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Tomos G, Saussine C, Gaillard V, Lang H, Tricard T. [Short-term functional outcomes of laparoscopic robotic-assisted cystectomy (RAC) with ileal conduit urinary diversion (ICUD) for lower urinary tract dysfunction (LUTD): A single-center retrospective study]. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102639. [PMID: 38636808 DOI: 10.1016/j.fjurol.2024.102639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To assess the short-term functional outcomes and morbidity of robotic-assisted cystectomy (RAC) and intracorporeal urinary diversion (ICUD) in patients with lower urinary tract dysfunction (LUTD). METHODS All consecutive patients who underwent RAC+ICUD for LUTD in a tertiary hospital center, between July 2018 and May 2021 were retrospectively included. Medical records were systematically reviewed and patient, perioperative and postoperative data were collected. A good short-term functional outcome was defined by the combination of a satisfying urostomy equipment (absence of urine leakage and easy appliance of the urostomy bag), the absence of pelvicaliceal system dilatation on sonography, and the absence of renal function decrease at the 2months post-operative consultation. Intraoperative parameters and post-operative complications were collected to assess morbidity. RESULTS Thirty-five patients were included. Eight (22.8%) patients needed intraoperative conversion to laparotomy. Twenty-five patients (92,5%) met criteria for a good functional outcome 2months post-operatively. The median operative time was 346min (86.5-407.5). The median blood loss was 100mL (100-290) and 5 patients (18.5%) required blood transfusion. The median times to return of bowel function was 3 days (2-4) and the median length of hospital stay was 10 days (10-18). Peri-operative complications were reported in 16 patients (59.2%): 6 (22.2%) minor complications Clavien ≤ II and 10 (37%) major complications Clavien ≥ III. There was no significative decrease of the renal function (mean preoperative creatininemia of 61.2μmol/L (50.5-74.5) vs 64.5μmol/L (47-85.25) postoperatively) CONCLUSION: RAC+ICUD in LUTD can provide good short-term functional outcomes while limiting blood transfusion, time to return of bowel function and the length of hospital stay. These results should be confirmed by larger prospective study. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Georgios Tomos
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France.
| | - Christian Saussine
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Victor Gaillard
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Hervé Lang
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Thibault Tricard
- Département d'urologie, Nouvel Hôpital civil, 1, place de l'hôpital, 67000 Strasbourg, France
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Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [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: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
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Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
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Dequirez PL, Pues M, Queval L, Vercleyen S, Carpentier A, Lebuffe G, Seguy D, Blanchard A, Vermersch P, Biardeau X. Standardized one-day evaluation before urinary reconstructive surgery for neurogenic lower urinary tract dysfunction: Feasibility and impact on surgical strategy and care pathway. Prog Urol 2023; 33:1014-1025. [PMID: 37858377 DOI: 10.1016/j.purol.2023.09.032] [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: 07/13/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. MATERIALS AND METHODS All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. RESULTS One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. CONCLUSION A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- P-L Dequirez
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France.
| | - M Pues
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - L Queval
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - S Vercleyen
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Carpentier
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - G Lebuffe
- Department of Anesthesiology and Critical Care Anesthesiology, CHU de Lille, université de Lille, 59000 Lille, France
| | - D Seguy
- Department of Nutrition, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Blanchard
- Department of Physical and Rehabilitation Medicine, CHU de Lille, université de Lille, 59000 Lille, France
| | - P Vermersch
- UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
| | - X Biardeau
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France; UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
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4
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Calën L, Mesnard B, Hedhli O, Broudeur L, Reiss B, Loubersac T, Branchereau J, Baron M, Rigaud J, Le Fort M, Perrouin-Verbe B, Le Normand L, Lefevre C, Perrouin-Verbe MA. Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes. Neurourol Urodyn 2023; 42:586-596. [PMID: 36695768 DOI: 10.1002/nau.25134] [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: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. RESULTS One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). CONCLUSION Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.
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Affiliation(s)
- Laura Calën
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Benoît Mesnard
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Oussama Hedhli
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Lucas Broudeur
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Thomas Loubersac
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | | | - Maximilien Baron
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Marc Le Fort
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
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Robotic versus open cystectomy with ileal conduit for the management of neurogenic bladder: a comparative study. World J Urol 2022; 40:2963-2970. [DOI: 10.1007/s00345-022-04190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/06/2022] [Indexed: 12/01/2022] Open
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Chkir S, Michel F, Akakpo W, Chinier E, Capon G, Peyronnet B, Saussine C, Baron M, Biardeau X, Ruffion A, Gamé X, Denys P, Chartier-Kastler E, Phé V, Karsenty G. Non-continent urinary diversion (ileal conduit) as salvage therapy in patients with refractory lower urinary tract dysfunctions due to multiple sclerosis: results of a national cohort from the French Association of Urology (AFU) Neurourology Committee and the French-speaking Neurourology Study Group (GENULF). Urology 2022; 168:216-221. [PMID: 35768028 DOI: 10.1016/j.urology.2022.06.014] [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: 02/14/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network. METHODS A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the QualiveenTM short-form questionnaire (QSFTM) and patient global impression of improvement (PGI-I) were collected and analyzed. RESULTS Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF™ confirmed by evaluation of PGI-I. CONCLUSION This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.
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Affiliation(s)
- Sadok Chkir
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - Floriane Michel
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - William Akakpo
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Eva Chinier
- Neuro-Rehabilitation, University of Nantes, Hôpital Saint Jacques, Nantes, France.
| | - Gregoire Capon
- Urology, University of Bordeaux, Hôpital Pellegrin, Bordeaux France.
| | - Benoit Peyronnet
- Urology, University of Rennes, Hôpital Pontchaillou, Renne, France.
| | - Christian Saussine
- Urology, University of Strasbourg, Hôpital Hautepierre, Strasbourg, France.
| | | | | | - Alain Ruffion
- Urology, University Claude Bernard Lyon 1, Hôpital Lyon Sud, HCL, Pierre Bénite, France.
| | - Xavier Gamé
- Urology, University of Toulouse Purpan, Hôpital Rangueil, Toulouse, France.
| | - Pierre Denys
- Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Emmanuel Chartier-Kastler
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France; Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Véronique Phé
- Urology, Sorbonne University, Tenon Academic Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Gilles Karsenty
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
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Special surgical aspects of radical cystectomy in spinal cord injury patients with bladder cancer. World J Urol 2022; 40:1961-1970. [PMID: 35092468 DOI: 10.1007/s00345-022-03939-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/09/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Radical cystectomy in people with spinal cord injury (SCI) provides numerous additional difficulties, compared to able-bodied people. Therefore, it is important to obtain information from an experienced team about optimally managing these patients. METHODS Surgical procedures, based on the experience of 12 radical cystectomies in SCI patients with bladder cancer between January 1st, 2001, and December 31st, 2020, were recorded and the operative and perioperative clinical data were evaluated. Surgery was performed in a high-volume center by the surgeon most experienced in radical cystectomies, assisted by the neuro-urologist, involved in the care of the patient from the spinal cord center. Furthermore, a checklist based on the experience of the surgeon and the assisting neuro-urologist was developed. RESULTS SCI patients mostly suffered from an advanced disease and were always operated by the same team. The hospital stays ranged from 23 to 134 days (median 42 days). Four of the patients suffered from a postoperative paralytic ileus. Otherwise, both the operation time and the intraoperative blood loss as well as intraoperative and postoperative complications were basically comparable with those in able-bodied patients. The special features of radical cystectomy in SCI bladder cancer patients are described. Furthermore, a checklist addressing preoperative red flags, intra-operative challenges and post-operative challenges is presented. CONCLUSION Radical cystectomy in SCI patients should be performed in a high-volume department by the most experienced surgical team. The inclusion of the urologist caring for the patient from the spinal cord injury center is highly recommended.
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Haudebert C, Hascoet J, Freton L, Khene ZE, Dosin G, Voiry C, Samson E, Richard C, Neau AC, Drouet A, Mathieu R, Bensalah K, Verhoest G, Manunta A, Peyronnet B. Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches. Neurourol Urodyn 2021; 41:601-608. [PMID: 34962653 DOI: 10.1002/nau.24855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/17/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
AIM The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). METHODS The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. RESULTS After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. CONCLUSION Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.
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Affiliation(s)
| | | | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | | | - Gilles Dosin
- Department of Urology, University of Rennes, Rennes, France
| | - Caroline Voiry
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France
| | - Emmanuelle Samson
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | - Anne-Cécile Neau
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Anais Drouet
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Andréa Manunta
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
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Factors impacting bowel symptoms in a contemporary spinal cord injury cohort: results from the Neurogenic Bladder Research Group Registry. Spinal Cord 2021; 59:997-1002. [PMID: 34345004 DOI: 10.1038/s41393-021-00667-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross sectional. OBJECTIVES To identify variables associated with severe bowel symptoms in spinal cord injured people. SETTING National cohort. METHODS Adult spinal cord injured (SCI) people were recruited for an online registry and 1373 were included for analysis. Univariate analysis and logistic regression was used to evaluate associations between severity of bowel symptoms and variables. Bowel symptoms were assessed by the Neurogenic Bowel Dysfunction (NBD) score and patients scoring ≥14 were categorized as having severe bowel symptoms. Autonomic dysreflexia (AD) severity was measured using a six item questionnaire and reported as total AD score (0-24). Bladder management was categorized as: voiding, clean intermittent catheterization (CIC), surgery (augmentation/diversion) or indwelling catheter. RESULTS Severe bowel symptoms were reported in 570 (42%) On multivariable logistic regression, every point increase of AD total score was associated with 5% increased odds of having more severe bowel symptoms [OR 1.05 95% CI 1.03-1.10]. Type of bladder management was also associated with more severe symptoms (p = 0.0001). SCI people with indwelling catheters (OR = 2.16, 95% CI 1.40-3.32) or reconstructive surgery (OR = 1.79, 95% CI 1.08-3.32) were almost twice as likely to report more severe bowel symptoms than those performing CIC.
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The functioning and the complication rate of extreme long existing urinary diversions. Curr Opin Urol 2021; 31:562-569. [PMID: 34342291 DOI: 10.1097/mou.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review is timely and relevant because many patients live many years with urinary diversions. Knowledge about the long term outcome with respect to function and complications are important for patient counseling and for the manner to follow-up patients. This study was performed to investigate the functioning of urinary diversions constructed > 25 years earlier. RECENT FINDINGS Most studies have a relatively shorter follow-up, mainly focussing on short term postoperative complications. Focussing on the long term, urinary tract infections (UTI) including pyelonephritis are common. Mild kidney function deterioration is described. SUMMARY Retrospective study (2018-2019); 43 patients with regular follow-up at the Radboud University Medical Centre Nijmegen the Netherlands. Ileal conduit (n = 19) and ureterosigmoidostomy (n = 11) are the most common diversion types for reasons such as: bladder exstrophy (n = 15), urinary incontinence (n = 9) and malignancy (n = 8). This series with a median follow-up of 40 years, shows it is possible to live and cope with a urinary diversion for a very long time. Ureterosigmoidostomies give relatively good results. Ileal conduits are functioning properly with acceptable complication rates. 95% suffers from chronic UTI's. Kidney function deterioration was mild. Diversions for benign reasons have more complex complications compared to diversion constructed for malignant reasons.Supplementary video abstracthttp://links.lww.com/COU/A32.
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Mazouin C, Hubert J, Tricard T, Lecoanet P, Haudebert C, Bentellis I, Baron P, Hascoet J, Castes C, Verhoest G, Tibi B, Pradere B, Bruyere F, Capon G, Manunta A, Saussine C, Peyronnet B. Robot-Assisted Cystectomy and Ileal Conduit for Neurogenic Bladder: Comparison of Extracorporeal vs Intracorporeal Urinary Diversion. J Endourol 2021; 35:1350-1356. [PMID: 33499755 DOI: 10.1089/end.2020.0921] [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] [Indexed: 12/14/2022] Open
Abstract
Objectives: The aim of the present study was to compare the perioperative outcomes of extracorporeal (EXTRA) vs intracorporeal (INTRA) urinary diversion in patients undergoing robotic cystectomy and ileal conduit for neurogenic bladder. Methods: All consecutive patients who underwent robot-assisted cystectomy and ileal conduit for neurogenic bladder in six centers between 2011 and 2020 were included in a retrospective study. Four centers performed exclusively INTRA urinary diversion all over the study period, one center performed exclusively EXTRA urinary diversion, and the last center performed EXTRA urinary diversion during a first period and INTRA during the subsequent period. Results: Ninety-seven patients were included: 66 in the EXTRA group and 31 in the INTRA group. There were 11 major (Clavien grade ≥3) postoperative complications in the overall population (11.3%) with no statistically significant difference between both groups (EXTRA = 12.1% vs INTRA = 9.7%; p = 0.99). The mean length of stay did not differ significantly between INTRA and EXTRA (13.1 vs 14.1 days; p = 0.44). The mean times to oral feeding and to return of bowel function were similar in the two groups (3.9 vs 3.5 days; p = 0.28 and 4.1 vs 4.1 days; p = 0.51, respectively). There was no incisional hernia in the INTRA group vs five in the EXTRA group (0% vs 7.6%; p = 0.17). Conclusion: The perioperative morbidity of robotic cystectomy and ileal conduit for neurogenic bladder appears to be relatively limited compared with the historical open series. Possibly due to the relatively small sample size, no difference was found between INTRA and EXTRA urinary diversion in terms of perioperative outcomes.
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Affiliation(s)
| | - Jacques Hubert
- Department of Urology, University of Nancy, Nancy, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | | | - Pierre Baron
- Department of Urology, University of Tours, Tours, France
| | | | - Camille Castes
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Branwell Tibi
- Department of Urology, University of Nice, Nice, France
| | | | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andréa Manunta
- Department of Urology, University of Rennes, Rennes, France
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12
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Denys P, Chartier-Kastler E, Even A, Joussain C. How to treat neurogenic bladder and sexual dysfunction after spinal cord lesion. Rev Neurol (Paris) 2021; 177:589-593. [PMID: 33610350 DOI: 10.1016/j.neurol.2020.07.013] [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: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023]
Abstract
Neurogenic bladder and sexual dysfunction after spinal cord lesions are highly prevalent. The treatment algorithm for neurogenic bladder is well described. Clean intermittent self-catheterisation associated with treatment of neurogenic detrusor overactivity is the gold standard. Goals of treatment are twofold: i) control risk factors to avoid upper urinary tract complications, and ii) improve quality of life by treating incontinence when feasible. Lower urinary tract dysfunction is still a major cause of complications and hospitalisation. Sexual dysfunction must be addressed and treated and is at the top of patient expectations one year after injury.
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Affiliation(s)
- P Denys
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France.
| | - E Chartier-Kastler
- Department of urology, Hôpital de la Pitié, Paris-Sorbonne Université, Paris, France
| | - A Even
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France
| | - C Joussain
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France
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13
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Lepoittevin L, Leon G, Perrouin-Verbe B, Lefort M, Reiss B, Karam G, Rigaud J, Le Normand L, Perrouin-Verbe MA. [External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. Prog Urol 2021; 32:40-46. [PMID: 33541792 DOI: 10.1016/j.purol.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Lepoittevin
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.
| | - G Leon
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - B Perrouin-Verbe
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Lefort
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - B Reiss
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - G Karam
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J Rigaud
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - L Le Normand
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M A Perrouin-Verbe
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
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14
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Husmann DA, Viers BR. Neurogenic bladder: management of the severely impaired patient with complete urethral destruction: ileovesicostomy, suprapubic tube drainage or urinary diversion-is one treatment modality better than another? Transl Androl Urol 2020; 9:132-141. [PMID: 32055477 DOI: 10.21037/tau.2019.09.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Management of the severely impaired patient (pt) with a neurogenic bladder (NGB) and complete urethral destruction employs three therapeutic options; bladder neck closure (BNC) with ileovesicostomy, BNC with suprapubic tube (SPT) placement or in pts with an end-stage bladder, cystectomy with enteric conduit diversion. This paper was performed to test the hypothesis that pts managed with an ileovesicostomy would have the best long-term prognosis. Methods Patients with a NGB and complete urethral destruction managed between 1986-2018 were reviewed. Three treatment populations were assessed, pts treated with BNC with ileovesicostomy, BNC with SPT placement or cystectomy with enteric conduit diversion. A minimal follow-up interval of 2 years was necessary to be entered into the study. The number of uroseptic episodes, development of urolithiasis, the onset of new renal scars, ≥ stage 3 chronic renal failure, or need for additional surgery were recorded. Statistical evaluations used either chi-squared contingency table analysis, Fisher's exact 2-tailed tests, or Kaplan-Meier curve analysis where indicated. P values of <0.05 were considered significant. Results Ten pts were managed by cystectomy, and enteric conduit, 17 by BNC and ileovesicostomy and 21 by BNC and SPT placement, median follow up of 8 yrs (range, 2-30 yrs). No significant differences between the three groups regarding the development of urolithiasis (30%, 3/10 pts; 53%, 9/17 pts; 52%, 11/21 pts; respectively), new onset of renal scarring (30%, 6/20 kidneys; 41%, 14/34 kidneys; 45%, 19/42 kidneys; respectively) or stage 3 chronic renal failure (40%, 4/10 pts; 47%, 8/17 pts; 24%, 5/21 pts; respectively. However, the number of hospitalizations for uroseptic episodes significantly increased in patients managed with an ileal conduit (60%, 6/10 pts) and ileovesicostomy (82%; 14/17 pts) compared to those maintained with a SPT (29%, 6/21 pts) P=0.025 and 0.006, respectively. When evaluating the need for delayed surgical intervention due to either urolithiasis or other complications, a total of 50% (5/10 pts) of the patients managed by an ileal conduit, 88% (15/17 pts) of the ileovesicostomy and 52% (11/21 pts) of the patients with a SPT required additional operations. In essence, significantly more pts undergoing BNC and ileovesicostomy required delayed surgical interventions for complications arising from the surgery compared to patients managed with either a cystectomy and ileal conduit (P=0.0285) or BNC and SPT placement (P=0.0180). Conclusions In severely impaired pts with a NGB and urinary outlet destruction, BNC and ileovesicostomy are associated with a significantly increased incidence of urosepsis and late surgical complications that required operative intervention compared to alternative treatments. This finding has resulted in the abandonment of the ileovesicostomy from our surgical armamentarium.
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Affiliation(s)
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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15
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Akakpo W, Chartier-Kastler E, Joussain C, Denys P, Lubetzki C, Phé V. Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis. Neurourol Urodyn 2020; 39:771-777. [PMID: 31951678 DOI: 10.1002/nau.24279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/05/2020] [Indexed: 12/23/2022]
Abstract
AIM The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). MATERIAL AND METHODS A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. RESULTS Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. CONCLUSION Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.
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Affiliation(s)
- William Akakpo
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charles Joussain
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital Academic Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital Academic Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Catherine Lubetzki
- Department of Neurology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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16
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Groenendijk IM, van den Hoek J, Blok BFM, Nijman RJM, Scheepe JR. Long-term results of continent catheterizable urinary channels in adults with non-neurogenic or neurogenic lower urinary tract dysfunction. Scand J Urol 2019; 53:145-150. [PMID: 30958079 DOI: 10.1080/21681805.2019.1596156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To evaluate the long-term results after the construction of a Continent Catheterizable Urinary Conduit (CCUC) in adults. Methods: This study retrospectively reviewed the charts of 41 adults from two tertiary centers who received a CCUC. The demographics, underlying diseases, indications for a CCUC and outcomes such as the reoperation rate and the occurrence of complications were extracted. The patient reported outcome was measured with the Patient Global Impression of Improvement (PGI-I) scale and four additional questions about continence, leakage and stomal problems. Results: Twenty-nine patients were women. The median age at surgery was 32 years, with a median follow-up of 52 months. Twenty-six patients had a neurogenic bladder. The reoperation rate was 48.8%, with a median of 10.5 months after constructing the CCUC. Superficial stomal stenosis was the most common registered complication (20 times) and stoma revision was the most often performed reoperation (12 times). Twenty-four patients completed the PGI-I; the mean improvement rating was 2 (=much better). Conclusion: The construction of a CCUC in adults is associated with a high complication and reoperation rate. The high reoperation rate is in accordance with the sparse literature. Despite this, patients reported 'much better' on the PGI-I.
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Affiliation(s)
- Ilse M Groenendijk
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Joop van den Hoek
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Bertil F M Blok
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Rien J M Nijman
- b Department of Urology, University Medical Center Groningen , Rijksuniversiteit Groningen , Groningen , The Netherlands
| | - Jeroen R Scheepe
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
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