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Stein JP, Daneshmand S, Dunn M, Garcia M, Lieskovsky G, Skinner DG. Continent right colon reservoir using a cutaneous appendicostomy. Urology 2004; 63:577-80; discussion 580-1. [PMID: 15028464 DOI: 10.1016/j.urology.2003.10.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Accepted: 10/31/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Although orthotopic reconstruction has become the preferred form of lower urinary tract reconstruction after cystectomy there remains a select group of patients who are not appropriate for an orthotopic neobladder substitute. A continent cutaneous reservoir provides an alternative means to store urine and protect the upper urinary tract without the need for a urostomy appliance. We report our surgical technique of a continent cutaneous right colon reservoir using a catheterizable submucosally embedded appendicostomy. TECHNICAL CONSIDERATIONS The continent cutaneous right colon reservoir with bilateral ureteroileal coloappendicostomy incorporates the ascending and proximal transverse colon, which are detubularized and folded to form the reservoir component of the urinary diversion. The terminal ileum acts as the afferent limb, with the intact native ileocecal valve providing the antireflux mechanism. The continence catheterizable mechanism incorporates the submucosally tunneled appendix with preservation of the mesentery in a flap-valve technique. CONCLUSIONS The continent cutaneous right colon reservoir with bilateral ureteroileal coloappendicostomy is a reasonable alternative for cutaneous urinary diversion when an intact appendix is present, with good functional results and excellent continence.
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Affiliation(s)
- John P Stein
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California 90089, USA
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Metzger J, Degen LP, Beglinger C, Siegemund M, Studer W, Heberer M, Harder F, von Flüe MO. Ileocecal valve as substitute for the missing pyloric sphincter after partial distal gastrectomy. Ann Surg 2002; 236:28-36. [PMID: 12131082 PMCID: PMC1422545 DOI: 10.1097/00000658-200207000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Accelerated gastric emptying (including dumping syndrome) occurs frequently after gastric resections, largely resulting from rapid entry of meal contents into the small intestine. The authors hypothesized that an ileocecal segment used as an interpositional graft placed between the remaining part of the stomach and the small intestine would slow down food transit and thus replace pyloric function. METHODS Thirty Göttingen minipigs were randomized into three groups. Group 1: partial gastrectomy and Roux-en-Y reconstruction; Group 2: partial gastrectomy and ileocecal interpositional graft; and Group 3: sham laparotomy. Gastric emptying in the nonsedated animals was quantified using radioscintigraphy at 3 and 6 months postoperatively. The animals ingested 300 grams of soft food containing 99mTc labeled resin- pellets using a technique previously described. Data were analyzed using ANOVA. RESULTS Three months postoperatively, the ileocecal group had a significantly prolonged gastric emptying time compared with the Roux-en-Y group, but gastric emptying time was also significantly faster compared to the control group (sham laparotomy). After 6 months no significant difference was seen between the ileocecal group and the controls, while emptying rates were still significantly faster in the Roux-en-Y group. CONCLUSIONS Reconstruction of the gastric reservoir with an ileocecal segment largely restores gastric emptying patterns of food in minipigs. Six months postoperatively, gastric emptying time is similar to that of controls, and significantly slower when compared with the group with Roux-en-Y reconstruction. These results suggest that the ileocecal interposition graft could offer specific advantages over current reconstruction procedures.
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Affiliation(s)
- Jürg Metzger
- Department of Surgery, University Hospital Basel, Basel, Switzerland.
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Abstract
Continent urinary diversion has evolved from an investigational method of urinary tract reconstruction to an accepted, and in many instances preferred, option for men and women facing radical cystectomy. Over the last 15 years, we have learned much about the different procedures, their durability, and their success rates. This article reports on the procedures that the authors believe are associated with the highest success rates and the lowest complication rates. At this time, continent diversion should be offered to all appropriate candidates, and these procedures should be considered a part of the standard urologic armamentarium.
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Affiliation(s)
- M C Benson
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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De Carli P, Micali S, O'Sullivan D, Mainiero G, Cusumano G, Fattahi H, Cancrini A. Ureteral Anastomosis in the Orthotopic Ileal Neobladder: Comparison of 2 Techniques. J Urol 1997. [DOI: 10.1016/s0022-5347(01)65175-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Piero De Carli
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Salvatore Micali
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Denis O'Sullivan
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Giovanni Mainiero
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Giuseppe Cusumano
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Hassan Fattahi
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Antonio Cancrini
- Departments of Urologic Oncology, Regina Elena Cancer Institute, and Urology, Tor Vergata University, Rome, Italy, and Department of Urology, Royal Liverpool University Hospital, Liverpool, United Kingdom
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De Carli P, Micali S, O'Sullivan D, Mainiero G, Cusumano G, Fattahi H, Cancrini A. Ureteral anastomosis in the orthotopic ileal neobladder: comparison of 2 techniques. J Urol 1997; 157:469-71. [PMID: 8996334 DOI: 10.1097/00005392-199702000-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The functional results and complications of 2 different ureteroileal anastomoses were evaluated in patients with bladder cancer undergoing radical cystectomy and orthotopic ileal bladder substitution. MATERIALS AND METHODS Between 1989 and 1995, 102 patients underwent creation of a low pressure neobladder. In the first 50 cases the ureteroileal anastomosis was created with a split-cuff nipple technique as an additional antireflux mechanism. In the next 52 cases the ureteroileal anastomoses were constructed via the direct end-to-side technique counting on the antireflux protection of the afferent tubular limb. RESULTS Stenosis occurred in 7 of the 100 ureters (6 patients) treated with the split-cuff nipple technique and 7 of 104 treated with a direct end-to-side anastomosis. This complication occurred more commonly in the left ureter (11 of 14 patients). Reflux was noted at cystography in 10 cases with the split-cuff nipple method and 12 with end-to-side anastomoses, and was symptomatic in only 3 patients. Four ureteral strictures were treated successfully with primary open repair. Percutaneous dilation and stenting were performed for 8 ureteral strictures: 2 cases were successful, 3 failed and 3 are unresolved. CONCLUSIONS We observed no differences between the antireflux split-cuff and end-to-side anastomoses with regard to stricture formation or ureteral reflux. Therefore, we do not believe that there is a need to create antireflux ureteral anastomoses due to the tubular afferent ileal segment and given that the reflux is asymptomatic in most patients. Strictures may be treated with percutaneous balloon dilation and stenting but open repair appeared to be more effective.
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Affiliation(s)
- P De Carli
- Department of Urologic Oncology, Regina Elena Cancer Institute, Tor Vergata University, Rome, Italy
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Racioppi M, D'Addessi A, Alcini A, Alcini E. Bladder replacement in women: a new experience. Int Urogynecol J 1997; 8:36-46. [PMID: 9260095 DOI: 10.1007/bf01920292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bladder replacement in women in a new experience. In this article the authors reviewed in a critical way the patho-physiological principles involved in the previous male bladder replacement techniques and the results achieved both leading to the recent experience of bladder replacement in women. The authors present the recent acquirements about pelvic surgical anatomy and postcystectomy oncological radicality in female, and the more common surgical techniques for building a neobladder in women with the results achieved up to now. They also examined the problems arising from this exciting but precocious experience which will surely involve the urological community in the future.
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Affiliation(s)
- M Racioppi
- Department of Urology, Università Cattolica S. Cuore, Rome, Italy
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Roth S, Weining C, Hertle L. Simplified Uretero-Intestinal Implantation in Continent Cutaneous Urinary Diversion Using Ileovalvular Segment as Afferent Loop and Appendix as Continent Outlet. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66215-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stephan Roth
- Department of Urology, University of Munster, Munster, Germany
| | | | - Lothar Hertle
- Department of Urology, University of Munster, Munster, Germany
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Simplified Uretero-Intestinal Implantation in Continent Cutaneous Urinary Diversion Using Ileovalvular Segment as Afferent Loop and Appendix as Continent Outlet. J Urol 1996. [DOI: 10.1097/00005392-199604000-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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