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Brandt SB, Kingo PS, Laurberg JR, Lam GW, Jensen JB. Definition of Benign Ureteroenteric Anastomotic Strictures in Ileal Conduits After Radical Cystectomy: Experience From a Single Center and Previously Published Literature. Urology 2024; 187:131-136. [PMID: 38458324 DOI: 10.1016/j.urology.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To evaluate a cohort of patients diagnosed with benign ureteroenteric stricture (UES) after radical cystectomy with ileal conduits using a strict predefined definition of strictures. Additionally, we want to illustrate the UES debut, regarding symptoms and clinical findings. UES is a well-known long-term complication after radical cystectomy, affecting up to 20% of all patients. In the literature, different incidence rates are reported. However, these are based on various definitions of strictures. METHODS We used strict predefined criteria to evaluate UES incidence including symptoms, timing, diagnostic methods, treatment, and outcome in all patients who underwent radical cystectomy with an ileal conduit between 2012 and 2018 at a single high-volume center. RESULTS Of a total of 693 patients who underwent radical cystectomy with ileal conduit, we found 109 patients with 135 UES in total, corresponding to 15.7% of patients (CI: 13.2-18.6) and 10% of all included ureteroenteric anastomosis (CI: 8.5-11.6) after radical cystectomy. Median follow-up was 24months (interquartile range (IQR): 12-31), and postoperatively UES was diagnosed after a median of 6months (IQR: 3-16). A total of 56% was diagnosed with elevated creatinine. Every UES underwent a median of two (IQR: 1-2) treatment attempts and 122 UES were treated successfully. CONCLUSION Benign UES is a significant cause of morbidity following radical cystectomy. Our findings contribute to the knowledge of timing, incidence, and recommended treatment of strictures. We argue the importance of establishing a clear gold standard when defining UES to ensure accurate reporting in future research.
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Affiliation(s)
- Simone Buchardt Brandt
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Pernille Skjold Kingo
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Gitte Wrist Lam
- Department of Urology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Das A, Zeng E, Risk M, Shapiro DD, Jason Abel E, Jarrard DF, Richards KA. Shorter Ureters Lead to Fewer Strictures Following Cystectomy and Urinary Diversion. Urology 2024; 184:272-277. [PMID: 38122989 DOI: 10.1016/j.urology.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To identify the impact of length of distal ureteral resection on the risk of benign uretero-enteric anastomotic stricture (UEAS) formation following cystectomy and urinary diversion. METHODS A database of patients who underwent cystectomy and urinary diversion from 2015 to 2022 was analyzed. Distal ureteral resections were sent for final pathology. The length of resected ureter was collected from pathology reports. Benign UEAS were confirmed with renal scintigraphy, antegrade nephrostogram, or endoscopic evaluation. The relationship between stricture formation and clinical parameters were assessed using T-tests, chi-square tests, and multivariable analysis. RESULTS A total of 366 patients underwent cystectomy and urinary diversion. Of the cohort, 35 (9.5%) patients developed UEAS. Median time to stricture formation was 12.5months (IQR 4-30). Of the 711 uretero-enteric anastomoses, 40 (5.6%) ultimately formed a UEAS. Median distal ureteral resection was significantly longer among ureteral anastomoses which did not form a UEAS (2.3 cm vs 1.65 cm, P = .028). Multivariable logistic regression adjusting for surgical approach, prior radiation, ureteral side, and urinary diversion type demonstrated that longer distal ureteral resections were inversely associated with odds of UEAS formation (OR 0.73, 95% CI 0.58-0.92). Multivariable Cox regression analysis similarly showed that length of distal ureteral resection was inversely associated with time to stricture formation (HR 0.78, 95% CI 0.62-0.98). CONCLUSION The etiology of benign UIA strictures is multifactorial. Vascular compromise is a critical hypothesis. We found that longer distal ureteral resections (and thus shorter ureters) were associated with a significantly lower risk of stricture formation in cystectomy patients.
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Affiliation(s)
- Arighno Das
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Erica Zeng
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Michael Risk
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Daniel D Shapiro
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Edwin Jason Abel
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - David F Jarrard
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Kyle A Richards
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
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Can O, Danış E, Kutlutürk EG, Polat EC, Ötünçtemur A. Hybrid technique has lower stricture rates than Wallace and Bricker. Surg Oncol 2024; 52:102036. [PMID: 38198985 DOI: 10.1016/j.suronc.2024.102036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION A clear consensus has not yet been reached on the optimal ureteroenteric anastomosis technique for ileal conduit urinary diversion following radical cystectomy. This study aims to determine the incidence of strictures and their management associated with these anastomosis techniques. METHODS We conducted a retrospective, single-center study of patients who underwent radical cystectomy and urinary diversion between March 2014 and August 2022. Patients were categorized based on the ureteroenteric anastomosis technique used: Wallace, Bricker, or Hybrid. Strictures were identified through antegrade pyelography following nephrostomy placement. RESULTS A total of 141 patients were included in the study, with 60 patients in the Wallace group (42 %), 42 patients in the Bricker group (30 %), and 39 patients in the Hybrid group (28 %). The overall incidence of ureteroenteric strictures was 15 %, with 7 patients in the Wallace group, 11 patients in the Bricker group, and 3 patients in the Hybrid group experiencing strictures. There was no statistically significant difference in stricture rates between the Wallace and Bricker groups (11 % vs. 26 %, p = 0.09) or between the Wallace and Hybrid groups (11 % vs. 7 %, p = 0.73). However, a statistically significant difference was observed between the Bricker and Hybrid groups (26 % vs. 7 %, p = 0.03). The mean time to stricture development was 9.2 ± 3.3 months for the Wallace group, 9.5 ± 3.7 months for the Bricker group, and 12.6 ± 5 months for the Hybrid group (p = 0.407). CONCLUSION The Hybrid ureteroenteric anastomosis technique exhibits a lower stricture rate compared to the Bricker and Wallace techniques. It represents a safe and feasible alternative technique.
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Affiliation(s)
- Osman Can
- Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Eyyüp Danış
- Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
| | | | - Emre Can Polat
- Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
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Limmer AM, Lendzion RJ, Leung C, Wong E, Gilmore AJ. A single centre experience on the formation of double barrelled uro-colostomy in pelvic exenteration surgery: a cohort study. ANZ J Surg 2024. [PMID: 38193615 DOI: 10.1111/ans.18856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Double barrelled uro-colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES). METHODS This cohort study evaluated short- and long-term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database. RESULTS Mean age 59 years (range 27-76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7-17 h). Mean follow-up duration 29.1 months (range 2.6-90.1 months). Early DBUC-related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC-related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication. CONCLUSION DBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion.
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Affiliation(s)
- Alexandra M Limmer
- Complex Pelvic Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca J Lendzion
- Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia
| | - Christopher Leung
- Complex Pelvic Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Eddy Wong
- Complex Pelvic Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Andrew J Gilmore
- Complex Pelvic Surgery Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
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Salihagic IK, Hrkac A, Ovcaricek S, Bokarica P, Gilja I. Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up. Technol Health Care 2024; 32:951-962. [PMID: 37661899 DOI: 10.3233/thc-230339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). CONCLUSION Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.
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Affiliation(s)
| | - Adelina Hrkac
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Slaven Ovcaricek
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Pero Bokarica
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Ivan Gilja
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
- Department of Urology, University Hospital Mostar, Mostar, Bosnia and Herzegovina
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Chen Z, Deng K, Sun L, Qu L, Chao X, Rao J, Hong C, Zhuo Y, Lin Z, Lai C. 3D laparoscopic treatment of bladder cancer with pelvic multi-organ invasion: a case report and literature review. Front Oncol 2023; 13:1249389. [PMID: 37920155 PMCID: PMC10619152 DOI: 10.3389/fonc.2023.1249389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Radical cystectomy with dissection of pelvic lymph nodes and urethral diversion is the standard surgical treatment for muscle-invasive non-metastatic bladder cancer. In rare cases where patients with bladder cancer without distant metastasis have pelvic multi-organ invasion, the cancer compresses or invades the ureter and, in severe cases, leads to bilateral upper urinary tract obstruction and renal damage. The treatment recommended by guidelines often cannot improve the patients' clinical symptoms immediately, and patients cannot complete the treatment owing to severe side effects, resulting in poor survival benefits. Case presentation A 69-year-old woman with facial edema was treated at the First Affiliated Hospital of Jinan University. The serum creatinine and potassium values were 1244 umol/L and 5.86 mmol/L, respectively. Pelvic magnetic resonance and abdominal computed tomography revealed that the bladder tumor had infiltrated the uterus, anterior vaginal wall, rectum, right ureter, right fallopian tube, and right ovary and metastasized to multiple pelvic lymph nodes. Tumor invasion of the right ureter resulted in severe hydronephrosis of the right kidney and loss of function and obstructive symptoms in the left kidney. Four days later, the patient's creatinine level decreased to 98 u mol/L, the general condition significantly improved, and the patient and family members strongly desired surgical treatment of the tumor. Through a comprehensive preoperative discussion, possible intraoperative and postoperative complications were evaluated. Right nephrectomy, right ureterectomy, total pelvic organ resection, extended pelvic lymph node dissection, and bowel and urinary diversion were conducted under 3D laparoscopy-assisted treatment. The patient was followed-up for 1.5 years and showed good tumor control, self-care, and mental status. Conclusion Minimally invasive surgery is a curative option for patients with bladder cancer with pelvic multi-organ invasion without distant metastasis. Surgeons should strictly control the indications for surgery and warn patients about the occurrence of related post-surgical complications.
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Affiliation(s)
- Zheng Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Kaifeng Deng
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Luping Sun
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Lijun Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Xinhui Chao
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Jingmin Rao
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Caimmei Hong
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Zhichao Lin
- Medical Image Center, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
| | - Caiyong Lai
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou Guangdong, China
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Wang L, Hussein AA, Guru K, Li Q. Robotic ileal ureter with bladder augmentation in a modified Studer fashion for a long ureteral stricture and small bladder. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Nesbitt AL, Yuhico MP, Khan M, Pridgeon SW. Guideline proposal for the conservative management of a ruptured neobladder. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415819865707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Level of evidence: 4
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Affiliation(s)
| | | | - Munad Khan
- Department of Urology, Cairns Hospital, Australia
| | - Simon W Pridgeon
- Department of Urology, Cairns Hospital, Australia
- Northern Urology, Australia
- College of Medicine and Dentistry, James Cook University, Australia
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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Floberg JM, Blitzer GC, Yadav P. Use of stereotactic magnetic resonance-guided online adaptive radiation therapy for treatment of a pelvic recurrence of prostate cancer in a patient with an orthotopic neobladder. Adv Radiat Oncol 2022; 7:100958. [PMID: 35647410 PMCID: PMC9130090 DOI: 10.1016/j.adro.2022.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- John M. Floberg
- Department of Human Oncology, University of Wisconsin School of Medicine; and Public Health, Madison, Wisconsin
- Corresponding author.
| | - Grace C. Blitzer
- Department of Human Oncology, University of Wisconsin School of Medicine; and Public Health, Madison, Wisconsin
| | - Poonam Yadav
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:49-56. [PMID: 34838493 DOI: 10.1016/j.acuroe.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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Tuo Z, Zhang Y, Wang J, Zhou H, Lu Y, Wang X, Yang C, Yu D, Bi L. Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study. BMC Urol 2021; 21:159. [PMID: 34781963 PMCID: PMC8591944 DOI: 10.1186/s12894-021-00920-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit. METHODS Eighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed. RESULTS There were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups. CONCLUSIONS Three-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.
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Affiliation(s)
- Zhouting Tuo
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Ying Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Jinyou Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Huan Zhou
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Youlu Lu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Xin Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Chao Yang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China.
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Djordjevic D, Dragicevic S, Vukovic M. Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate. Arch Ital Urol Androl 2021; 93:262-267. [PMID: 34839626 DOI: 10.4081/aiua.2021.3.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. MATERIALS AND METHODS A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. RESULTS Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). CONCLUSION Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.
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Affiliation(s)
| | | | - Marko Vukovic
- Urology clinic, Clinical centre of Montenegro, Podgorica.
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von Knobloch R, Seybold M, Fischer HP, Kibele M, Samad WA. Modification of the Indiana Pouch Ileo-Caecal Cutaneous Continent Urinary Diversion: Tubular Ileal Afferent Limb for Ureteral Anastomosis Has Low Stricture Rate and Allows Ileal Ureter Replacement. Urol Int 2021; 106:180-185. [PMID: 34569528 DOI: 10.1159/000518561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to introduce our new modification of the Indiana pouch with a refluxing ureteral anastomosis in a tubular afferent ileal segment of the ileo-caecal urinary reservoir. PATIENTS AND METHODS Between February 2008 and December 2020, we performed a total of 37 modified continent ileo-caecal pouches for urinary diversion when orthotopic bladder substitution was not possible. Hereby, we modified the Indiana pouch procedure with a new refluxing end-to-end ureteral anastomosis into an 8-cm afferent tubular ileal segment. RESULTS We performed the modified Indiana pouch in 27 women (73%) and 10 men (27%). The median age of the patients at time of operation was 64 years (43-80 years). To date, the average follow-up is 69 months (3-156 months). In 32/37 cases, we performed the new pouch procedure after radical cystectomy for muscle-invasive bladder cancer and in 1/37 cases after radical cystectomy for locally advanced prostate cancer. In 4 cases, the procedure was performed after total exenteration of the pelvis due to locally advanced bladder, colorectal, or gynaecological cancers. Ureteral anastomotic strictures were seen in 2/37 patients (5.4%) or 2/72 (2.8%) of renal units. CONCLUSIONS Our modification of the Indiana pouch cutaneous continent urinary diversion with the ureteral anastomosis to a tubular segment of the pouch is easy to perform and effective in reducing the rate of ureteral anastomotic strictures. By lengthening, the afferent tubular ileal segment, it additionally allows easy ureteral replacement.
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Affiliation(s)
| | - Marc Seybold
- Department of Urology, Klinikum Kempten, Kempten, Germany
| | | | - Monika Kibele
- Department of Urology, Klinikum Kempten, Kempten, Germany
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Hai X, Yang J. A neo-rectal bladder by uretero-rectal anastomosis: a case report. Transl Androl Urol 2021; 10:3080-3083. [PMID: 34430410 PMCID: PMC8350253 DOI: 10.21037/tau-21-298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Urinary diversion has always been a great challenge for urologists. There are many reasons and various methods for urinary diversion in clinical practice. In this report, who was diagnosed with a pelvic fracture complicated by enterostomy, urethral stricture, and bilateral inferior ureteral stricture. We performed laparoscopic bilateral ureterorectal reimplantation for this patient. Postoperatively, the patient recovered well and was able to perform volitional emptying. Bilateral DJ stents were removed under ureteroscopy at 6 weeks postoperatively. Six months after operation, no hydronephrosis was found in both kidneys. No increase of blood urea nitrogen (BUN) and creatinine were observed in renal function examination. It is clearly stated that in the present report a modified version of Heitz-Boyer-Houvelac uretero-rectostomy technique was carried out, as the technically demanding surgical step of retrorectal pull-through of the sigmoid colon was unneccesary given that the patient already had enterostomy. This surgery was performed laparoscopically and that the most relevant benefit for the patient was to avoid incontinent urinary diversion or possibly a more complex surgical procedure.
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Affiliation(s)
- Xin Hai
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyan Yang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Peng YL, Ning K, Wu ZS, Li ZY, Deng MH, Xiong LB, Yu CP, Zhang ZL, Liu ZW, Lu HM, Zhou FJ. Ureteral stents cannot decrease the incidence of ureteroileal anastomotic stricture and leakage: A systematic review and meta-analysis. Int J Surg 2021; 93:106058. [PMID: 34416355 DOI: 10.1016/j.ijsu.2021.106058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ileal conduit and ileal orthotopic neobladder were the most popular methods for urinary diversion following radical cystectomy. Stenting the anastomosis of ileo-ureter or ureter-neobladder was a common practice. However, it is still controversial if ureteral stents could prevent complications such as ureteroileal anastomosis stricture (UIAS) and ureteroileal anastomosis leakage (UIAL) after ureteral anastomosis. OBJECTIVES This study aims to investigate the role of the ureteral stent in preventing UIAS and UIAL. DATA SOURCES We systematically searched the related studies in PubMed, Embase, and Cochrane Library up to June 2020. STUDY ELIGIBILITY CRITERIA Cohort studies that identified the use of stent and the incidence of UIAS or UIAL were recorded. DATA SYNTHESIS Comparative meta-analysis was conducted on four cohort studies for comparison of UIAS and UIAL between the stented and nonstented groups. Besides, eleven studies which reported the events of UIAS and UIAL were used for meta-analysis of single proportion. RESULTS A total of 11 studies were qualified for analysis. Comparative meta-analysis identified that the incidence of UIAS was higher in the stented group than that in the nonstented group, but this did not reach a significant difference (odds ratio [OR]: 1.64; 95% confidence interval [CI]: 0.88-3.05; P = 0.12). Besides, there was no difference in the incidences of UIAL between the stented and the nonstented groups. On meta-analysis of single proportion, the incidence of UIAS was 7% (95% CI: 3%-10%) in the stented group and 3% (95% CI: 1%-6%) in the nonstented group. The UIAL rate was 1% (95% CI, 0%-4%) in stented patients and 2% (95% CI, 1%-4%) in nonstented patients. CONCLUSION Stenting the ureteroileal anastomosis resulted in a higher incidence of UIAS. There is no evidence to support ureteral stents could prevent the occurrence of UIAL after urinary diversion.
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Affiliation(s)
- Yu-Lu Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Kang Ning
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ze-Shen Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Yong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Min-Hua Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Long-Bin Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Chun-Ping Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Ling Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hui-Ming Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:S0210-4806(21)00119-4. [PMID: 34332809 DOI: 10.1016/j.acuro.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España
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18
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Tartaglione G, Foschi N, Ragonese M, Recupero SM, Ieria FP, Tarantino G, Bassi P. A gravity-assisted approach to the management of urinary diversion: 99mTc-MAG3 diuresis renography with F + 10(sp) method. Ann Nucl Med 2021; 35:1127-1135. [PMID: 34236580 DOI: 10.1007/s12149-021-01648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Radical cystectomy with permanent urinary diversion is the gold standard treatment for invasive muscle bladder cancer. Hydronephrosis is common in these patients, but Ultrasound (US) or Computed Tomography Urography (CTU) scan are unable to discriminate obstructive from non-obstructive hydronephrosis. We used Diuresis Renography (DR) with F + 10 in seated position (sp) method in the identification of patients with a Uretero-ileal Anastomosis Stricture (UAS) who would benefit from surgical therapy. METHODS We studied 39 asymptomatic patients, who underwent radical cystectomy and urinary diversion. Based on radiological findings (US, CTU) 44 kidneys were hydronephrotic. All patients underwent a 99mTc-MAG3 DR with F + 10(sp) method. We acquired a DR for 20 min with the patient in a seated position. Patient drank 400-500 mL of water at 5 min after tracer injection and received a 20 mg bolus of Furosemide at 10 min during dynamic acquisition. The indices Time to peak, diuretic half time, and 20 min/peak ratio have been evaluated. Retrograde pyelography confirmed UAS in all patients with DR obstructive findings. We repeated DR as follow-up in two subgroups of patients. RESULTS DR with F + 10(sp) method showed obstructive findings in 36 out of 44 hydronephrotic kidneys. 6 patients showed non-obstructive findings. 32 patients showed obstructive findings (20 out of 32 developed UAS within 12 months after surgery). Fifteen pts underwent a surgical treatment of UAS. In 1 patient with equivocal findings, we observed an ileo-ureteral reflux. CONCLUSIONS The DR with F + 10(sp) method in the seated position has a lower uncertain diagnostic rate, compared to the radiological findings of US or CTU, in management of bladder cancer patients with urinary diversion. The semiquantitative indices diuretic half time and 20 min/peak ratio evaluated in a condition of favorable gravity reduce uncertain responses improving interobserver concordance.
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Affiliation(s)
- Girolamo Tartaglione
- Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy.
| | - Nazario Foschi
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore M Recupero
- Department of Urology, Fatebenefratelli San Giovanni Calibita Hospital, Rome, Italy
| | - Francesco P Ieria
- Department of Nuclear Medicine, Cristo Re Hospital, 25 Via delle, Calasanziane, 00167, Rome, Italy
| | | | - Pierfrancesco Bassi
- Department of Urology, A. Gemelli Hospital IRCCS-Catholic University of Sacred Heart, Rome, Italy
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Kalemci S, Kizilay F, Simsir A. A new technique in the treatment of ureteroenteric anastomosis stricture: Repair of ureteroenteric anastomosis stricture with low lombotomy incision (retroperitoneal approach). Int J Clin Pract 2021; 75:e14155. [PMID: 33743548 DOI: 10.1111/ijcp.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND AIM Ureteroenteric anastomosis stricture (UEAS) is one of the complications of urinary diversion and may lead to serious consequences. In this study, we evaluated our UEAS revision technique outcomes performed with a low lombotomy incision in the lateral decubitus position. MATERIALS AND METHODS Eleven patients who underwent surgical repair due to isolated right UEAS between January 2010 and June 2019 were included in the study. Anastomosis stricture was confirmed by ultrasonography, computed tomography or magnetic resonance urography techniques. Ultrasonography was used to detect hydronephrosis, which is a finding secondary to stricture. However, opaque urography imaging methods were used to confirm the definitive diagnosis of the stricture. Demographic and clinical data, preoperative and postoperative 3rd month serum creatinine, estimated glomerular filtration rate (eGFR) and dynamic renal scintigraphy data of patients were evaluated. RESULTS The mean operation time was 49.7 ± 9.3 minutes. No perioperative complications were observed. While the overall stricture rate was 11.4%, the isolated right-sided stricture rate was 5.7%. Preoperative and postoperative serum creatinine values were similar. Preoperative eGFR value was 58.8 ± 12.9 mL/min/1.73 m2 and postoperative value was 53.5 ± 11.5 mL/min/1.73 m2 . T½ level decreased in postoperative period (22.3 ± 8.2 min vs 15.1 ± 4.3 min). CONCLUSIONS Open revision of the UEAS with retroperitoneal approach provides lower morbidity rates and shorter hospitalisation time compared to other methods. The retroperitoneal approach is the main advantage of this technique and prevents morbidity caused by other techniques performed intraperitoneally and owing to it is an open technique, it can be easily applied in isolated right-sided UEAS.
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Affiliation(s)
- Serdar Kalemci
- Department of Urology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Fuat Kizilay
- Department of Urology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Adnan Simsir
- Department of Urology, Ege University Faculty of Medicine, Izmir, Turkey
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Bröder S, Jäger W, Thüroff JW, Stein R. Orthotopic MAINZ pouch bladder substitution - long-term follow-up. Cent European J Urol 2021; 74:235-240. [PMID: 34336244 PMCID: PMC8318017 DOI: 10.5173/ceju.2021.0275.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. MATERIAL AND METHODS Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-end (Wallace) and the right ureter by an end-to side technique (Nesbit). Surgical and medical follow-up reports were evaluated and a recent follow-up was obtained by a questionnaire. RESULTS Median follow-up in 183 patients was 72 months (1-336). A total of 74 patients (38%) died during the follow-up. A surgical intervention was required in 26 out of 193 patients with early complications while 45 out of 183 patients had late and 17 patients had both, early and late complications. Ureteral stenosis was found in 13% of submucosal implanted ureters, 13% with the Wallace technique, and 3.6% with the Nesbit technique. In total, 66 patients responded to the questions concerning long-term continence (minimal follow-up >2 years). Overall, 84.8% were completely continent, 1.6%, reported grade I and 9.8% grade II stress incontinence. CONCLUSIONS The long-term continence and complication rates are comparable to those of other types of orthotopic bladder substitution. Orthotopic MAINZ pouch procedure can be considered as one of the options for orthoptic diversion, which stands the test of time.
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Affiliation(s)
- Saskia Bröder
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Joachim W. Thüroff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Locke JA, Neu S, Herschorn S. Diagnosis and Management of Kock Afferent Nipple Valve Obstruction. Urology 2021; 152:173-177. [PMID: 33652027 DOI: 10.1016/j.urology.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize afferent nipple valve obstruction in Kock diversions presenting with hydronephrosis and discuss appropriate work-up and management. METHODS We retrospectively reviewed 7 cases of afferent nipple valve obstruction. RESULTS The median time from diversion creation to afferent nipple valve intervention was 17-years. Presentations included febrile-UTIs, worsening renal function and hydronephrosis. All patients underwent upper tract imaging confirming bilateral hydronephrosis or hydronephrosis of a solitary kidney followed by nephrostomy tube insertion to drain the obstructed kidney(s). On nephrostogram assessment afferent nipple valve obstruction was confirmed by a lack of contrast passing through the valve. In 4 of these patients the afferent valve could not be cannulated while in one patient endoscopic retrograde balloon dilation was performed but failed after 12-months. One patient had successful antegrade balloon dilation (four-years follow-up). In five patients and the one patient who failed retrograde balloon dilation open surgical repair of the afferent nipple valve was successful (median follow-up time 5-years). CONCLUSION It is essential to consider afferent nipple valve obstruction in a patient with a Kock diversion presenting with bilateral hydronephrosis/hydronephrosis of a solitary kidney, even after many years following the original diversion. Appropriate work-up consists of upper tract imaging, endoscopy and retrograde studies or nephrostomy insertion with nephrostogram. Management options include endoscopic retrograde or antegrade balloon dilation or valve incision. Failing that, surgical repair may be successful with long-term upper tract preservation.
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Affiliation(s)
- Jennifer A Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Neu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Haywood S, Donahue TF, Bochner BH. Management of Common Complications After Radical Cystectomy, Lymph Node Dissection, and Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benson CR, Ajay D, Barrett-Harlow BL, Cunningham KG, Bootwala Y, Pendleton C, Li H, Ayoub HI, Graber WJ, Westney OL. Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate? World J Urol 2020; 39:1171-1176. [PMID: 32468109 DOI: 10.1007/s00345-020-03266-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Radical cystectomy (RC) and urinary diversion in the treatment of muscle-invasive bladder cancer is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity often requiring secondary interventions. We sought to evaluate our experience with benign UEAS in our open ileal orthotopic neobladder (ON) population. METHODS After Internal Review Board (IRB) approval, we performed a retrospective review of patients who had RC and ON between 2000 and 2015 at MD Anderson Cancer Center and had at least 6 months of follow-up. Baseline demographics and treatment characteristics, peri-operative and post-operative outcomes, as well as information regarding anastomosis technique and suture types were evaluated. Patients with malignant ureteral obstruction were excluded from the analysis. RESULTS 418 patients had ON creation and the mean age was 59 years (SD 9.4 years) and 90% were males. The mean follow-up was 57 months (6-183 months). 37 patients (8.9%) developed UEAS in 42 renal units and the mean time to diagnosis was 15.8 months (0.85-90 months). Anastomosis and suture type were not predictive of UEAS (p = 0.594, p = 0.586). Perioperative UTI within 30 days of surgery, and recurrent UTI were predictive of UEAS, HR 2.4 p = 0.03, HR 5.1 p < 0.001, respectively. CONCLUSIONS UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following ON, but may occur as late as 7 years following surgery. Indeed, technical factors and surgeon experience contribute to the rates of UEAS, but perioperative UTI appears to herald future stricture development.
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Affiliation(s)
- Cooper R Benson
- Division of Urology, University of Texas at Houston Health Science Center McGovern School of Medicine, Houston, USA.,Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Divya Ajay
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Brittani L Barrett-Harlow
- Division of Urology, University of Texas at Houston Health Science Center McGovern School of Medicine, Houston, USA.,Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Kathryn G Cunningham
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yasmin Bootwala
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Clay Pendleton
- Division of Urology, University of Texas at Houston Health Science Center McGovern School of Medicine, Houston, USA.,Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hanhan Li
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hajar I Ayoub
- Division of Urology, University of Texas at Houston Health Science Center McGovern School of Medicine, Houston, USA
| | - William J Graber
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - O Lenaine Westney
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Wu B, Pan C, Yao Z, Zhu X, Bai S. A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy. World J Surg Oncol 2020; 18:72. [PMID: 32278349 PMCID: PMC7151641 DOI: 10.1186/s12957-020-01831-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study is to describe a modified technique in ileal orthotopic bladder substitution with a new ureteroileal anastomosis. Case presentation After a classic open radical cystectomy with bilateral pelvic lymphadenectomy was performed extraperitoneally, a 56-cm ileal segment was used to construct the spheroidal shape bladder substitution. The 8-cm long proximal and distal ends of the ileal segment were used as afferent limbs. Two-centimeter ileal segments of afferent limbs were detubularized and transversally tubularized. The elongated ileal tube was anastomosed with the ureter in an end-to-end fashion. The pathway of the ureteroileal anastomosis was placed between the abdominal cutaneous fat and the anterior rectus muscular sheath. Perioperative data and long-term functional outcomes were assessed. Between December 2011 and December 2015, seven male patients underwent this procedure with a median 46 (30–77) months follow-up in our hospital. There was no difference between preoperative and postoperative estimated glomerular filtration rates (Z = − 1.693, P = 0.09). One of 14 sides had ureteroileal anastomotic stenosis; two of 14 sides in one patient had ureteroileal anastomotic stenosis caused by invasion of pelvic recurrence 15 months postoperatively. Reflux was completely prevented by placing pressure on the corresponding point on the abdominal surface when voiding urine in all patients. Conclusions We describe a feasible technique modification in detail, which provides some advantages for effective anti-reflux by mechanical finger pressing and abdominal contraction, a low incidence of stricture, and ease for a secondary operation in the long-term follow-up period.
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Affiliation(s)
- Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Chunyu Pan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
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Shen JK, Jamnagerwalla J, Yuh BE, Bassett MR, Chenam A, Warner JN, Zhumkhawala A, Yamzon JL, Whelan C, Ruel NH, Lau CS, Chan KG. Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy. Ther Adv Urol 2019; 11:1756287219839631. [PMID: 31057669 PMCID: PMC6452578 DOI: 10.1177/1756287219839631] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher's exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs (p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion (p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.
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Affiliation(s)
- Jim K Shen
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Juzar Jamnagerwalla
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Bertram E Yuh
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mitchell R Bassett
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Avinash Chenam
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan N Warner
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ali Zhumkhawala
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan L Yamzon
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher Whelan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Clayton S Lau
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin G Chan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 East Duarte Road, MOB L002H, Duarte, CA 91010, USA
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Omar K, Gan C, Rottenberg G, O’Brien TS, Thomas K, Thurairaja R, Khan MS. A prospective study of the utility of a routine ‘loopogram’ at three months for the early detection of anastomotic stricture post-cystectomy and conduit urinary diversion. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817747475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The objective of this study is to evaluate the utility of routine loopogram follow-up three months after cystectomy and urinary diversion in the early detection of benign ureteroileal anastomotic stricture (UAS). Materials and methods: A loopogram was incorporated into our standard follow-up three months after cystectomy and conduit urinary diversion in August 2010–December 2015. Data were maintained prospectively in a database. Results: A total of 250 patients (181 male; 69 female); median age of 70 years (range: 38–83) underwent cystectomy and conduit urinary diversion during this period. Of these, 167 (66.8%) had a routine loopogram at three months. Seven of 167 were confirmed to have a benign UAS. Twenty-three of 250 (9.2%) had an early loopogram prior to the planned three-month study in response to symptoms. Nine of 23 were diagnosed with benign UAS. Sixty of 250 (24%) did not have a routine loopogram for a variety of reasons. Five patients with normal three-month loopograms developed late strictures after a median time of 22 months (range 5–38). In total 21/250 (8.4%) patients developed UAS. Stricture rates for the open, robotic and laparoscopic modalities were 8/129 (6.2%), 12/111 (10.8%) and 1/10 (10%) respectively. Five of seven of patients with early, asymptomatic UAS diagnosed on routine loopogram received treatment; four of five had improvement in renal function. Conclusion: Overall stricture rate in this series was 8.4%. The majority of UAS occur early and are more likely to be symptomatic. A policy of routine loopogram benefitted only 4/250 (1.6%) patients. We advocate the use of loopograms in cases with a high index of suspicion rather than for routine screening. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Kawa Omar
- Guy’s and St Thomas’ NHS Foundation Trust, UK
| | | | | | | | - Kay Thomas
- Guy’s and St Thomas’ NHS Foundation Trust, UK
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Shimura H, Mitsui T, Fukasawa M, Ihara T, Kira S, Sawada N, Takeda M. Ileocystoplasty with ureteral reimplantation into the afferent ileal limb for high-grade vesicoureteral reflux in a boy with lower urinary tract dysfunction. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Padovani GP, Mello MF, Coelho RF, Borges LL, Nesrallah A, Srougi M, Nahas WC. Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion. Int Braz J Urol 2018; 44:624-628. [PMID: 29211394 PMCID: PMC5996801 DOI: 10.1590/s1677-5538.ibju.2017.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/16/2017] [Indexed: 11/29/2022] Open
Abstract
Objective: To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by “ureteroileal bypass”, one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.
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Affiliation(s)
- Guilherme P Padovani
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Marcos F Mello
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Rafael F Coelho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Leonardo L Borges
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Adriano Nesrallah
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Affiliation(s)
- D. Fontana
- Divisione Universitaria di Urologia 2, Ospedale San Giovanni Battista-Molinette, Università degli Studi di Torino
| | - P. Destefanis
- Divisione Universitaria di Urologia 2, Ospedale San Giovanni Battista-Molinette, Università degli Studi di Torino
| | - A. Cugiani
- Divisione Universitaria di Urologia 2, Ospedale San Giovanni Battista-Molinette, Università degli Studi di Torino
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Open Techniques and Extent (Including Pelvic Lymphadenectomy). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hautmann RE, de Petriconi R, Kahlmeyer A, Enders M, Volkmer B. Preoperatively Dilated Ureters are a Specific Risk Factor for the Development of Ureteroenteric Strictures after Open Radical Cystectomy and Ileal Neobladder. J Urol 2017; 198:1098-1106. [DOI: 10.1016/j.juro.2017.05.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Linder BJ, Frank I, Occhino JA. Extravesical robotic ureteral reimplantation for ureterovaginal fistula. Int Urogynecol J 2017; 29:595-597. [PMID: 28884348 DOI: 10.1007/s00192-017-3459-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We present a video describing the technical considerations for performing an extravesical robotic ureteral reimplantation. METHODS A 55-year old woman presented with urinary incontinence secondary to a ureterovaginal fistula after robotic-assisted hysterectomy. After failure of more conservative measures, she proceeded to a robotic ureteral reimplantation. Following port placement, the ureter is identified at the level of the iliac vessels and dissected circumferentially. The ureter is dissected free to the level of the ureterovaginal fistula, transected, and the distal remnant ligated. The ureter is spatulated, a cystotomy created, and a running anastomosis with mucosa-to-mucosa apposition performed over a stent. Care is taken to ensure it is tension free. The integrity of the anastomosis is tested with retrograde filling of the bladder. Postoperatively, a drainage catheter is left to allow for adequate healing. Follow-up imaging is performed to ensure a patent anastomosis. RESULTS The patient had an uncomplicated postoperative course. A cystogram showed adequate healing at 10 days, and the stent was removed at 6 weeks. A follow-up renal ultrasound 6 weeks later showed no hydronephrosis. CONCLUSIONS Extravesical robotic ureteral reimplantation is a useful technique for managing ureterovaginal fistula; here we highlight pertinent technical considerations.
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Affiliation(s)
- Brian J Linder
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Igor Frank
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John A Occhino
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Desai MM, Simone G, de Castro Abreu AL, Chopra S, Ferriero M, Guaglianone S, Minisola F, Park D, Sotelo R, Gallucci M, Gill IS, Aron M. Robotic Intracorporeal Continent Cutaneous Diversion. J Urol 2017; 198:436-444. [PMID: 28336308 DOI: 10.1016/j.juro.2017.01.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Robotic intracorporeal urinary diversion has mostly been done for ileal conduit or orthotopic neobladder diversion. We present what is to our knowledge the initial series, detailed technique and outcomes of the robotic intracorporeal Indiana pouch with a minimum 1-year followup. MATERIALS AND METHODS Ten patients underwent robotic radical cystectomy, pelvic lymphadenectomy and intracorporeal Indiana pouch urinary diversion for cancer in 9 and benign disease in 1. Data were collected prospectively. Baseline demographics, pathology data, and 1-year complication rates and functional outcomes were assessed. RESULTS All 10 cases were successfully completed intracorporeally without open conversion. Median total operative time was 6 hours, including 3.5 hours for pouch creation. Median blood loss was 200 cc and median hospital stay was 10 days. Four Clavien grade 1-2 and 3 Clavien 3-5 complications occurred. None of the patients had a bowel leak. One noncompliant patient requested undiversion to an ileal conduit. The remaining 9 patients successfully catheterized the ileal channel and were completely continent at the last followup at a median of 13.7 months (range 12.3 to 15.2). Study limitations include small sample size and short followup. CONCLUSIONS We present what is to our knowledge the initial series of robotic completely intracorporeal Indiana pouch diversion. Early perioperative data indicate acceptable operative efficiency and complication rates. Longer followup is required to assess the functional outcomes of this less commonly performed diversion.
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Affiliation(s)
- Mihir M Desai
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy.
| | - Giuseppe Simone
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Andre Luis de Castro Abreu
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Sameer Chopra
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Mariaconsiglia Ferriero
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Salvatore Guaglianone
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Francesco Minisola
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Daniel Park
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Rene Sotelo
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Michele Gallucci
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Inderbir S Gill
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
| | - Monish Aron
- Section of Robotic Surgery, University of Southern California Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California; Department of Urology, Regina Elena National Cancer Institute (GS, MF, SG, FM, MG), Rome, Italy
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Hoag N, Papa N, Beharry BK, Lawrentschuk N, Chiu D, Sengupta S, Bolton D. Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation. Can Urol Assoc J 2017; 11:E88-E92. [PMID: 28360953 DOI: 10.5489/cuaj.3848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. METHODS A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. RESULTS Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing uretero-ileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). CONCLUSIONS In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required.
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Affiliation(s)
- Nathan Hoag
- Department of Urology, Austin Hospital, University of Melbourne, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, University of Melbourne, Australia
| | | | | | - Danny Chiu
- Department of Urology, Austin Hospital, University of Melbourne, Australia
| | - Shomik Sengupta
- Department of Urology, Austin Hospital, University of Melbourne, Australia
| | - Damien Bolton
- Department of Urology, Austin Hospital, University of Melbourne, Australia
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Helfand AM, Beach R, Hadj-Moussa M, Krishnan N, He C, Montgomery JS, Morgan TM, Weizer AZ, Hafez K, Lee CT, Stoffel JT, Skolarus TA. Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion. Urol Oncol 2017; 35:33.e1-33.e9. [DOI: 10.1016/j.urolonc.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/14/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
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Scherr DS. The Camey Procedure. J Urol 2016; 197:S180-S181. [PMID: 28010974 DOI: 10.1016/j.juro.2016.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Douglas S Scherr
- Department of Urology, Weill Medical College of Cornell University, New York, New York
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Abdominal Imaging Following Urinary Reconstruction: Recommendations and Pitfalls. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kingo PS, Rasmussen TM, Nørregaard R, Borre M, Høyer S, Jensen JB. Evaluation of robot-assisted laparoscopic versus open cystectomy and effect of carbon dioxide-pneumoperitoneum on histopathological findings in ureteroenteric anastomoses: results from an experimental randomized porcine study. Scand J Urol 2016; 51:50-56. [PMID: 27809635 DOI: 10.1080/21681805.2016.1247294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the histopathology of ureteroenteric anastomoses (UEAs) after radical cystectomy (RC) with an ileal conduit in a porcine model using different surgical techniques. The study also evaluated the potential anti-inflammatory effect of preoperative carbon dioxide-pneumoperitoneum (CO2P). MATERIALS AND METHODS Forty female Danish Landrace pigs were randomized to four groups: three intervention groups [open surgery ± prior CO2P and robot-assisted laparoscopic cystectomy (RALC)], all subjected to RC and an ileal conduit, and one control group. After euthanization, UEAs were harvested and histopathologically evaluated. RESULTS Five pigs were excluded from the study owing to postoperative complications. Operating room time and clamping of the right and left ureters were significantly longer in the robotic than in the open groups (p < .01). Inflammatory infiltration grade of the left ureter was significantly higher in RALC (p = .032). No statistically significant difference was observed between the open groups receiving prior CO2P or not. CONCLUSIONS Results showed a statistically significant higher inflammatory infiltration grade of the left ureter in RALC, emphasizing the importance of using meticulous techniques when mobilizing the left ureter using the robot. It was not possible to conclude with certainty whether CO2P could constitute an anti-inflammatory agent for local inflammation.
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Affiliation(s)
- Pernille Skjold Kingo
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | | | - Rikke Nørregaard
- b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | - Michael Borre
- a Department of Urology , Aarhus University Hospital , Aarhus , Denmark.,b Department of Clinical Medicine , Aarhus University Hospital , Aarhus , Denmark
| | - Søren Høyer
- c Department of Pathology , Aarhus University Hospital , Aarhus , Denmark
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Baten E, Akand M, Floyd MS, Van Cleynenbreugel B, Albersen M, Everaerts W, Van Poppel H, Van Der Aa F, Joniau S. Evaluation of conservative approach in the management of ureteroenteric strictures following radical cystectomy with Bricker ileal conduit: a single-center experience. Scand J Urol 2016; 50:439-444. [PMID: 27686879 DOI: 10.1080/21681805.2016.1232307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the risk factors and treatment options for ureteroenteric strictures (UES) following radical cystectomy (RC) and ileal conduit (IC) formation, and specifically to comment on the conservative management of UES in asymptomatic patients. MATERIALS AND METHODS The datasheets were reviewed of 304 consecutive patients who were treated with an RC and IC between January 2001 and May 2011 in a Belgian tertiary center and who followed a strict follow-up protocol. Long-term treatment outcomes were retrospectively analyzed. RESULTS Twenty-two patients (7.2%) were diagnosed with UES (affecting 27 ureters in total), when a new-onset hydroureteronephrosis or increase of the pre-existing hydroureteronephrosis was detected by ultrasound or computed tomography. A retrograde loopogram was then performed to confirm the UES. The mean follow-up time was 33 months. A decline in renal function, the presence of flank pain and urinary tract infections were indications for interventional treatment. Six patients underwent double-J stent placement, two patients received percutaneous nephrostomies as a definitive treatment and two patients underwent ureterointestinal reimplantation. Asymptomatic patients with a UES and a favorable renal function were conservatively managed. They remained asymptomatic during follow-up and required no active treatment. CONCLUSIONS No clinical variable was independently associated with an increased risk of UES. These long-term data suggest that a selected patient population of asymptomatic patients with good renal function at the time of UES diagnosis can be safely managed conservatively.
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Affiliation(s)
- Evert Baten
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Murat Akand
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium.,b Department of Urology, School of Medicine , Selcuk University , Konya , Turkey
| | - Michael S Floyd
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Ben Van Cleynenbreugel
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Maarten Albersen
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Wouter Everaerts
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Hendrik Van Poppel
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Frank Van Der Aa
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Steven Joniau
- a Department of Urology, School of Medicine , Katholieke Universiteit Leuven , Leuven , Belgium
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Nicita G, Martini A, Filocamo MT, Saieva C, Tosto A, Stomaci N, Bigazzi B, Villari D. Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results. Int J Urol 2016; 23:984-990. [DOI: 10.1111/iju.13201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Giulio Nicita
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Alberto Martini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Maria T Filocamo
- Department of Urology; Azienda Sanitaria Locale Cn1; Savigliano Italy
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit; Cancer Research and Prevention Institute; Florence Italy
| | - Aldo Tosto
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Niceta Stomaci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Barbara Bigazzi
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - Donata Villari
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
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Abstract
Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture is a well-known complication of urinary diversion and is associated with serious sequelae that lead to total or partial loss of kidney function, infectious complications, and the need for additional procedures. Although the exact aetiology of benign ureteroenteric anastomotic strictures is unclear, they most likely occur secondary to ischaemia at the anastomotic region. Diagnosis can be achieved using retrograde contrast studies, CT scan or MAG3 renography. Open revision remains the gold-standard treatment for ureteroenteric anastomotic strictures; however, endourological techniques are being increasingly used and, in select patients, might be the optimal approach.
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Komasara L, Stefanowicz J, Bryks-Laszkowska A, Gołębiewski A, Czauderna P. Reconstructive option after radical mutilating surgery in children with genitourinary rhabdomyosarcoma: When sparing the bladder is not an option. Int J Urol 2016; 23:679-85. [DOI: 10.1111/iju.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Leszek Komasara
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk Poland
| | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and Oncology; Medical University of Gdansk; Gdansk Poland
| | - Anna Bryks-Laszkowska
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk Poland
| | - Andrzej Gołębiewski
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk Poland
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk Poland
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Moomjian LN, Carucci LR, Guruli G, Klausner AP. Follow the Stream: Imaging of Urinary Diversions. Radiographics 2016; 36:688-709. [DOI: 10.1148/rg.2016150180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Quarto G, Muscariello R, Sorrentino D, Perdonà S. Techniques of Urological Reconstruction. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gomez-Gomez E, Malde S, Spilotros M, Shah PJ, J. Greenwell T, Ockrim JL. A tertiary experience of ileal–ureter substitution: Contemporary indications and outcomes. Scand J Urol 2015; 50:192-9. [DOI: 10.3109/21681805.2015.1106579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Neisius A, Thüroff JW. Continent cutaneous diversion. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Skinner EC. Orthotopic neobladder. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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[Urinary diversion with continent umbilical stoma: Which techniques are suitable for which patients?]. Urologe A 2015; 54:1240-7. [PMID: 26228593 DOI: 10.1007/s00120-015-3924-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: 10/23/2022]
Abstract
BACKGROUND Continent cutaneous diversions play a secondary role even in many centers for urinary diversion. The result is that knowledge about, indications and operation technique does not exist in many clinics. RESULTS The general complication rates of the various forms of urinary diversion are not significantly different. There is no quality of life study showing a significant advantage for either form of urinary diversion. The functional results of neobladders in females with up to 70% hypercontinence are worse than in men, resulting in 2.4-fold more continent urinary diversions in men compared to women. The complication rates of the various forms of continent cutaneous pouches are different. CONCLUSION Continent cutaneous pouches are an option for all patients with non-existing or functionally unusable urethra and as primary indication in all women with bladder cancer, consulting in very good quality of life and perfect body image. Age (<75 years), manual skills and psychological ability are selection criteria. As far as the results and complication rates are concerned the ileocecal pouch with an appendix umbilical stoma is the best option. In cases of non-existing appendix, alternatives are a neoappendix, serosal lined tapered ileum and ileal invagination nipple.
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Davis NF, Burke JP, McDermott T, Flynn R, Manecksha RP, Thornhill JA. Bricker versus Wallace anastomosis: A meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc J 2015; 9:E284-90. [PMID: 26029296 DOI: 10.5489/cuaj.2692] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data comparing the incidence of ureteroenteric strictures for Bricker and Wallace anastomoses are limited. This study compares both anastomotic techniques in terms of ureteroenteric stricture rates after radical cystectomy and ileal conduit urinary diversion. METHODS Electronic databases (Medline, EMBASE, and Cochrane database) were searched for studies comparing Bricker and Wallace ureteroeneteric anastomoses for ileal conduit urinary diversion after radical cystectomy. Meta-analyses were performed using the random effects method. The primary outcome measure was to determine differences in postoperative ureteroenteric stricture rates for both surgical techniques. Four studies describing 658 patients met the inclusion criteria. The total number of ureters used for ureteroeneteric anastomoses was 1217 (545 in the Bricker group and 672 in the Wallace group). RESULTS There were no significant differences in age (p = 0.472), gender (p = 0.897), duration of follow-up (p = 0.168), and duration to stricture development between groups (p = 0.439). The overall stricture rate was 29 of 1217 (2.4%); 16 of 545 ureters (2.9%) in the Bricker group and 13 of 672 ureters (1.9%) in the Wallace group. The Bricker anastomosis was not associated with a significantly higher overall stricture rate compared to the Wallace ureteroenteric anastomosis (odds ratio: 1.393, 95% confidence interval: 0.441-4.394, p = 0.572). CONCLUSION Accepting limitations in the available data, we found no significant difference in the incidence of ureteroenteric stricture for Bricker and Wallace anastomoses.
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Affiliation(s)
- Niall F Davis
- Department of Urology, Tallaght Hospital, Co Dublin, Ireland
| | - John P Burke
- Department of Urology, Tallaght Hospital, Co Dublin, Ireland
| | - Ted McDermott
- Department of Urology, Tallaght Hospital, Co Dublin, Ireland
| | - Robert Flynn
- Department of Urology, Tallaght Hospital, Co Dublin, Ireland
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Tayib AMS, Abdel-Meguid TA, Al-Sayyad AJ, Altayloni TE, Khan MK, Zugail AS. Novel augmentation ileocystoplasty technique to manage non-compliant bladders in the presence of obstructed megaureters: the "fez procedure". Int J Urol 2015; 22:301-5. [PMID: 25586010 DOI: 10.1111/iju.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/26/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To show the efficacy and safety of a novel modification of Studer's neobladder, herein defined as the "fez procedure." METHODS The medical records of 21 children (mean age 9.4 ± 1.3 years) who underwent the "fez procedure" at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, to manage refractory poorly-compliant bladders and concomitantly obstructed megaureters were retrospectively reviewed. The patients had been previously managed by either preliminary cutaneous ureterostomy (17 patients) or temporary nephrostomy (four patients) to improve and stabilize the renal functions. The "fez procedure" entailed augmentation ileocystoplasty and the use of an afferent tubularized ileal loop for direct ureteroileal anastomosis. The augmented bladder together with the tubularized loop were fashioned as a "fez" with its tassel. The outcome measures were changes in cystometric capacity, bladder compliance, glomerular filtration rate, serum creatinine, technetium 99m-diethylene triamine pentaacetic acid diuretic renography (T1/2), ureteral diameter, vesicoureteral reflux, febrile urinary tract infections, continence and complications. RESULTS The mean study follow-up period was 52.5 ± 12.8 months. Means of changes of cystometric capacity (273.2 ± 60.9 mL) and bladder compliance (15.6 ± 4.2 mL/cm H2 O) were significant (P < 0.0001). Resolution of ureteral obstruction was documented with improved T1/2 and ureteral diameter (P < 0.0001, each) of all patients. The initially improved renal functions after ureterostomies or nephrostomies were maintained after "fez surgery," with non-significant changes in the improved glomerular filtration rate (P = 0.22) and serum creatinine (P = 0.18). None of the patients experienced ureteral restenosis, vesicoureteral reflux, febrile urinary tract infections, incontinence or significant complications. CONCLUSIONS The "fez procedure" represents a versatile and successful surgical option for these selected patients, as it offers improved bladder capacity/compliance, resolution of ureteral obstruction and vesicoureteral reflux, preservation of the renal function, control of urinary tract infections and urinary continence, and acceptable morbidity.
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Affiliation(s)
- Abdulmalik M S Tayib
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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