LA NEOVESCICA CONTINENTE NELLA DONNA RISULTATI ONCOLOGICI E FUNZIONALI

Presentazione sul tema: "LA NEOVESCICA CONTINENTE NELLA DONNA RISULTATI ONCOLOGICI E FUNZIONALI"— Transcript della presentazione:

1 LA NEOVESCICA CONTINENTE NELLA DONNA RISULTATI ONCOLOGICI E FUNZIONALI
Anila Minja Divisione Clinicizzata di Urologia Direttore Prof. Walter Artibani 1

2 LA NEOVESCICA CONTINENTE NELLA DONNA

3 LA NEOVESCICA CONTINENTE NELLA DONNA
Risultati ONCOLOGICI NB: età biologica e pregressa radioterapia pelvicanon controindic assoluta; Stenzl et al. (2012), World J Urol

4 LA NEOVESCICA CONTINENTE NELLA DONNA
NB: età biologica e pregressa radioterapia pelvicanon controindic assoluta; 4

5 LA NEOVESCICA CONTINENTE NELLA DONNA
NB: età biologica e pregressa radioterapia pelvicanon controindic assoluta; 5

6 LA NEOVESCICA CONTINENTE NELLA DONNA
Distal portion of the urethra is covered with squamous epithelium, proximal portions with urothelial epithelium It is extremely rare for urothelial tumor to implant with squamous epithelium if the primary tumor and the entire urothelium of the bladder has been removed The only consistent risk factor for urethral tumor was tumor in the trigone or in bladder neck 6

7 LA NEOVESCICA CONTINENTE NELLA DONNA
59 donne dal 1995 al 2006; 15(28%)recurrence including 7 (13%) n the pelvis 7

8 LA NEOVESCICA CONTINENTE NELLA DONNA
NB: età biologica e pregressa radioterapia pelvicanon controindic assoluta; 8

9 LA NEOVESCICA CONTINENTE NELLA DONNA
Radical cystectomy: resection of bladder neck and a portion of proximal urethra continence dependent solely upon urethral sphincter (omega shape muscular complex multiple layers of smooth and striated muscle) Smooth muscle innervated by authomonic fibres in the pelvic plexus Striated muscle innervated by branches of pudental nerve The only consistent risk factor for urethral tumor was tumor in the trigone or in bladder neck 9

10 LA NEOVESCICA CONTINENTE NELLA DONNA
Somatic pathway (S2-S4) course along the levator ani muscle underneath the endopelvic fascia, adjacent to the bladders inferior vascular pedicle (attention during it’s dissection) and continue along the anterior wall of vagina o innervate the urethra Careful dissection of the lateral vaginal walls, bladder neck and urethra The only consistent risk factor for urethral tumor was tumor in the trigone or in bladder neck 10

11 LA NEOVESCICA CONTINENTE NELLA DONNA
Importand for manteinance of continence: preservation of suspensory fascial attachments of the remnant urethra to the pelvis, endopelvic fascia and the pubourethral ligaments Chronic urinary retention remains a significant issue for female patients The only consistent risk factor for urethral tumor was tumor in the trigone or in bladder neck 11

12 LA NEOVESCICA CONTINENTE NELLA DONNA
Videourodynamics showed a falling back of the pouch into the pelvic cavity: acute angulation of the neobladder-urethral junction Recostruction of pelvic floor increases back support of the pouch and decreases urinary retention The only consistent risk factor for urethral tumor was tumor in the trigone or in bladder neck 12

13 LA NEOVESCICA CONTINENTE NELLA DONNA
136 women ( ), mean follow-up 36 months 95 continent day-time; 86 continent at night; completely incontinent; 16 in chronic retention Omental packing behind the pouch, suturing of the peritoneum on the rectal wall to the vaginal stump, suspension of the later by the preserved round ligaments and suspension of the pouch near its dome to the back of the rectus muscle (Increase back support and ventral suspension near its dome) decreased the incidence of retention from 18,7% to 8% 13

14 LA NEOVESCICA CONTINENTE NELLA DONNA
42 donne 14

15 LA NEOVESCICA CONTINENTE NELLA DONNA
62 donne , hautmann neobladder; 35 con tecnica nuova; imp for continence: nerve sparing; for retention: mechanical posterior support 15

16 LA NEOVESCICA CONTINENTE NELLA DONNA
Ali stenzl mills shimokagi jarolim stein hautman 16

17 LA NEOVESCICA CONTINENTE NELLA DONNA
15 pz dal 1995 al 2010 17

18 LA NEOVESCICA CONTINENTE NELLA DONNA
Tot 37; 12 Cus (cutaneous urethrostomy); 16 BK-IC bricker’s ileal conduit;9 ONB –VIP; , f-up 36 months 18

19 COMPLICANZE E QUALITA’ DI VITA DOPO CISTECTOMIA RADICALE E DERIVAZIONE URINARIA
20 f, 2 mort per progr malattia; 3 vip 15 uics

20 RESULTS Patients with complications showed a significantly worse HR-QoL on the following domains The HR-QoL was significantly better in patients with VIP as regards the following domains 20

21 RESULTS 21

22 Grazie