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Engel O, Soave A, Rink M, Dahlem R, Hellwinkel O, Chun FK, Fisch M. [Tissue engineering in reconstructive urology]. Urologe A 2015; 54:690-5. [PMID: 25700861 DOI: 10.1007/s00120-014-3714-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The term tissue engineering incorporates various techniques for the production of replacement tissues and organs. In urology tissue engineering offers many promising possibilities for the reconstruction of the urinary tract. Currently, buccal mucosa and urothelial cells are most commonly used for tissue engineering of the urinary tract. Various materials have been tested for their suitability as tissue scaffolds. The ideal scaffold, however, has not yet been found. In addition to material sciences and cell culture methods, surgical techniques play an important role in reconstructive urology for the successful implantation of tissue engineered transplants.
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Affiliation(s)
- O Engel
- Urologische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
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Stewart D, Inouye BM, Goldstein SD, Shah BB, Massanyi EZ, DiCarlo H, Kern AJ, Tourchi A, Baradaran N, Gearhart JP. Pediatric surgical complications of major genitourinary reconstruction in the exstrophy-epispadias complex. J Pediatr Surg 2015; 50:167-70. [PMID: 25598117 DOI: 10.1016/j.jpedsurg.2014.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Urinary continence is the goal of exstrophy-epispadias complex (EEC) reconstruction. Patients may require a continent urinary diversion (CUD) if they are a poor candidate for bladder neck reconstruction or are receiving an augmentation cystoplasty (AC) or neobladder (NB). This study was designed to identify the incidence of surgical complications among various bowel segments typically used for CUD. METHODS A prospectively kept database of 1078 patients with EEC at a tertiary referral center from 1980 to 2012 was reviewed for major genitourinary reconstruction. Patient demographics, surgical indications, perioperative complications, and outcomes were recorded. RESULTS Among reviewed EEC patients, 134 underwent CUD (81 male, 53 female). Concomitant AC was performed in 106 patients and NB in 11. Median follow up time after initial diversion was 5 years. The most common CUD bowel segments were appendix and ileum. The most common surgical complications after CUD were small bowel obstruction, post-operative ileus, and intraabdominal abscess. There was a significantly increased risk in the occurrence of pelvic or abdominal abscess when colon was used as a conduit compared to all other bowel segments (OR=16.7, 95% CI: 1.16-239) and following NB creation compared to AC (OR=39.4, 95% CI: 3.66-423). At postoperative follow-up, 98% of patients were continent of urine via their stoma. CONCLUSION We report the largest series to date examining CUD in the EEC population. The increased risk of abdominal and pelvic abscesses in patients who receive a colon CUD and undergo NB compared to AC indicates that while surgical complications following major genitourinary reconstruction are rare, they do occur. Practitioners must be wary of potential complications that are best managed by a multi-disciplinary team approach.
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Affiliation(s)
- Dylan Stewart
- The Johns Hopkins University School of Medicine, Division of Pediatric Surgery, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Baltimore, MD 21287
| | - Brian M Inouye
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Seth D Goldstein
- The Johns Hopkins University School of Medicine, Division of Pediatric Surgery, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Baltimore, MD 21287
| | - Bhavik B Shah
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Eric Z Massanyi
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Heather DiCarlo
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Adam J Kern
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Ali Tourchi
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287
| | - Nima Baradaran
- Medical University of South Carolina, Department of Urology, 171 Ashley Ave, Charleston, SC 29425
| | - John P Gearhart
- The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
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Inouye BM, Shah BB, Massanyi EZ, Di Carlo HN, Kern AJ, Tourchi A, Baradaran N, Stewart D, Gearhart JP. Urologic complications of major genitourinary reconstruction in the exstrophy-epispadias complex. J Pediatr Urol 2014; 10:680-7. [PMID: 25082713 DOI: 10.1016/j.jpurol.2014.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/20/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the authors' experiences with urologic complications associated with various techniques used to create a continent stoma (CS), augmentation cystoplasty (AC), and neobladder in the exstrophy-epispadias complex (EEC) population. METHODS Retrospective review of medical records of patients who underwent CS with or without bladder augmentation were identified from an institutional review board-approved database of 1208 EEC patients. Surgical indications, tissue type, length of hospital stay, age, preoperative bladder capacity, prior genitourinary surgeries, postoperative urological complications, and continence status were reviewed. RESULTS Among the EEC patients reviewed, 133 underwent CS (80 male, 53 female). Mean follow-up time after initial continent stoma was 5.31 years (range: 6 months to 20 years). Appendix and tapered ileum were the primary bowel segments used for the continent channel and stoma in the EEC population. The most common stomal complications in this population were stenosis, incontinence, and prolapse. Seventy-nine percent of EEC CS patients underwent AC primarily done with sigmoid colon or ileum. Eleven patients (8%) underwent neobladder creation with either colon or a combination of colon and ileum. Bladder calculi, vesicocutaneous fistula, and pyelonephritis were the most common non-stomal complications. Stomal ischemia was significantly increased in Monti ileovesicostomy compared to Mitrofanoff appendicovesicostomy in classic bladder exstrophy patients (p = 0.036). Furthermore, pyelonephritis was more than twice as likely in colonic neobladder than all other reservoir tissue types in the same cohort (OR = 2.53, 95% CI: 1.762-3.301, p < 0.001). CONCLUSIONS To the best of the authors' knowledge, this is the largest study examining catheterizable stomas in the exstrophy population. While Mitrofanoff appendicovesicostomy is preferred to Monti ileovesicostomy because it is technically less challenging, it may also confer a lower rate of stomal ischemia. Furthermore, even though ileum or colon can be used in AC with equally low complication rates, practitioners must be wary of potential urologic complications that should be primarily managed by an experienced reconstructive surgeon.
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Affiliation(s)
- Brian M Inouye
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhavik B Shah
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Z Massanyi
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heather N Di Carlo
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam J Kern
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Tourchi
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nima Baradaran
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Dylan Stewart
- Division of Pediatric Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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