign by ureteroscopy. All cases with positive cytology (n⫽23) and 85.7% of cases with positive FISH (n⫽14) were confirmed malignant by retrograde ureteroscopy, and two of the four cases of calculi were successfully managed retrogradely. CONCLUSIONS: Retrograde ureteroscopic evaluation of upper tract abnormalities is feasible and practical in patients with orthotopic neobladders. Identification and cannulation of the ureteral orifice, particularly in tortuous situations, are challenging but can be overcome with fluoroscopic techniques. Retrograde ureteroscopy avoids the morbidity of percutaneous access with minimal complications. Source of Funding: None
1421 BILATERAL DILATATION OF THE UPPER URINARY TRACT (UUT) FOLLOWING ILEAL BLADDER SUBSTITUTION USING AN AFFERENT ISOPERISTALTIC TUBULAR SEGMENT: ETIOLOGY AND THERAPY Bernhard Kiss*, Susan D. Meierhans Ruf, George N. Thalmann, Urs E. Studer, Beat Roth, Bern, Switzerland INTRODUCTION AND OBJECTIVES: Bilateral dilatation of the UUT following cystectomy and ileal bladder substitution using an afferent isoperistaltic tubular segment is usually caused by neobladder outlet obstruction with consecutive incomplete neobladder voiding, completely resolving after transurethral catheterisation. However, some bilateral hydronephrosis still persist. The aim of this study was to evaluate the etiology and therapy in these patients. METHODS: Retrospective analysis of incidence and therapy of bilateral hydronephrosis not responding to transurethral catheterisation in our cohort of 739 cystectomy patients who received an ileal orthotopic bladder substitute with an afferent tubular segment between April 1985 and August 2012. RESULTS: 11 patients (1.5%; median age 69 years range 23-81) developed bilateral hydronephrosis not responding to transure-
RESULTS: We included 540 patients (Ulm: 471, Kassel: 69). The 5- and 10-year overall survival was 27.6% and 16.2%, respectively. 284 patients had an ileal neobladder (NBL), 256 other forms of urinary diversion (OTH). The rates of lymph-node metastases and distant metastases were: NBL: 63% and 6%, OTH: 56% and 13%. After 10 years the overall survival was better in the NBL group for pT3b-4b pN0/1 tumors (28.6% vs. 17.6%) and for pN2-3 or M1 tumors (8.0% vs. 3.7%).The rate of local recurrence was 17.3% in the NBL-group, but only 18/49 patients developed tumor-related neobladder complications (6.3% of all neobladder patients in this group): hydronephrosis (n⫽8), subneovesical obstruction (n⫽4), hematuria (n⫽4), neovesico-intestinal fistula (n⫽5). In all cases the storage function of the neobladder could be maintained. No neobladder was removed. In the cases with a fistula, the affected intestinal segment was bypassed. In subneovesical obstruction, a TUR-BT was successfull in 2, chemotherapy in 1 case. 1 patient had an undiversion to a continent pouch. CONCLUSIONS: Patients with ileal neobladders were younger, had a lower comorbidity and better tumor stages than patients with other forms of urinary diversion. The risk of tumor-related neobladder complications remained low and could be handled with preservation of the neobladder in almost all cases. Ileal neobladders can be safely offered to patients even with advanced tumor stages, as long as there is no residual tumor visible in the true pelvis at the end of cystectomy. Source of Funding: None
1419 COMPARING HEALTH RELATED QUALITY OF LIFE OUTCOMES AFTER INTRA-CORPOREAL AND EXTRA-CORPOREAL URINARY DIVERSION AFTER RADICAL CYSTECTOMY: A MULTI INSTITUTIONAL STUDY Ahmed Aboumohamed*, Buffalo, NY; Kristopher Tallman, Alon Weizer, Ann Arbor, MI; Aabroo Khan, Rakeeba Din, Ali Al-Daghmin, Diana Mehedint, Terry Creighton, Buffalo, NY; Stephen Dailey, Ann Arbor, MI; Yi Shi, Mohamed Sharif, Gregory Wilding, Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: With the increase in robot-assisted approach for radical cystectomy, Intra-corporeal urinary diversion (IUD) is now gaining wider acceptance. We compared healthrelated quality of life (HRQL) outcomes utilizing the validated bladderspecific Bladder Cancer Index (BCI) and European Organization for Research and Treatment of Cancer (EORTC) Body Image Scale (BIS) between IUD and Extra-corporeal urinary diversion (EUD). METHODS: Patients undergoing radical cystectomy at Roswell Park Cancer Institute (RPCI) and University of Michigan (UofM) were enrolled in the study; patients who had IUD following robot-assisted radical cystectomy (RARC) at RPCI were compared to patients who underwent EUD (following either open radical cystectomy or RARC) at both centers. All patients completed the validated questionnaires (BCI and BIS), preoperatively, and at standardized postoperative intervals (at least twice postoperatively). The primary outcome measure was difference in interval and baseline BCI and BIS scores in both categories. RESULTS: 107 patients were included in the study; 57 and 50 underwent IUD and EUD, respectively after radical cystectomy; all were ileal conduits. Age, American Society of Anesthesiology (ASA) score, and Pathological tumor stage were similar in both groups. Baseline urinary function, bowel habits, sexual function, and Body image based on the two HRQL questionnaires were not statistically different between both groups. Postoperative analysis at 1, 3, 6, 12, 18, and 24 months revealed statistically significant differences between both groups in overall return of sexual function in favor of the EUD group (pvalue⫽0.039). Bowel function was better for EUD at 12 months (pvalue⫽0.04), meanwhile the overall Bowel function over time was not statistically different between the two groups (p-value⫽0.068). Urinary function and body image did not show statistically significant differences between the two groups (p-value⫽0.93 and 0.81, respectively).
THE JOURNAL OF UROLOGY姞
e581
CONCLUSIONS: Based on BCI and BIS scores, no differences were seen between IUD and EUD in terms of urinary function, bowel habits, and body image. Source of Funding: None
1420 RETROGRADE URETEROSCOPY IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER RECONSTRUCTION FOR BLADDER CANCER: A 17-YEAR EXPERIENCE Nirmish Singla*, James E. Montie, Cheryl T. Lee, J. Stuart Wolf, Jr., Gary J. Faerber, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: To further assess the feasibility, technique, complications, and outcomes of retrograde ureteroscopy in patients with orthotopic neobladder. METHODS: We retrospectively reviewed our ureteroscopy experience in patients who underwent cystectomy with orthotopic ileal neobladder urinary diversion. Procedures were reviewed and data collected regarding patient characteristics, indications for ureteroscopy, surgical technique, success, and complications. RESULTS: Between 1995-2012, 45 patients (37 male, 8 female) with neobladder diversion underwent 77 sessions of attempted retrograde ureteroscopy on 97 renal units for filling defect (47 cases), urothelial thickening (9 cases), calculi (4 cases), positive cytology (27 cases), and/or positive FISH (15 cases) on follow-up. The ureter and renal pelvis were successfully instrumented in 78 of 97 units (80.4%), with 85.3% success in Hautmann-type (n⫽75 renal units attempted), 50% in Studer-type (n⫽8), and 71.4% in unascertained-type (n⫽14) neobladders. Causes of failure included inability to locate the ureteral orifice (8 cases), inability to cannulate the orifice (6 cases), or inability to advance the ureteroscope due to tortuosity (5 cases). Among successful attempts with appropriately documented findings, 35.9% of cases with filling defects (n⫽39) were confirmed malignant and 61.5% benign by ureteroscopy. All cases with positive cytology (n⫽23) and 85.7% of cases with positive FISH (n⫽14) were confirmed malignant by retrograde ureteroscopy, and two of the four cases of calculi were successfully managed retrogradely. CONCLUSIONS: Retrograde ureteroscopic evaluation of upper tract abnormalities is feasible and practical in patients with orthotopic neobladders. Identification and cannulation of the ureteral orifice, particularly in tortuous situations, are challenging but can be overcome with fluoroscopic techniques. Retrograde ureteroscopy avoids the morbidity of percutaneous access with minimal complications. Source of Funding: None
1421 BILATERAL DILATATION OF THE UPPER URINARY TRACT (UUT) FOLLOWING ILEAL BLADDER SUBSTITUTION USING AN AFFERENT ISOPERISTALTIC TUBULAR SEGMENT: ETIOLOGY AND THERAPY Bernhard Kiss*, Susan D. Meierhans Ruf, George N. Thalmann, Urs E. Studer, Beat Roth, Bern, Switzerland INTRODUCTION AND OBJECTIVES: Bilateral dilatation of the UUT following cystectomy and ileal bladder substitution using an afferent isoperistaltic tubular segment is usually caused by neobladder outlet obstruction with consecutive incomplete neobladder voiding, completely resolving after transurethral catheterisation. However, some bilateral hydronephrosis still persist. The aim of this study was to evaluate the etiology and therapy in these patients. METHODS: Retrospective analysis of incidence and therapy of bilateral hydronephrosis not responding to transurethral catheterisation in our cohort of 739 cystectomy patients who received an ileal orthotopic bladder substitute with an afferent tubular segment between April 1985 and August 2012. RESULTS: 11 patients (1.5%; median age 69 years range 23-81) developed bilateral hydronephrosis not responding to transure-