Aarhus, Denmark (UroToday.com) Richard Hautmann, from the University of Ulm, Ulm Germany, presented the International Bladder Cancer Network (IBCN) Keynote address regarding the evolution of surgical innovation in bladder cancer care. Dr. Hautmann is Chairman emeritus University of Ulm who’s published over 500 papers and book chapters specific to bladder cancer. He presented the history of the concept of orthotopic neobladder began over 100 years ago in 1888 by Tizzoni and Foggi which resulted in several surgical irregularities. The study involved one healthy dog in which no cystectomy was performed and only underwent augmentation. A transposed ileal segment became a diverticulum on top of a completely regenerated bladder. Despite excellent results, these preliminary findings represent the regenerated bladder and not an orthotopic reconstruction. With that being said, he went on to suggest from 1888 to 1987 countless orthotopic reconstructions in humans could have been avoided.
In 1987 and 1988, both Drs. Hautmann and Studer developed the concept of a refluxing low pressure, detubularized, crossfolded orthotopic neobladder. This concept continues to remain cornerstone for orthotopic neobladders and in widespread use today. He mentioned briefly mechanical neobladders which never made its way into human implantation mainly owing to the inherently complicated mechanics required in these devices with increased morbidity and mortality from the procedures required. Regenerative medicine/tissue engineering is promising and ongoing research needed. Challenges to future progress include quality of life concerns and while he understands no difference in oncologic outcomes between robotic vs. open surgery he saw robotics as the future of bladder cancer surgery given widespread dissemination.
Presented by: Richard Hautmann, MD, Chairman emeritus, Professor of Urology, University of Ulm, Ulm, Germany
Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 17th meeting of the International Bladder Cancer Network, (IBCN, #IBCN2019) October 3rd – 5th, 2019 in Aarhus, Denmark.