Does the Success of Ureterointestinal Implantation in Orthotopic Bladder Substitution Depend More on Surgeon Level of Experience or Choice of Technique?

No AccessJournal of UrologyClinical Urology: Original Article1 Jan 1997Does the Success of Ureterointestinal Implantation in Orthotopic Bladder Substitution Depend More on Surgeon Level of Experience or Choice of Technique? Stephan Roth, Hermann Van Ahlen, Axel Semjonow, Frank Oberpenning, and Lothar Hertle Stephan RothStephan Roth , Hermann Van AhlenHermann Van Ahlen , Axel SemjonowAxel Semjonow , Frank OberpenningFrank Oberpenning , and Lothar HertleLothar Hertle View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65279-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We attempted to determine the relative risk of ureterointestinal anastomosis using 2 antireflux techniques of orthotopic bladder substitution, and we assessed the degree to which success is determined by surgeon experience. Materials and Methods: A total of 120 patients underwent surgery, including 74 with the Hautmann (Le Duc) technique and 46 with a somewhat modified Studer (Nesbit/Studer) technique. The urologists who performed the operations were classified as expert, skilled and learner. Evaluation was done retrospectively. All patients in the Studer group, except 3 who died and 1 who was lost to followup, were monitored a minimum of 12 months. Results: There was a 20.4% rate of nonneoplastic obstructions in the 142 ureters reimplanted with the Le Duc technique (Hautmann group). The variation in obstruction rates of 16.7, 18.2 and 25%, respectively, for expert, skilled and learning surgeons was statistically insignificant. Only 3 nonneoplastic obstructions (3.6%) developed in the 83 ureters reimplanted with the Nesbit/Studer technique (Studer group). The variation in obstruction rates of 5.1, 0 and 3.6%, respectively, for expert, skilled and learner surgeons was statistically insignificant. Conclusions: The Nesbit/Studer technique results in a generally lower rate of ureterointestinal anastomotic stricture than the Le Duc technique. Using the Le Duc technique there was no statistically significant correlation between incidence of obstruction and surgeon level of experience, indicating that obstruction with this technique probably arises from other factors. References 1 : A novel uretero-ileal reimplantation technique: the serous lined extramural tunnel. A preliminary report. J. Urol.1994; 151: 1193. Google Scholar 2 : Renal function and upper urinary tract configuration following urinary diversion to a continent urinary reservoir (Kock pouch): a prospective 5 to 11-year followup after reservoir construction.. J. Urol.1986; 142: 964. Google Scholar 3 : Urinary diversion via a continent ileum reservoir: clinical experience.. Scand. J. Urol. Nephrol.1982; 49: 23. Google Scholar 4 : An original antireflux ureteroileal implantation technique: long-term followup.. J. 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Abstract, Google Scholar Department of Urology, University of Munster, Munster, Germany.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKälble T and Roth S (2018) Serosa Lined and Tapered Ileum as Primary and Secondary Continence Mechanism for Various Catheterizable PouchesJournal of Urology, VOL. 180, NO. 5, (2053-2057), Online publication date: 1-Nov-2008.Hautmann S, Chun K, Currlin E, Braun P, Huland H and Juenemann K (2018) Refluxing Chimney Versus Nonrefluxing LeDuc Ureteroileal Anastomosis for Orthotopic Ileal Neobladder: A Comparative Analysis for Patients With Bladder CancerJournal of Urology, VOL. 175, NO. 4, (1389-1394), Online publication date: 1-Apr-2006.MINERVINI A, BONI G, SALINITRI G, MARIANI G and MINERVINI R (2018) EVALUATION OF RENAL FUNCTION AND UPPER URINARY TRACT MORPHOLOGY IN THE ILEAL ORTHOTOPIC NEOBLADDER WITH NO ANTIREFLUX MECHANISMJournal of Urology, VOL. 173, NO. 1, (144-147), Online publication date: 1-Jan-2005.YONEDA T, ADACHI H, URAKAMI S, KISHI H, SHIGENO K, SHIINA H and IGAWA M (2018) HEALTH RELATED QUALITY OF LIFE AFTER ORTHOTOPIC NEOBLADDER CONSTRUCTION AND ITS COMPARISON WITH NORMATIVE VALUES IN THE JAPANESE POPULATIONJournal of Urology, VOL. 174, NO. 5, (1944-1947), Online publication date: 1-Nov-2005.SHIOJI Y, MURAISHI O and TOKUE A (2018) A Deserosalized Muscle Layer Covering Method for Antireflux Ureteroileostomy: A Preliminary Clinical TrialJournal of Urology, VOL. 168, NO. 6, (2521-2523), Online publication date: 1-Dec-2002.CONSTANTINIDES C, MANOUSAKAS T, CHRISOFOS M and GIANNOPOULOS A (2018) ORTHOTOPIC BLADDER SUBSTITUTION AFTER RADICAL CYSTECTOMY: 5 YEARS OF EXPERIENCE WITH A NOVEL PERSONAL MODIFICATION OF THE ILEAL S POUCHJournal of Urology, VOL. 166, NO. 2, (532-537), Online publication date: 1-Aug-2001.HUMKE J, LAMPEL A and ROTH S (2018) POUCH SHRINKAGE FROM MESENTERIC THROMBOSIS IN ORTHOTOPIC BLADDER SUBSTITUTIONJournal of Urology, VOL. 165, NO. 6 Part 1, (1999-2000), Online publication date: 1-Jun-2001.ABOL-ENEIN H and GHONEIM M (2018) FUNCTIONAL RESULTS OF ORTHOTOPIC ILEAL NEOBLADDER WITH SEROUS-LINED EXTRAMURAL URETERAL REIMPLANTATION: EXPERIENCE WITH 450 PATIENTSJournal of Urology, VOL. 165, NO. 5, (1427-1432), Online publication date: 1-May-2001.Muraishi O, Yamashita T, Ishikawa S, Hara Y and Tokue A (2018) IMPROVEMENT OF URETEROILEAL ANASTOMOSIS IN ORTHOTOPIC ILEAL NEOBLADDER WITH MODIFIED LE DUC PROCEDURE: SHORT SUBMUCOSAL TUNNEL TECHNIQUEJournal of Urology, VOL. 165, NO. 3, (798-801), Online publication date: 1-Mar-2001.PANTUCK A, HAN K, PERROTTI M, WEISS R and CUMMINGS K (2018) URETEROENTERIC ANASTOMOSIS IN CONTINENT URINARY DIVERSION: LONG-TERM RESULTS AND COMPLICATIONS OF DIRECT VERSUS NONREFLUXING TECHNIQUESJournal of Urology, VOL. 163, NO. 2, (450-455), Online publication date: 1-Feb-2000.WALDNER M, HERTLE L and ROTH S (2018) ILEAL URETERAL SUBSTITUTION IN RECONSTRUCTIVE UROLOGICAL SURGERY: IS AN ANTIREFLUX PROCEDURE NECESSARY?Journal of Urology, VOL. 162, NO. 2, (323-326), Online publication date: 1-Aug-1999.SCHWAIBOLD H, FRIEDRICH M, FERNANDEZ S, CONRAD S and HULAND H (2018) IMPROVEMENT OF URETEROILEAL ANASTOMOSIS IN CONTINENT URINARY DIVERSION WITH MODIFIED LE DUC PROCEDUREJournal of Urology, VOL. 160, NO. 3 Part 1, (718-720), Online publication date: 1-Sep-1998. Volume 157Issue 1January 1997Page: 56-60 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Stephan Roth More articles by this author Hermann Van Ahlen More articles by this author Axel Semjonow More articles by this author Frank Oberpenning More articles by this author Lothar Hertle More articles by this author Expand All Advertisement PDF downloadLoading ...