Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Feb 15;2012(2):CD003306.
doi: 10.1002/14651858.CD003306.pub2.

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

June D Cody  1 , Ghulam Nabi, Norman Dublin, Samuel McClinton, David E Neal, Robert Pickard, Sze M Yong
Affiliations
Review

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

June D Cody et al. Cochrane Database Syst Rev. .

Abstract

Background: Surgery performed to improve or replace the function of the diseased urinary bladder has been carried out for over a century. Main reasons for improving or replacing the function of the urinary bladder are bladder cancer, neurogenic bladder dysfunction, detrusor overactivity and chronic inflammatory diseases of the bladder (such as interstitial cystitis, tuberculosis and schistosomiasis). There is still much uncertainty about the best surgical approach. Options available at the present time include: (1) conduit diversion (the creation of various intestinal conduits to the skin) or continent diversion (which includes either a rectal reservoir or continent cutaneous diversion), (2) bladder reconstruction and (3) replacement of the bladder with various intestinal segments.

Objectives: To determine the best way of improving or replacing the function of the lower urinary tract using intestinal segments when the bladder has to be removed or when it has been rendered useless or dangerous by disease.

Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 October 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles.

Selection criteria: All randomised or quasi-randomised controlled trials of surgery involving transposition of an intestinal segment into the urinary tract.

Data collection and analysis: Trials were evaluated for appropriateness for inclusion and for risk of bias by the review authors. Three review authors were involved in the data extraction. Data were combined in a meta-analysis when appropriate.

Main results: Five trials met the inclusion criteria with a total of 355 participants. These trials addressed only five of the 14 comparisons pre-specified in the protocol. One trial reported no statistically significant differences in the incidence of upper urinary tract infection, uretero-intestinal stenosis and renal deterioration in the comparison of continent diversion with conduit diversion. The confidence intervals were all wide, however, and did not rule out important clinical differences. In a second trial, there was no reported difference in the incidence of upper urinary tract infection and uretero-intestinal stenosis when conduit diversions were fashioned from either ileum or colon. A meta-analysis of two trials showed no statistically significant difference in daytime or nocturnal incontinence amongst participants who were randomised to ileocolonic/ileocaecal segment bladder replacement compared to an ileal bladder replacement. However, one small trial suggested that bladder replacement using an ileal segment compared to using an ileocolonic segment may be better in terms of lower rates of nocturnal incontinence. There were no differences in the incidence of dilatation of upper tract, daytime urinary incontinence or wound infection using different intestinal segments for bladder replacement. However the data were reported for 'renal units', but not in a form that allowed appropriate patient-based paired analyses. No statistically significant difference was found in the incidence of renal scarring between anti-refluxing versus freely refluxing uretero-intestinal anastomotic techniques in conduit diversions and bladder replacement groups. Again, the outcome data were not reported as paired analysis or in form to carry out paired analysis.

Authors' conclusions: The evidence from the included trials was very limited. Only five studies met the inclusion criteria; these were small, of moderate or poor methodological quality, and reported few of the pre-selected outcome measures. This review did not find any evidence that bladder replacement (orthotopic or continent diversion) was better than conduit diversion following cystectomy for cancer. There was no evidence to suggest that bladder reconstruction was better than conduit diversion for benign disease. The clinical significance of data from one small trial suggesting that bladder replacement using an ileal segment compared to using an ileocolonic segment is better in terms of lower rates of nocturnal incontinence is uncertain. The small amount of usable evidence for this review suggests that collaborative multi centre studies should be organised, using random allocation where possible.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1
1
PRISMA study flow diagram.
1.3
1.3. Analysis
Comparison 1 Continent diversion versus conduit, Outcome 3 Number of patients with upper urinary tract infection.
1.9
1.9. Analysis
Comparison 1 Continent diversion versus conduit, Outcome 9 Number with uretero‐intestinal stenosis.
1.23
1.23. Analysis
Comparison 1 Continent diversion versus conduit, Outcome 23 Physiological/radiological measures.
9.1
9.1. Analysis
Comparison 9 One segment versus another in bladder replacement, Outcome 1 Urinary leakage.
9.2
9.2. Analysis
Comparison 9 One segment versus another in bladder replacement, Outcome 2 Incontinence.
9.3
9.3. Analysis
Comparison 9 One segment versus another in bladder replacement, Outcome 3 Wound infection.
11.1
11.1. Analysis
Comparison 11 One segment versus another for conduit diversion, Outcome 1 Number of patients with upper urinary tract infection.
11.2
11.2. Analysis
Comparison 11 One segment versus another for conduit diversion, Outcome 2 Number with uretero‐intestinal stenosis.
12.1
12.1. Analysis
Comparison 12 Anti reflux versus reflux for bladder replacement, Outcome 1 Number of patients with upper urinary tract infection.
12.2
12.2. Analysis
Comparison 12 Anti reflux versus reflux for bladder replacement, Outcome 2 Number with urinary incontinence.
12.3
12.3. Analysis
Comparison 12 Anti reflux versus reflux for bladder replacement, Outcome 3 Number with uretero‐intestinal stenosis.
12.4
12.4. Analysis
Comparison 12 Anti reflux versus reflux for bladder replacement, Outcome 4 Physiological/radiological measures.
14.1
14.1. Analysis
Comparison 14 Anti reflux versus reflux for conduit diversion, Outcome 1 Physiological/radiological measures.
See this image and copyright information in PMC

Update of

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Chen 2009 {published data only}
    1. Chen Z, Lu G, Li X, Li X, Fang Q, Ji H, et al. Better compliance contributes to better nocturnal continence with orthotopic ileal neobladder than ileocolonic neobladder after radical cystectomy for bladder cancer. Urology 2009;73(4):838‐43; discussion 843‐4. - PubMed
Khafagy 2006 {published data only}
    1. Khafagy M, Shaheed FA, Moneim TA. Ileocaecal vs ileal neobladder after radical cystectomy in patients with bladder cancer: a comparative study. BJU International 2006;97(4):799‐804. [21954] - PubMed
Kristjansson 1995 {published data only}
    1. Kristjansson A, Bajc M, Wallin L, Willner J, Mansson W. Renal function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria. British Journal of Urology 1995;76:546‐50. [MEDLINE: ] - PubMed
    1. Kristjansson A, Wallin L, Mansson W. Renal Function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent diversion. 1. Glomerular filtration rate and patency of uretero‐intestinal anastomosis. British Journal of Urology 1995;76:539‐45. [MEDLINE: ] - PubMed
    1. Mansson W, Ahlgren G, White T. Glomerular filtration rate up to 10 years after urinary diversion of different types. Scandinavian Journal of Urology and Nephrology 1989;23:195‐200. [MEDLINE: ] - PubMed
Shaaban 2006 {published data only}
    1. Shaaban AA, Abdel‐Latif M, Mosbah A, Gad H, Eraky I, Ali‐El‐Dein B, et al. A randomized study comparing an antireflux system with a direct ureteric anastomosis in patients with orthotopic ileal neobladders. BJU International 2006;97(5):1057‐62. [21881] - PubMed
Studer 1996 {published data only}
    1. Hugonnet CL, Danuser H, Thalmann GN, Studer UE. [Long‐term urodynamic and clinical follow‐up in 70 patients with ileal bladder replacement combined with an antireflux mechanism or an afferent tubular segment] [French] [Resultats urodynamiques et cliniques a long terme chez 70 patients ayant une vessie ileale de substitution combinee a un mecanisme anti‐reflux ou un segment tubulaire afferent]. Progres en Urologie 1997;7:960‐6. [MEDLINE: ] - PubMed
    1. Studer U, Danuser H, Thalmann G, Springer J, Turner W. Antireflux nipples or afferent tubular segments in 70 patients with ileal low pressure bladder substitutes: Long term results of a prospective randomized trial. Journal of Urology 1996;156:1913‐7. [MEDLINE: ] - PubMed
    1. Studer U, Spiegel T, Casanova G, Springer J, Gerber E, Ackermann D, et al. Ileal bladder substitute: Antireflux nipple or afferent tubular segment. European Urology 1991;20:315‐26. [MEDLINE: ] - PubMed

References to studies excluded from this review

Bassi 1996 {published data only}
    1. Bassi E, Valerio S, Antoniazzi G, Fornasiero GF, Petterle YV. Comparison between results of ileal conduit and continent ileal bladder (VIP), after radical cystectomy. Archivos Espanoles de Urologia 1996;49(9):1003‐6. [MEDLINE: ] - PubMed
Boyd 1987 {published data only}
    1. Boyd SD, Feinberg SM, Skinner DG, Lieskovsky G, Baron D, Richardson J. Quality of life survey of urinary diversion patients: Comparison of ileal conduits versus continent Kock ileal reservoirs. Journal of Urology 1987;138:1386‐9. [MEDLINE: ] - PubMed
Brough 1998 {published data only}
    1. Brough RJ, O'Flynn KJ, Fishwick J, Gough DCS. Bladder washout and stone formation in paediatric enterocystoplasty. Pediatric Urology 1998;33:500‐2. [MEDLINE: ] - PubMed
Davidsson 1996 {published data only}
    1. Davidsson T, Hedlund H, Mansson W. Detubularized right colonic reservoir with intussuscepted ileal nipple valve or stapled ileal ("Lundiana") outlet. World Journal of Urology 1996;14:78‐84. [MEDLINE: ] - PubMed
De Carli 1997 {published data only}
    1. Carli P, Micali S, O'Sullivan D, Mainiero G, Cusumano G, Fattahi H, et al. Ureteral Anastomosis in the Orthotopic Ileal Neobladder: Comparison of 2 techniques. The Journal of Urology 1997;157(2):469‐71. [MEDLINE: ] - PubMed
Degen 1997 {published data only}
    1. Degen LP, Flue MO, Collet A, Hamel C, Beglinger C, Harder F. Ileocecal segment transposition does not alter whole gut transit in humans. Annals of Surgery 1997;226(6):746‐52. [MEDLINE: ] - PMC - PubMed
El 2002 {published data only}
    1. Bahnasawy MS, Shaaban HS, Gomha MA, Nabeeh A. Management of nocturnal incontinence in orthotopic ileal reservoirs using oxybutinin versus verapamil: A prospective randomized cross‐over study (Abstract). Journal of Urology 2002;167(4 Suppl):86. [17608]
Ghoneim 1981 {published data only}
    1. Ghoneim M, Shehab‐El‐Din A, Ashamallah A, Gaballah M. Evolution of rectal bladder as a method for urinary diversion. Journal of Urology 1981;126:737‐40. [MEDLINE: ] - PubMed
Ghoneim 1988 {published data only}
    1. Ghoneim MA, Adhmallah AK, Awaad HK, Shebab El‐Din AB, Kock NG, Whitmore Jr WF. Cystectomy and diversion for carcinoma of the bilharzial bladder. Management of advanced cancer of prostate and bladder. New York: Alan R Liss, Inc, 1988:315‐9. [MEDLINE: ] - PubMed
Kolettis 1996 {published data only}
    1. Kolettis PN, Klein EA, Novick AC, Winters JC, Appell RA. The Le Bag orthotopic urinary diversion. Journal of Urology 1996;156(3):926‐30. [MEDLINE: ] - PubMed
Lampel 1995 {published data only}
    1. Lampel A, Hohenfellner M, Schultz‐Lampel D, Thuroff JW. In situ tunneled bowel flap tubes: 2 new techniques of a continent outlet for Mainz pouch cutaneous diversion. Journal of Urology 1995;153:308‐15. [MEDLINE: ] - PubMed
Lightfoot 2007 {published data only}
    1. Lightfoot AJ, Eno M, Kreder KJ, O'Donnell MA, Rao SS, Williams RD. Treatment of postoperative ileus after bowel surgery with low‐dose intravenous erythromycin. Urology 2007;69(4):611‐5. [MEDLINE: ] - PubMed
Mansson 1997 {published data only}
    1. Mansson A, Colleen S, Hermeren G, Johnson G. Which patient will benefit from psychosocial intervention after cystectomy for bladder cancer. British Journal of Urology 1997;80:50‐7. [MEDLINE: ] - PubMed
Mansson 2004 {published data only}
    1. Mansson A, Henningsohn L, Steineck G, Mansson W. Neutral third party versus treating institution for evaluating quality of life after radical cystectomy. European Urology 2004;46(2):195‐9. [19501] - PubMed
Mattei 2008 {published data only}
    1. Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. Journal of Urology 2008;179(2):582‐6. - PubMed
Morey 2006 {published data only}
    1. Morey AF, Evans LA, McDonough RC, III, Park AM, Sexton WJ, Basler JW, et al. Evaluation of mechanical bowel preparation methods in urinary diversion surgery. Canadian Journal of Urology 2006;13(5):3250‐4. [23037] - PubMed
Okada 1989 {published data only}
    1. Okada Y, Arai Y, Oishi K, Takeuchi H, Yoshida O. Stable formation of the nipple valve in Kock Pouch for diversion of the urinary tract. Surgery, Gynecology and Obstetrics 1989;169:315‐8. - PubMed
Osman 2004 {published data only}
    1. Osman Y, Abol‐Enein H, Nabeeh A, Gaballah M, Bazeed M. Long‐term results of a prospective randomized study comparing two different antireflux techniques in orthotopic bladder substitution. European Urology 2004;45(1):82‐6. - PubMed
Osman 2009 {published data only}
    1. Osman Y, Abol‐Enein H, El‐Mekresh M, Gad H, Elhefnawy A, Ghoneim M. Comparison between a serous‐lined extramural tunnel and T‐limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial. BJU International 2009;104(10):1518‐21. - PubMed
Shaaban 1992 {published data only}
    1. Shaaban AA, Gaballah MA, El‐Diasty TA, Ghoneim MA. Urethral controlled bladder substitution: A comparison between the intussuscepted nipple valve and the technique of Le Duc as antireflux procedures. Journal of Urology 1992;148:1156‐61. [MEDLINE: ] - PubMed
Shokeir 1995 {published data only}
    1. Shokeir AA, Ghoneim MA. Further experience with the modified ileal ureter. Journal of Urology 1995;154(1):45‐8. - PubMed
Speakman 1989 {published data only}
    1. Speakman MJ, Bramwell SP, Deane RF. A prospective comparison of ileocystoplasty and human dura mater cystoplasty in the treatment of detrusor instability (Abstract number 134). Proceedings of the 19th Annual Meeting of the International Continence Society; 1989 Sept 7‐9; Ljubljana, Slovenia. 1989:266‐7.
Studer 1997 {published data only}
    1. Studer UE, Zingg EJ. Ileal orthotopic bladder substitutes. Urologic Clinics of North America 1997;24(4):781‐93. [MEDLINE: ] - PubMed
Thakar 1998 {published data only}
    1. Thakar BR, Stanton SL, Robinson G, Clarkson P, Shah K, Manyonda IT. Does hysterectomy affect bladder and bowel function (Abstract number 166). Neurourology and Urodynamics 1998;17:83‐4.
Vakalopoulos 2011 {published data only}
    1. Vakalopoulos I, Dimitriadis G, Anastasiadis A, Gkotsos G, Radopoulos D. Does intubated uretero‐ureterocutaneostomy provide better health‐related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?. International Urology & Nephrology 2011;43(3):743‐8. - PubMed

References to ongoing studies

Skinner 2009 {published data only}
    1. Skinner EC, Skinner DG. Does reflux in orthotopic diversion matter? A randomized prospective comparison of the Studer and T‐pouch ileal neobladders. World Journal of Urology 2009;27(1):51‐5. - PubMed

Additional references

Bramble 1982
    1. Bramble FJ. The treatment of adult enuresis and urge incontinence by enterocystoplasty. British Journal of Urology 1982;54(6):693‐6. [MEDLINE: ] - PubMed
Bramble 1990
    1. Bramble FJ. The clam cystoplasty. British Journal of Urology 1982;66(4):337‐41. [MEDLINE: ] - PubMed
Bricker 1950
    1. Bricker EM. Bladder substitution after pelvic evisceration. Surgical Clinics of North America 1950;30:1511‐21. - PubMed
Couillard 1995
    1. Couillard DR, Webster GD. Detrusor instability. Urologic Clinics of North America 1995;22(3):593‐612. [MEDLINE: ] - PubMed
George 1991
    1. George VK, Russell GL, Shutt A, Gaches CG, Ashken MH. Clam ileocystoplasty. British Journal of Urology 1991;68(5):487‐9. [MEDLINE: ] - PubMed
Hanno 1990
    1. Hanno P, Levin RM, Monson FC, Teuscher C, Zhou ZZ, Ruggieri M, et al. Diagnosis of interstitial cystitis. Journal of Urology 1990;143(2):278‐81. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Kock 1982
    1. Kock NG, Nilson AE, Nilsson LO, Norlen LJ, Philipson BM. Urinary diversion via a continent ileal reservoir: clinical results in 12 patients. Journal of Urology 1982;128(3):469‐75. [MEDLINE: ] - PubMed
Kock 1988
    1. Kock NG, Ghoneim MA, Lycke KG, Mahran MR. Urinary diversion to the augmented and valved rectum: preliminary results with a novel surgical procedure. Journal of Urology 1988;140(6):1375‐79. [MEDLINE: ] - PubMed
Kockelbergh 1991
    1. Kockelbergh RC, Tan JB, Bates CP, Bishop MC, Dunn M, Lemberger RJ. Clam enterocystoplasty in general urological practice. British Journal of Urology 1991;68(1):38‐41. [MEDLINE: ] - PubMed
Kristjansson 1995a
    1. Kristjansson A, Wallin L, Mansson W. Renal Function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent diversion. 1. Glomerular filtration rate and patency of uretero‐intestinal anastomosis. British Journal of Urology 1995;76:539‐45. [MEDLINE: ] - PubMed
Kristjansson 1995b
    1. Kristjansson A, Bajc M, Wallin L, Willner J, Mansson W. Renal function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria. British Journal of Urology 1995;76:546‐50. [MEDLINE: ] - PubMed
Lapides 1972
    1. Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self‐catheterization in the treatment of urinary tract disease. Journal of Urology 1972;107(3):458‐61. [MEDLINE: ] - PubMed
Lewis 1990
    1. Lewis DK, Morgan JR, Weston PM, Stephenson TP. The "clam": indications and complications. British Journal of Urology 1990;65(5):488‐91. [MEDLINE: ] - PubMed
Mansson 1989
    1. Mansson W, Ahlgren G, White T. Glomerular filtration rate up to 10 years after urinary diversion of different types. Scandinavian Journal of Urology and Nephrology 1989;23:195‐200. [MEDLINE: ] - PubMed
Mikulicz 1899
    1. Mikulicz J. [Zur operation der augeborenen blasenspalte]. Zentralblatt für Chirurgie 1899;26:641.
Nabi 2005
    1. Nabi G, Yong SM, Ong E, McPherson G, Grant A, N'Dow J. Is orthotopic bladder replacement the new gold standard? Evidence from a systematic review. Journal of Urology 2005;174(1):21‐8. - PubMed
Neal 1989
    1. Neal DE. Urodynamic investigation of the ileal conduit: upper tract dilatation and the effects of revision of the conduit. Journal of Urology 1989;142(1):97‐100. [MEDLINE: ] - PubMed
Office for National Statistics 2002
    1. http://info.cancerresearchuk.org/cancerstats/types/bladder/. website Cancer Research UK.
Sethia 1991
    1. Sethia KK, Webb RJ, Neal DE. Urodynamic study of ileocystoplasty in the treatment of idiopathic detrusor instability. British Journal of Urology 1991;67(3):286‐90. [MEDLINE: ] - PubMed
Studer 1991
    1. Studer UE, Spiegel T, Casanova GA, Springer J, Gerber E, Ackermann DK, et al. Ileal bladder substitute: antireflux nipple or afferent tubular segment?. European Urology 1991;20(4):315‐26. [MEDLINE: ] - PubMed
Thompson 1996
    1. Thompson AC, Christmas TJ. Interstitial cystitis‐‐an update. British Journal of Urology 1996;78(6):813‐20. [MEDLINE: ] - PubMed
Ware 1993
    1. Ware JE, Snow KK, Kosinski M, Gandek B. SF‐36 Health Survey Manual and Interpretation Guide. Boston, Massachusetts: The Health Institute, New England Medical Centre, 1993.
Webb 1990
    1. Webb RJ, Lawson AL, Neal DE. Clean intermittent self‐catheterisation in 172 adults. British Journal of Urology 1990;65(1):20‐3. [MEDLINE: ] - PubMed

MeSH terms