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Husmann DA. Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non-lethal complications of bladder augmentation. Int J Urol 2017; 25:94-101. [DOI: 10.1111/iju.13417] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/11/2017] [Indexed: 12/19/2022]
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2
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Game X, Karsenty G, Chartier-Kastler E, Ruffion A. Chapitre C-2 C - Traitement de l’hyperactivité détrusorienne neurologique : entérocystoplasties. Prog Urol 2007; 17:584-96. [PMID: 17622095 DOI: 10.1016/s1166-7087(07)92373-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The importance of a good capacity bladder reservoir able to fill at low pressure has now been clearly established. These properties have a double advantage: they ensure urinary continence and prevent damage to the upper urinary tract. In the case of failure of the various medical treatments, including botulinum toxin injections, surgical bladder augmentation can be considered, especially in the presence of poor bladder compliance. The authors present the technical details of bladder augmentation by enterocystoplasty or by alternative techniques and their medium- and long-term results, and define the postoperative surveillance of this type of surgery.
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Affiliation(s)
- X Game
- Service d'urologie, Centre hospitalo-universitaire de Toulouse, France.
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Zhang H, Yamataka A, Koga H, Kobayashi H, Lane GJ, Miyano T. Bladder stone formation after sigmoidocolocystoplasty: statistical analysis of risk factors. J Pediatr Surg 2005; 40:407-11. [PMID: 15750938 DOI: 10.1016/j.jpedsurg.2004.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Bladder stone formation (BSF) after sigmoidocolocystoplasty (SCP) is a major source of morbidity. The authors identify risk factors and analyze them statistically. METHODS Medical records of 106 patients who had SCP at our institute were reviewed to examine the incidence of post-SCP BSF, the stone removal method and length of follow-up. The primary underlying pathological conditions were myelomeningocele in 103 patients and other conditions in 3. Risk factors for BSF were statistically assessed by comparing cases with and without BSF. RESULTS Bladder stone formation occurred in 20 (18.9%) of 106 patients (BSF group). The remaining 86 did not have stones (NBSF group). Mean age at SCP was 11.7 years in the BSF group and 10.2 years in the NBSF group. Mean follow-up was 12.0 years in the BSF group and 11.0 years in the NBSF group. BSF developed after a mean of 30.3 +/- 25.6 months after SCP. Twenty-two stone removal procedures were performed in the BSF group and spontaneous evacuation occurred in 4 instances. Once stone free, BSF recurred in 4 patients. Although differences between the 2 groups with respect to sex, age at SCP, follow-up period, bladder capacity, bladder compliance, incidence of gram-negative bacteriuria, incidence of gram-positive coccus bacteriuria, electrolytes, frequency of urinary catheterization, post-SCP incidence of vesicoureteric reflux, and incidence of ureteric reimplantation were not statistically significant, differences in the incidence of spontaneous micturition, bladder neck tightening procedures, or gram-positive bacillus bacteriuria, or frequency of bladder irrigation were all statistically significant (P < .05 in all, Fisher's Exact test). CONCLUSIONS The authors are the first to statistically analyze a wide range of varying risk factors for BSF. BSF would appear to be common after SCP.
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Affiliation(s)
- Hongbo Zhang
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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Wullt B, Agace W, Mansson W. Bladder, bowel and bugs--bacteriuria in patients with intestinal urinary diversion. World J Urol 2004; 22:186-95. [PMID: 15309491 DOI: 10.1007/s00345-004-0432-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 05/28/2004] [Indexed: 11/25/2022] Open
Abstract
The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of "antibacterial defenses", and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.
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Affiliation(s)
- Björn Wullt
- Department of Urology, Lund University, 22185 Lund, Sweden.
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Vajda P, Pinter AB, Harangi F, Farkas A, Vastyan AM, Oberritter Z. Metabolic findings after colocystoplasty in children. Urology 2003; 62:542-6; discussion 546. [PMID: 12946764 DOI: 10.1016/s0090-4295(03)00580-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate whether colocystoplasty has resulted in metabolic changes in the growing child during long-term follow-up according to whether cecum with ascending or sigmoid colon was used. METHODS Twenty-eight patients (mean age at surgery 11 years) were included in the study and divided into two groups: group 1, cystoplasty with cecum and ascending colon (12 patients) and group 2, sigmoid cystoplasty (16 patients). Patients' linear growth, body mass index, and the following parameters were estimated before surgery and at 3, 6, and 12 months, and then yearly after surgery: blood and urine electrolytes (sodium, potassium, chloride, calcium, phosphorus, magnesium), creatinine, urea, blood gases, blood pH, urine pH, and blood alkaline phosphatase (ALP). All the data were statistically analyzed. RESULTS In group 1, the blood ALP increased significantly (P = 0.026) during follow-up. Severe metabolic acidosis with or without hyperchloremia was found in 7 patients. In group 2, the serum sodium and serum calcium levels decreased significantly (P = 0.014 and P = 0.003, respectively); however, the blood ALP, urine sodium, and urine phosphorus levels increased significantly (P = 0.033, P = 0.027, and P = 0.026, respectively) during follow-up. A statistically significant decrease in blood pH (P = 0.022) was found after surgery. Severe metabolic acidosis with or without hyperchloremia was detected in 5 patients. The average linear growth decreased significantly (P = 0.001 and P = 0.016, respectively) 1 and 2 years postoperatively. CONCLUSIONS The statistically significant increase in blood ALP and decrease in serum calcium indicate bone demineralization after colocystoplasty. Our investigations in children suggest that bone demineralization is more frequent after sigmoid cystoplasty than after the use of cecum and ascending colon.
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Affiliation(s)
- P Vajda
- Department of Pediatrics, Surgical Unit, University of Pecs Faculty of Medicine, Pecs, Hungary
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Keegan SJ, Graham C, Neal DE, Blum-Oehler G, N'Dow J, Pearson JP, Gally DL. Characterization of Escherichia coli strains causing urinary tract infections in patients with transposed intestinal segments. J Urol 2003; 169:2382-7. [PMID: 12771802 DOI: 10.1097/01.ju.0000067445.83715.7b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Transposition of intestinal segments into the urinary tract predisposes to urinary tract infections. We characterized bacterial infections in these patients and examined the virulence genotype and persistence of Escherichia coli isolates. MATERIALS AND METHODS We followed 26 patients who underwent bladder reconstructive surgery using transposed intestinal segments. E. coli strains isolated from the urine of these patients were genotyped for established virulence determinants and the frequency of carriage was compared with E. coli strains isolated from community acquired urinary infections and the fecal flora of anonymous volunteers. A longitudinal study of E. coli strains in 9 patients was also done using pulsed field gel electrophoresis. RESULTS E. coli was the most frequently isolated organism, responsible for 59% (62 of 105) of monobacterial infections. Other bacteria isolated included Klebsiella species, Proteus species and Enterococcus faecalis. Community acquired E. coli strains were more likely to carry multiple determinants for particular adhesins (P and S fimbriae) and toxins (alpha-hemolysin and cytotoxic necrotizing factor) than fecal strains. Carriage frequency for bladder reconstruction strains was intermediary and not significantly different. The key finding was that E. coli strains persisted for prolonged periods, including 2 years in certain patients, often despite various antimicrobial treatments. CONCLUSIONS This study highlights that further steps must be taken to prevent and treat urinary tract infections in this susceptible group. Particular attention should be given to the treatment of persistent infections.
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Affiliation(s)
- S J Keegan
- Department of Microbiology and Immunology, University of Newcastle upon Tyne and Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Abstract
PURPOSE OF REVIEW This paper reviews recent advances in the strategies for urinary tract reconstruction in children with spina bifida. The aims of reconstruction are the preservation of renal function and achievement of urinary continence. Considerable controversy exists on the subjects of bladder augmentation, procedures to increase outlet resistance, and continent stomas. The authors put the most recently published information in perspective in the light of their own personal experience. RECENT FINDINGS Thirty-seven papers covering the above-mentioned subjects published in the past 5 years (25 of them published since 2000) have been selected. Seven relevant older references are included. There is persistent interest in developing methods to enlarge the urinary bladder that avoid bringing the urine in contact with the intestinal mucosa. The artificial urinary sphincter and fascial slings are the most frequently reported methods to increase outlet resistance. The Mitrofanoff principle continues to be regarded as an effective method to construct a continent catheterizable channel, either with the appendix or reconfigured intestinal segments. The achievement of fecal continence has to be pursued in parallel with urinary continence. Incontinent diversions continue to be best for a small group of patients. The role of continent urinary diversion requires reassessment. SUMMARY Progress in this area continues to be made. Periodic, critical and objective reviews on the subject should help the practitioner to arrive at sound decisions.
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Affiliation(s)
- Ricardo González
- Division of Pediatric Urology, University of Miami, Florida 33101, USA.
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Keegan SJ, Hormaeche CE, Pearson JP, Gally DL. Characterisation and adherence mechanisms of Escherichia coli strains causing infections in patients with a reconstructed bladder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2001; 485:263-71. [PMID: 11109115 DOI: 10.1007/0-306-46840-9_35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- S J Keegan
- Department of Microbiology, Medical School, University of Newcastle upon Tyne
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Affiliation(s)
- Jerald A. Hochstetler
- From the Departments of Urology and Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Michael J. Flanigan
- From the Departments of Urology and Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Karl J. Kreder
- From the Departments of Urology and Internal Medicine, University of Iowa, Iowa City, Iowa
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Risk of Bowel Dysfunction with Diarrhea After Continent Urinary Diversion with Ileal and Ileocecal Segments. J Urol 1995. [DOI: 10.1097/00005392-199511000-00025] [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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Roth S, Semjonow A, Waldner M, Hertle L. Risk of Bowel Dysfunction with Diarrhea After Continent Urinary Diversion with Ileal and Ileocecal Segments. J Urol 1995. [DOI: 10.1016/s0022-5347(01)66754-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephan Roth
- Department of Urology, University of Munster, Munster, Germany
| | - Axel Semjonow
- Department of Urology, University of Munster, Munster, Germany
| | - Michael Waldner
- Department of Urology, University of Munster, Munster, Germany
| | - Lothar Hertle
- Department of Urology, University of Munster, Munster, Germany
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14
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Re: Ileocecal Valve Reconstruction During Continent Urinary Diversion. J Urol 1995. [DOI: 10.1097/00005392-199501000-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hollander JB, Diokno AC. URINARY DIVERSION AND RECONSTRUCTION IN THE PATIENT WITH SPINAL CORD INJURY. Urol Clin North Am 1993. [DOI: 10.1016/s0094-0143(21)00508-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- C R Woodhouse
- Institute of Urology and Nephrology, University College and Middlesex School of Medicine, London
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Nutritional and Gastrointestinal Complications of the Use of Bowel Segments in the Lower Urinary Tract. Urol Clin North Am 1991. [DOI: 10.1016/s0094-0143(21)00375-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bihrle R, Klee LW, Adams MC, Foster RS. Early clinical experience with the transverse colon-gastric tube continent urinary reservoir. J Urol 1991; 146:751-3. [PMID: 1875486 DOI: 10.1016/s0022-5347(17)37912-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The clinical results of the first 4 patients undergoing reconstruction with the transverse colon-gastric tube urinary reservoir are presented. All patients had a minimum 1-year follow-up. All 4 patients are continent with stable or improved renal function. Two patients required reoperation. Indications as well as possible modifications of this procedure are discussed.
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Affiliation(s)
- R Bihrle
- Department of Urology, Indiana University Medical Center, Indianapolis
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20
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Abstract
We describe our technique for a new form of continent urinary diversion. This reservoir includes a detubularized segment of transverse colon to provide low pressure urine storage, tunneled ureteral reimplants to prevent reflux, and a tubularized gastric segment used as a continent catheterizable efferent limb. This technique provides a new option for continent diversion in a variety of patients.
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21
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Hendren WH. Urinary tract re-functionalization after long-term diversion. A 20-year experience with 177 patients. Ann Surg 1990; 212:478-94; discussion 494-5. [PMID: 2222014 PMCID: PMC1358284 DOI: 10.1097/00000658-199010000-00011] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From 1969 to 1990, previously diverted urinary tracts were 'undiverted' in 177 patients whose ages ranged from 1 to 31 years. Fifty-six of the patients (32%) had been diverted for 10 years or longer. There were 67 female and 110 male patients. Forty-four patients had only one kidney and in two of those patients it was a previous renal transplant. One patient was anephric at the time of reconstruction, having had two unsuccessful transplants. Most of the diversions had been considered permanent. Types of diversions that were reversed include ileal loop, colon conduit, loop ureterostomy or pyelostomy, end ureterostomy, cystostomy or vesicostomy, long-term nephrostomy, and ureterosigmoidostomy.
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Affiliation(s)
- W H Hendren
- Department of Surgery, Children's Hospital Boston, Massachusetts, MA 02115
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22
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Abstract
During the last 3 years 20 patients (median age 8 years) have undergone construction of a continent urinary reservoir at our pediatric urology service. Of the patients 12 had failed exstrophy reconstruction, 7 had myelodysplasia with a neurogenic bladder and 1 had extensive bladder damage as a result of a previous operation. In 5 patients a continent reservoir was constructed after cystectomy performed in early childhood. Techniques of reconstruction included the Mitrofanoff procedure (4 patients), a modification of the Indiana pouch (12), a modification of the Benchekroun procedure (2), the use of the appendix in situ as a continence mechanism (2) and a modified Kropp procedure using a duplicate vagina for catheterization (1). The morbidity from these procedures was acceptable and consisted primarily of chronic diarrhea (4 patients), stone formation within the pouch (5) and the need to revise the continence mechanism (7). All but 1 patient maintained stable or improved upper tracts after diversion. Over-all, 85% of the patients experienced diurnal continence on an intermittent catheterization regimen, while 75% were dry at night. The plicated/intussuscepted ileal nipples required revision because of difficulty with catheterization (7 patients) and urinary leakage. We currently favor the use of the Benchekroun or Mitrofanoff techniques for the ease of construction and minimal requirements for revision.
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Affiliation(s)
- M P Leonard
- Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
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Aliabadi H, Gonzalez R. Success of the artificial urinary sphincter after failed surgery for incontinence. J Urol 1990; 143:987-90. [PMID: 2329618 DOI: 10.1016/s0022-5347(17)40160-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We implanted the artificial urinary sphincter in 15 incontinent patients for whom multiple urethral and bladder neck operations, including sphincter placement, had been unsuccessful. The 5 male and 10 female patients ranged from 3 to 26 years old (mean age 11 years). The etiology of incontinence was neurogenic bladder in 10 patients, epispadias in 2, exstrophy in 1, ectopic ureters in 1 and traumatic urethral disruption in 1. Of the 15 patients 13 required augmentation enterocystoplasty and clean intermittent catheterization. The initial anti-incontinence procedures were Young-Dees-Leadbetter bladder neck reconstruction in 10 patients, artificial urinary sphincter placement in 4 and bladder neck suspension in 1. Causes of failure of the primary treatment were erosion (artificial urinary sphincter), and incontinence and/or difficult catheterization (Young-Dees-Leadbetter). Followup from the last salvage operation averaged 21 months (range 6 to 37 months). A total of 58 operations was performed. Among the 4 patients in whom the artificial urinary sphincter eroded the bladder neck repeated attempts to place the cuff at the same site were unsuccessful and erosion occurred in all 4 within 1 year. Sphincter placement was more successful among the 11 patients who initially underwent Young-Dees-Leadbetter bladder neck reconstruction or bladder neck suspension; acceptable continence was attained in 8 patients (73%). We conclude that placement of the sphincter cuff around a previously eroded bladder neck probably will result in erosion. Sphincter implantation should be attempted in patients in whom bladder neck reconstruction has failed. Persistence in the treatment of these patients is essential because multiple operations often are necessary to achieve continence.
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Affiliation(s)
- H Aliabadi
- Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis
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Sidi AA, Becher EF, Reddy PK, Dykstra DD. Augmentation enterocystoplasty for the management of voiding dysfunction in spinal cord injury patients. J Urol 1990; 143:83-5. [PMID: 2294270 DOI: 10.1016/s0022-5347(17)39872-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A total of 12 spinal cord injury adults underwent augmentation enterocystoplasty for treatment of a high pressure neurogenic bladder. These patients suffered from urinary incontinence, recurrent urinary tract infection, upper tract deterioration and severe autonomic dysreflexia. A sigmoid colon segment fashioned into a cup-patch was used in 11 patients and detubularized cecum was used in 1. The artificial urinary sphincter was implanted in 3 patients at augmentation enterocystoplasty and in 1 after enterocystoplasty. After a mean followup of 15 months all patients were continent on clean intermittent self-catheterization, the upper tract had remained stable or had improved and the symptoms of autonomic dysreflexia had disappeared. A third of the patients are on maintenance antibiotic therapy to control bacteriuria.
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Affiliation(s)
- A A Sidi
- Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis
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Gonzalez R, Nguyen DH, Koleilat N, Sidi AA. Compatibility of enterocystoplasty and the artificial urinary sphincter. J Urol 1989; 142:502-4; discussion 520-1. [PMID: 2746766 DOI: 10.1016/s0022-5347(17)38797-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Placement of the artificial urinary sphincter during augmentation enterocystoplasty may lead to infection, erosion and eventual removal of the device. To assess compatibility of artificial urinary sphincter implantation and enterocystoplasty we reviewed the records of 30 patients who had undergone enterocystoplasty and artificial urinary sphincter placement simultaneously (11), enterocystoplasty before artificial urinary sphincter placement (12) and artificial urinary sphincter placement before enterocystoplasty (7). The 19 male and 11 female patients were between 4 and 42 years old (median age 13.5 years). Followup in 28 patients ranged from 6 months to 8 years (average 17 months). Incontinence resulted from myelodysplasia in 16 patients, sacral agenesis in 3, spinal cord injury in 6, posterior urethral valves in 1, bilateral ectopic ureters in 1 and epispadias-exstrophy in 3. Erosion occurred in 2 patients (7 per cent): 1 female patient who underwent simultaneous sphincter implantation and enterocystoplasty and who had undergone previously many bladder neck reconstructive procedures, including polytetrafluoroethylene (Teflon) injection, and 1 female patient in whom the augmented bladder was entered at artificial urinary sphincter implantation. Mechanical failure occurred 4 times in 3 patients and the artificial urinary sphincter was improperly placed in 1. Over-all continence rate was 87 per cent (26 of 30 patients). Simultaneous placement of the artificial urinary sphincter and enterocystoplasty did not seem to affect the outcome of sphincter implantation if good bowel preparation, intravenous antibiotics and sterility of urine were accomplished preoperatively. Entering the augmented bladder during sphincter implantation may predispose to infection and erosion.
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Affiliation(s)
- R Gonzalez
- Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis
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Cumming J, Woodhouse CR. Role of the Kock pouch in adolescent urology. PROGRESS IN PEDIATRIC SURGERY 1989; 23:126-34. [PMID: 2498992 DOI: 10.1007/978-3-642-74241-5_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although cutaneous urinary diversion will continue to have a place in some urological diseases, some patients may benefit from an undiversion. The Kock pouch with a continent reservoir is an alternative where conventional undiversion to the bladder is impossible. Indications, pre-operative preparation, operative technique, results and complications are outlined in detail. In the adolescent patient requiring urinary diversion the Kock pouch should be considered as the last resort. Where reconstruction of the urinary tract is impossible, a continent urinary reservoir by means of the Kock pouch may be indicated.
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Affiliation(s)
- J Cumming
- Institute of Urology, Shaftesbury Hospital, London, UK
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McMullin ND. Urinary tract reconstruction in children. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1988; 58:619-29. [PMID: 3178601 DOI: 10.1111/j.1445-2197.1988.tb07572.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The successful introduction of clean intermittent catheterization and increased awareness of urinary tract physiology and urodynamics have been the basis for recent major advances in urinary tract reconstructive surgery. Surgical techniques are now available to manage anatomical and functional deficiencies of any isolated or combined components of the urinary tract. The high incidence of unsatisfactory long-term results with ileal conduit diversion has led to increased popularity in urinary tract undiversion and greater utilization of reconstructive principles. As with any new surgical field of endeavour, new operative techniques are appearing at a rapid rate. In particular, there has been a recent proliferation of surgical procedures that provide a continent, low pressure, catheterizable reservoir for urine storage. Most children with major urinary tract deficiencies can now be offered socially and cosmetically unobtrusive surgical solutions without jeopardizing renal function.
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Gonzalez R, Reinberg Y. Localization of bacteriuria in patients with enterocystoplasty and nonrefluxing conduits. J Urol 1987; 138:1104-5. [PMID: 3656567 DOI: 10.1016/s0022-5347(17)43515-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Urine cultures were obtained by percutaneous aspiration of renal pelvic urine in an attempt to localize the source of chronic asymptomatic bacteriuria in 10 patients with intestinal segments incorporated into the urinary tract. One child with a nonrefluxing colonic conduit and 6 of 8 patients with nonrefluxing enterocystoplasties had upper tract bacteriuria. One patient with a ureterosigmoidostomy and a history of pyelonephritis had negative cultures while on prophylactic antibacterials. The significance of upper tract bacteriuria in these patients is unknown but lifelong followup of renal function is necessary.
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Affiliation(s)
- R Gonzalez
- Department of Urologic Surgery, University of Minnesota Health Sciences Center, Minneapolis
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30
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Sidi AA, Reinberg Y, Gonzalez R. Influence of intestinal segment and configuration on the outcome of augmentation enterocystoplasty. J Urol 1986; 136:1201-4. [PMID: 3773089 DOI: 10.1016/s0022-5347(17)45282-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The clinical and urodynamic results of enterocystoplasty were compared in 3 groups of patients in which the intact ileocecal segment (10 patients), tubular sigmoid segment (16) or sigmoid cup-patch segment (8) was used. In all 3 groups the upper urinary tract and renal function improved or remained stable, and the functional bladder capacity increased. All patients experienced involuntary, volume-dependent vesical contractions of comparable intensity 3 months postoperatively. After a mean followup of 19.4 +/- 8.9 months only 12 per cent of the patients with a cup-patch configuration demonstrated volume-dependent contractions, compared to all patients with ileocecal cystoplasty and 94 per cent with sigmoid tubular cystoplasty. The intensity of these contractions was significantly less in the cup-patch configuration group compared to the other groups. Patients with cup-patch cystoplasty achieved a significantly higher rate of urinary continence than those in the other 2 groups. It appears that the sigmoid cup-patch configuration may provide a lower pressure system and better continence compared to the intact ileocecal or tubular sigmoid segment, although the latter techniques have specific applications when confronted with a wide gap between the ureters and bladder or when dilated ureters require anastomosis to the bowel.
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