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Barone B, Napolitano L, Reccia P, Calace FP, De Luca L, Olivetta M, Stizzo M, Rubinacci A, Della Rosa G, Lecce A, Romano L, Sciorio C, Spirito L, Mattiello G, Vastarella MG, Papi S, Calogero A, Varlese F, Tataru OS, Ferro M, Del Biondo D, Napodano G, Vastarella V, Lucarelli G, Balsamo R, Fusco F, Crocetto F, Amicuzi U. Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review. J Pers Med 2024; 14:392. [PMID: 38673019 PMCID: PMC11051023 DOI: 10.3390/jpm14040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.
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Affiliation(s)
- Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Pasquale Reccia
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Francesco Paolo Calace
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Luigi De Luca
- Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy;
| | - Michelangelo Olivetta
- Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d’Aragona, 84085 Mercato San Severino, Italy;
| | - Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Andrea Rubinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Giampiero Della Rosa
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Arturo Lecce
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Lorenzo Romano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | | | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Gennaro Mattiello
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Maria Giovanna Vastarella
- Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Salvatore Papi
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Octavian Sabin Tataru
- Department of Simulation Applied in Medicine, The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Vincenzo Vastarella
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
- Division of Cardiology, Cardiovascular Department, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Raffaele Balsamo
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Ferdinando Fusco
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Ugo Amicuzi
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
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Lampel A, Schultz-Lampel D. [Urinary diversion after uro-oncologic interventions in women: the right procedure for the right patient]. Aktuelle Urol 2021; 52:268-275. [PMID: 33906240 DOI: 10.1055/a-1377-2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Bladder carcinoma is a relatively rare tumour in women. The even rarer constellation of an invasive carcinoma or a high-risk situation when cystectomy is indicated requires adequate urinary diversion.The individual underlying circumstances of tumour and patient and the experience and preferences of the surgeon determine the choice of urinary diversion.A variety of alternatives are available for bladder replacement. The first decision to be made is between incontinent or continent urinary diversion. There is no general solution that fits all patients, but an individual solution must be found based on adequate information. Options include incontinent drainage with an ostomy, e. g. ureterocutaneostomy or ileum conduit, and the much more complex techniques of the continent variants of orthotopic or heterotopic replacement.Experience with continent diversion is significantly limited in women compared with men. In particular, the orthotopic connection to the urethra reveals gender-specific differences.All in all, clear inclusion or exclusion criteria for the different techniques have to be respected. Especially in cases when quality of life or body image play a crucial role, it is difficult to decide which type of urinary diversion is appropriate. This requires extensive experience on the part of the surgeon regarding the various options of surgical methods as well as knowledge and control of consecutive complications.
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Affiliation(s)
- Alexander Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
| | - Daniela Schultz-Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
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Bröder S, Jäger W, Thüroff JW, Stein R. Orthotopic MAINZ pouch bladder substitution - long-term follow-up. Cent European J Urol 2021; 74:235-240. [PMID: 34336244 PMCID: PMC8318017 DOI: 10.5173/ceju.2021.0275.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION After radical cystectomy, orthotopic neobladder is one surgical strategy for urinary diversion. To assess the usefulness of an operation, long-term data are essential. We examined long-term complications and continence rates of orthotopic ileocecal (MAINZ pouch) bladder substitution. MATERIAL AND METHODS Between 1986 and 2011, 193 patients underwent orthotopic MAINZ pouch bladder substitution. Until July 2000, ureter implantation was performed into the ascending colon through a submucosal tunnel technique (Goodwin-Hohenfellner). After July 2000, ureters were implanted into the terminal Ileum using the ileocecal valve to prevent reflux: the left spatulated ureter by an end-to-end (Wallace) and the right ureter by an end-to side technique (Nesbit). Surgical and medical follow-up reports were evaluated and a recent follow-up was obtained by a questionnaire. RESULTS Median follow-up in 183 patients was 72 months (1-336). A total of 74 patients (38%) died during the follow-up. A surgical intervention was required in 26 out of 193 patients with early complications while 45 out of 183 patients had late and 17 patients had both, early and late complications. Ureteral stenosis was found in 13% of submucosal implanted ureters, 13% with the Wallace technique, and 3.6% with the Nesbit technique. In total, 66 patients responded to the questions concerning long-term continence (minimal follow-up >2 years). Overall, 84.8% were completely continent, 1.6%, reported grade I and 9.8% grade II stress incontinence. CONCLUSIONS The long-term continence and complication rates are comparable to those of other types of orthotopic bladder substitution. Orthotopic MAINZ pouch procedure can be considered as one of the options for orthoptic diversion, which stands the test of time.
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Affiliation(s)
- Saskia Bröder
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Germany
| | - Joachim W. Thüroff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Non-obstructive, non-refluxing uretero-colonic anastomosis by colonic sero-muscular excision and extra mural peri-ureteric wrap - A new technique in 17 children. J Pediatr Urol 2021; 17:99.e1-99.e7. [PMID: 33223459 DOI: 10.1016/j.jpurol.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Uretero-enteric anastomosis with concomitant neobladder/augmentation/conduit becomes necessary when the bladder is unavailable or unfit for reimplantation or the ureters are short after high diversion or resection of lower ureteric pathology. Aiming to prevent both obstruction and reflux, we report a novel technique of sero-muscle denuded extra mural uretero-colic anastomosis. OPERATIVE TECHNIQUE (Fig 1) The ureter was brought through the colonic mesentery. An adjacent zone of colon "abcd" was chosen to receive the ureter and colonic sero-muscular layer was excised from this zone. The ureter was placed on the raw area and uretero-colic anastomosis was done (a-d).The edges of the sero-muscular layer (ab and cd) were sutured over the ureter to complete a submucosal tunnel. The augmentation/neo bladder was completed such that the implanted ureter lay within it between two regions of re-configured bowel, this adding to the anti-reflux mechanism created by the extra mural peri-ureteric wrap. AIM Surgical audit of this technique. MATERIALS AND METHODS 17 children (exstrophy - 8, ectopic ureter with bladder agenesis/hypoplasia - 3, prune belly - 2, neurogenic bladder -2, eosinophilic cystitis -1 and posterior urethral valve -1) underwent colonic implantation of 23 ureters while 6 ureters were drained via a trans uretero-ureterostomy into the reimplanted ureter. Nine augmentation, seven neo bladders and one sigmoid conduit was performed. The colon was available for ureteric re-implant in all patients. RESULTS Pre-operatively 21 had hydroureteronephrosis. The bladder was agenetic/hypoplastic, small and fibrosed or poorly compliant. Eleven ureters had been diverted. Post operatively (mean follow up - 3.4 years) 16 of 30 renal units were normal, 11 had mild and three had moderate residual hydronephrosis, with no new hydronephrosis. Cystogram showed no reflux in 14 children and unilateral reflux in three (one re-diverted). Of 29 renal units drained directly or via trans uretero-ureterostomy by the uretero-colic reimplantation, none are obstructed, 26 have no vesico-ureteric reflux while three (10%) have reflux. DISCUSSION We report results comparable to other extra mural techniques into the bowel, mainly from adult literature. Pediatric refluxing ureters are often large megaureters with or without preliminary diversions. The technique described avoids obstruction although having a slightly higher incidence of recurrent VUR. The ureters with recurrent reflux were massively dilated preoperatively and showed decrease in ureteric diameter postoperatively. The wrap, made for a larger ureter could have become too roomy and allowed reflux. CONCLUSION This technique of non refluxing non obstructive uretero-colonic anastomosis has proven useful in selected situations.
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Continent Cutaneous Urinary Diversions. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Furrer MA, Kiss B, Wüthrich PY, Thomas BC, Noser L, Studer UE, Burkhard FC. Long-term Outcomes of Cystectomy and Crossfolded Ileal Reservoir Combined with an Afferent Tubular Segment for Heterotopic Continent Urinary Diversion: A Longitudinal Single-centre Study. Eur Urol Focus 2020; 7:629-637. [PMID: 32654968 DOI: 10.1016/j.euf.2020.06.009] [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: 04/08/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The crossfolded ileal reservoir combined with an afferent tubular isoperistaltic segment for heterotopic continent urinary diversion has been performed on a regular basis for over 20 years. Yet data on long-term-outcomes remain sparse. OBJECTIVE To report long-term functional and oncological outcomes, gastrointestinal and metabolic disturbances, urinary tract infections (UTIs), and quality of life. DESIGN, SETTING, AND PARTICIPANTS Long-term functional and oncological outcomes of a consecutive series of 118 patients undergoing cystectomy and construction of a continent cutaneous crossfolded ileal reservoir from 2000 to 2018 were evaluated. INTERVENTION Patients underwent cystectomy and construction of a continent cutaneous crossfolded ileal reservoir according to the Studer technique for bladder reconstruction. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Pre- and postoperative data until last follow-up appointment were entered prospectively in the departmental database. Self-reported questionnaires regarding quality of life, patient satisfaction, and difficulty in catheterisation were sent to patients preoperatively; after 3, 6, 12, and 24 mo; and at last follow-up, and were then manually entered in the departmental database. RESULTS AND LIMITATIONS The median follow-up was 7.8 (interquartile range 3-12.7) yr. Patient satisfaction was high in 77.4% and moderate in 16.9%. Serum creatinine and estimated glomerular filtration rate remained stable during follow-up. Of all patients, 81% (96/118) had at least one UTI during follow-up. Recurrent UTIs occurred in 67% (79/118) of patients. Urolithiasis was found in 12% (14/118), with 6% (7/118) having a single and 6% a recurrent event. Of all stone formers, 79% (11/14) had recurrent UTIs. In oncological patients, 12.5% (10/79) developed a local recurrence. Cancer-specific survival and overall survival were 90% and 88%, and 68% and 56% after 1 and 10 yr, respectively. A limitations is the retrospective analysis from prospectively assessed data. CONCLUSIONS A high satisfaction level, stability of kidney function, and low rates of urolithiasis in patients with a heterotopic continent ileal reservoir can be achieved, provided that close attention is paid to intra- and postoperative details. Regular lifelong follow-up is essential for timely detection and treatment of complications. Oncological outcome is not affected by the urinary diversion. PATIENT SUMMARY In patients with a continent cutaneous ileal reservoir, good quality of life and a high satisfaction rate are possible provided that patients adhere to regular lifelong follow-up.
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Affiliation(s)
- Marc A Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Bernhard Kiss
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wüthrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin C Thomas
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ladina Noser
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs E Studer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fiona C Burkhard
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Neel N, Tarabay MS. Omphalocele, exstrophy of cloaca, imperforate anus, and spinal defect complex, multiple major reconstructive surgeries needed. Urol Ann 2018; 10:118-121. [PMID: 29416290 PMCID: PMC5791450 DOI: 10.4103/ua.ua_193_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OEIS complex is a rare combination of serious birth defects including omphalocele, exstrophy of cloaca, imperforate anus, and spinal defects. The aim of managements has shifted from merely providing survival to improve patient outcomes and quality of life with higher level of physical and social independence. Multiple complicated reconstructive surgeries always needed for achieving the goals of treatment. In this case report, we aimed to present our surgical approach for this rare abnormality to achieve functionally and socially acceptable outcome.
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Affiliation(s)
- Nada Neel
- Intern, Alfaisal University, King Khalid University Hospital, Riyadh, Saudi Arabia
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Open Techniques and Extent (Including Pelvic Lymphadenectomy). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abd Elwahab KM, Eliwa AM, Seleem MM, Ali MM, El-Babouly IM, Ragab A, Naguib M, Desouky HM, Desoky EAE, Omran M, Kamel HM. W-pouch With Modified Non-isolated Extra Limb for Continence in Cutaneous Diversion After Radical Cystectomy. Urology 2017; 105:202-207. [PMID: 28411100 DOI: 10.1016/j.urology.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/11/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the functional results of continent cutaneous ileal urinary diversion using modified W-pouch with non-isolated extra limb for continence. PATIENTS AND METHODS From January 2013 to January 2016, 21 patients with muscle-invasive bladder cancer with median (interquartile range) of 59 (56.5-62.5) years old underwent radical cystectomy with pelvic lymphadenectomy; they then had an ileal continent cutaneous pouch constructed from W-pouch with non-isolated extra limb for continence. The technique entails the creation of a detubularized ileal W-pouch with extra limb fashioned from 59 cm of the terminal ileum. This extra limb is not isolated from the pouch. The proximal part of this limb is tailored and fixed in a subserous extramural tunnel for continence, whereas the distal part is left continuous with the pouch. The median (interquartile range) of follow up was 12 (8-17) months. Evaluation of the technique included operative time, continence efficiency, overall complications, and quality of life questionnaire for the patients. RESULTS The median (interquartile range) of operative time of the operation was 4.7 (3.9-5.4) hours. The median (interquartile range) of operative time of the cutaneous pouch creation was 39 (33-43) minutes. No perioperative mortality had occurred. The incidence of continence was 95.2%. The overall complications were 42.8%, and most of them were grade 1 or 2 on Clavien-Dindo classification system. CONCLUSION Modification of W-pouch with non-isolated extra limb as continent cutaneous pouch can simplify the technique and shorten the operative time with efficient continence, less side effects, and good quality of life.
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Affiliation(s)
| | - Ahmed M Eliwa
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed M Seleem
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maged M Ali
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Islam M El-Babouly
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Ragab
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Naguib
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hamdy M Desouky
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Esam A E Desoky
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Omran
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hussein M Kamel
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Urodynamic Evaluation Following Bladder Reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW Radical cystectomy and urinary diversion remains the cornerstone in surgical management of patients with muscle-invasive or high-risk nonmuscle-invasive bladder cancer. This approach has been associated with remarkable increase in patient survival and more patients are now living for years after surgery who may present with long-term complications. This review describes long-term complications associated with urinary diversion including renal function deterioration, voiding dysfunction, stoma and bowel-related complications, ureteroenteric stricture, metabolic disorders, and infectious complications. RECENT FINDINGS The overall complication rate reported in recent large studies assessing long-term complications of urinary diversion is as high as 60%. Stoma-related complications followed by urinary tract infections are among the most common complications. Some of these complications may occur years after surgery; therefore, long-term follow-up of patients with urinary diversion is of utmost importance. SUMMARY Long-term regular follow-up is imperative in patients with urinary diversion as nonfatal complications may occur years after surgery.
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Kumar S, Devana SK, Sharma AP, Singh SK. Santosh PGI pouch: A new innovation in urinary diversion. Cent European J Urol 2015; 68:232-9. [PMID: 26251752 PMCID: PMC4526618 DOI: 10.5173/ceju.2015.584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/14/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction To know the feasibility and outcome of the Santosh PGI pouch as a new innovative technique of continent cutaneous diversion (CCD) following cystectomy. Material and methods Twelve patients (eleven with carcinoma of the bladder and one with an exstrophy of the bladder) underwent CCD using the Santosh PGI pouch after cystectomy. A 50-cm segment of terminal ileum was isolated 15-20 cm proximal to the ileocecal junction. The ileal segment was folded into the form of an ‘S’ configuration. On the antimesenteric border three longitudinal incisions were performed of about 7 cm in length. The terminal 8 cm portion of the distal part of the pouch was used for creating the intussuscepted nipple valve. Demucosalization of the interior of the nipple, fixing the nipple valve with the serosa of the pouch wall and wrapping of the catheterizable channel with a pouch wall for providing continence was done. The uretero-pouch anastomosis was done using the serosal lined tunnel technique. The catheterizable channel was brought out through the right rectus muscle. Results Median follow-up of the patients was 13.5 months. No significant complications were noted in the pouch reconstruction. Duration of the pouch reconstruction was around 75-110 min. Postoperatively, one patient had a UTI and another had paralytic ileus on the follow-up. All patients were doing regular CIC with acceptable continence of up to 400 ml. No ureteroileal anastomotic stricture or difficulty in catheterizing the pouch was seen. Conclusions The Santosh PGI pouch, which is a type of CCD, is technically feasible, easy to reconstruct with acceptable continence and offers minimal morbidity.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Kumar Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Prakash Sharma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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[Urinary diversion with continent umbilical stoma: Which techniques are suitable for which patients?]. Urologe A 2015; 54:1240-7. [PMID: 26228593 DOI: 10.1007/s00120-015-3924-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Continent cutaneous diversions play a secondary role even in many centers for urinary diversion. The result is that knowledge about, indications and operation technique does not exist in many clinics. RESULTS The general complication rates of the various forms of urinary diversion are not significantly different. There is no quality of life study showing a significant advantage for either form of urinary diversion. The functional results of neobladders in females with up to 70% hypercontinence are worse than in men, resulting in 2.4-fold more continent urinary diversions in men compared to women. The complication rates of the various forms of continent cutaneous pouches are different. CONCLUSION Continent cutaneous pouches are an option for all patients with non-existing or functionally unusable urethra and as primary indication in all women with bladder cancer, consulting in very good quality of life and perfect body image. Age (<75 years), manual skills and psychological ability are selection criteria. As far as the results and complication rates are concerned the ileocecal pouch with an appendix umbilical stoma is the best option. In cases of non-existing appendix, alternatives are a neoappendix, serosal lined tapered ileum and ileal invagination nipple.
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Patient Selection, Operative Technique, and Contemporary Outcomes of Continent Catheterizable Diversion: the Indiana Pouch. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kranz J, Anheuser P, Rausch S, Fechner G, Braun M, Müller SC, Steffens JA, Kälble T. Continent ileovesicostomy after bladder neck closure as salvage procedure for intractable incontinence. Cent European J Urol 2014; 66:481-6. [PMID: 24757550 PMCID: PMC3992445 DOI: 10.5173/ceju.2013.04.art25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/21/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We evaluated the success rate of continent vesicostomy using an ileal segment with seroserosally embedded, tapered ileum for bladder augmentation with continent stoma following bladder neck closure (BNC) for severely damaged bladders or persistent urinary incontinence. MATERIAL AND METHODS A total of 15 patients were treated for persistent urinary incontinence or non-reconstructible bladder outlet between 2003 and 2012. Underlying diagnosis included post-prostatectomy incontinence (n = 5), recurrent bladder neck stenosis (n = 5), neurogenic bladder (n = 3), urethral tumor recurrence following orthotopic neobladder (n = 1) and post-TVT and colposuspension incontinence (n = 1). All patients underwent open BNC, omental interposition and continent vesicoileostomy. The continent outlet was placed in the lower abdomen using a circumferential subcutaneous and skin plasty to avoid retraction. Data collected included age, underlying diagnosis, stoma site, time to complications and need for subsequent surgical revisions. All patients received a standardized questionnaire at the time of data acquisition and were personally interviewed. RESULTS Median follow-up was 24 months (range: 2-111). Primary BNC was successful in all patients and primary continence rate was 86.7%. Two patients (13.3%) suffered from failure of the continence mechanism, caused by stoma stenosis at skin level and insufficiency of the bladder augmentation and stoma due to local infection. One additional patient developed a mild stomal incontinence without need for further reconstruction. Regardless of the number of revisions, at the last follow-up 93.3% of patients had a functional channel. All complications occurred within the first postoperative year. CONCLUSIONS This technique is an effective last resort treatment for patients with non-reconstructible bladder outlet.
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Affiliation(s)
- Jennifer Kranz
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work
| | - Petra Anheuser
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany ; The selected authors contributed equally to this work
| | - Steffen Rausch
- Klinikum Fulda, Klinik für Urologie und Kinderurologie, Fulda, Germany
| | - Guido Fechner
- Universitätsklinikum Bonn, Klinik und Poliklinik für Urologie und Kinderurologie, Bonn, Germany
| | - Moritz Braun
- Heilig Geist-Krankenhaus, Klinik für Urologie, Köln-Longerich, Germany
| | - Stefan C Müller
- Universitätsklinikum Bonn, Klinik und Poliklinik für Urologie und Kinderurologie, Bonn, Germany
| | - Joachim A Steffens
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie, Eschweiler, Germany
| | - Tilman Kälble
- Klinikum Fulda, Klinik für Urologie und Kinderurologie, Fulda, Germany
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Abstract
We present a review on the current options for continent urinary diversion and their different indications on the basis of patient selection. In current clinical practice continent urinary diversion is being used world-wide in patients undergoing radical cystectomy and in severe cases of benign bladder pathologies. We also discuss the specific complications of continent urinary diversion and highlight the need to rigorously monitor these patients in the long- term specifically in terms of their renal function and cancer recurrence.
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Affiliation(s)
- Andrew Moon
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew C. Thorpe
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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Kälble T, Anheuser P, Steffens J. Serosa-lined and tapered ileum as primary and secondary continence mechanism for various catheterizable pouches. BJU Int 2012; 110:756-70. [PMID: 22897327 DOI: 10.1111/j.1464-410x.2012.11248.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tilman Kälble
- Department of Adult and Pediatric Urology, Hospital Fulda, Fulda, Germany.
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Anheuser P, Kranz J, Rausch S, Fechner G, Müller S, Braun M, Steffens J, Kälble T. Katheterisierbarer Kontinenzmechanismus für verschiedene Harnableitungsreservoire. Urologe A 2012; 51:947-55. [DOI: 10.1007/s00120-012-2908-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Elshal AM, Abol-Enein H, Mosbah A, Kamal MM, Abdel-latif M, Ghoneim MA. Serous-lined unidirectional valve for construction of continent cutaneous urinary reservoir: the test of time. Urology 2012; 80:452-8. [PMID: 22676948 DOI: 10.1016/j.urology.2012.02.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/17/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the long-term outcome of using the serous-lined extramural tunnel technique for construction of continent-cutaneous urinary reservoir in an objective way. METHODS Cases that were operated until the end of 2003 and were eligible for evaluation at the time of the study were included. Continence, upper tract status, and complications were the targets of evaluation. Clear definition of continence was used, and biochemical kidney function profile was assessed with calculation of estimated glomerular filtration rate (eGFR) as a measure of the overall renal function in addition to the standard radiological assessment tools. A modified Clavien scale was followed for grading of complications. RESULTS After a median of 121.3 months, the final continence rate was 91.1%. Maintained upper tract status was in almost 96.6% of cases and stricture of ureterointestinal anastomosis (UIA) was diagnosed in 3 renal units, and ureteral reflux was diagnosed in 24 renal units. Biochemical kidney function profile showed mean percent reduction of total eGFR to be 14.2%, and 3 patients had ≥50% reduction of total eGFR. On the Clavien scale, low-grade complications (GI-II) occurred in 30 patients (33%) and high-grade complications (≥GIII) occurred in 36 patients (40%). Stoma complications were the most frequent complications. At last follow-up, 42 patients (47%) were free of complications. CONCLUSION The serous-lined extramural valve is an efficient technique for maintaining unidirectional flow. Over a decade, good functional outcome of the cutaneous reservoir has been evident. However, with a clear definition of continence and objective assessment of the outcome, at least one third of patients will have high-grade complications, with excellent reintervention outcome maintaining efficacy of the technique.
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Affiliation(s)
- Ahmed M Elshal
- Mansoura Urology and Nephrology Center, Mansoura University, Egypt.
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Agarwal MM, Mavuduru R, Singh SK, Mandal AK. Preliminary short-term outcomes of a modified double-T ileal continent cutaneous urinary diversion using Yang-Monti tube implantation through serosa-lined extramural tunnel: the PGIMER pouch. Urology 2012; 79:943-9. [PMID: 22469584 DOI: 10.1016/j.urology.2011.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To present our simplified technical modification of double-T continent cutaneous diversion (CCD) using Yang-Monti tubes. METHODS During 2008-2011, 8 adult patients underwent CCD; 4 had classical exstrophy, 2 bladder cancer, 1 recurrent vaginal cancer post-radiotherapy, and 1 prostate cancer with post-simple retropubic prostatectomy urethral stricture with incontinence. For reconstruction, a 45- to 50-cm segment of terminal ileum sparing 25 cm of terminal ileum was harvested. Its distal 3- to 6-cm and proximal 3-cm segments were separated on vascular pedicle and fashioned into Yang-Monti tubes (1 proximally and 1 or 2 distally). The middle 40- to 45-cm detubularized segment was fashioned into a "W" shape, and serosal aspects of adjacent loops were sutured together close to the mesentery. The tubes were implanted into the W pouch via extramural serosa-lined tunnel (Abol-Enein and Ghoneim). The pouch was closed transversely over an 18-Fr pouchostomy and 16-Fr stomal catheter. The ureters were implanted into the proximal tube using the Wallace principle, over 6- to 8-Fr infant feeding tubes exteriorized through the pouch. The distal end of the distal tube was made into a flush stoma. RESULTS In the early postoperative period, intestinal obstruction (2 cases), ureteroileal anastomotic leakage (3 cases) and vesico-ileocutaneous fistula (1 case) were encountered. No ureteroileal anastomotic obstruction or catherization-related difficulty was observed until the last follow-up (2 months to 3 years). Of 15 anastomoses, 14 were nonrefluxing. CONCLUSION Ileal double-T CCD using the Yang-Monti principle is technically feasible and relatively simple, particularly in nonirradiated ileum. However, early complications indicate a learning curve, and long-term follow-up and larger data are needed.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Rink M, Kluth L, Eichelberg E, Fisch M, Dahlem R. Continent Catheterizable Pouches for Urinary Diversion. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Denewer A, Roshdy S, Farouk O, Elnahas W, Hegazy M, Shahatto F, Fady T, Khater A, Waly A. Continent catheterizable umbilical low-pressure intestinal pouch with split ileal end seromuscular anti-reflux technique. J Surg Res 2010; 166:e129-33. [PMID: 20869083 DOI: 10.1016/j.jss.2010.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 07/19/2010] [Accepted: 08/02/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cosmesis, better function, and stomal stricture avoidance are important issues in constructing continent urinary abdominal stomas for bladder cancer patients when orthotopic urinary diversion is not feasible. This study aims to evaluate the outcome of continent catheterizable umbilical low-pressure intestinal pouch incorporating a new split ileal end anti-reflux technique. METHODS Twenty-three patients underwent a continent umbilical low-pressure intestinal pouch incorporating a new seromuscular antireflux technique (split ileal end) after radical cystectomy when orthotopic reconstruction was not feasible. Mean operative time was 210 min (130 min for radical cystectomy and 80 min for reconstruction of the pouch). The mean follow-up after surgery was 18 mo (range 6-30 mo). RESULTS The most common early postoperative complications were urinary leak that occurred in nine patients: seven were conservatively managed and two by re-exploration. Late postoperative complications occurred in eight patients, of whom three developed stomal stenosis and treated successfully with repeated dilatation. Thirteen patients were totally continent, seven were fairly continent, and only two were poorly continent. CONCLUSIONS The functional results with this catheterizable umbilical low pressure intestinal pouch incorporating our new anti-reflux technique were satisfactory with better cosmesis.
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Affiliation(s)
- Adel Denewer
- Oncology Center, Mansoura University, Mansoura, Egypt.
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Kälble T, Roth S. Serosa lined and tapered ileum as primary and secondary continence mechanism for various catheterizable pouches. J Urol 2008; 180:2053-7. [PMID: 18804246 DOI: 10.1016/j.juro.2008.07.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Incontinence of catheterizable ileocecal pouches with an umbilical stoma using the original Mainz pouch technique can be repaired by a secondary ileal intussusception nipple fixed in the ileocecal valve. In cases of a modified Mainz pouch with ureteral anastomosis to the prevalvular ileal segment another form of troubleshooting is necessary. MATERIALS AND METHODS In 4 of 112 patients (3.6%) with the modified Mainz pouch described by Roth incontinence or stenosis of the catheterizable stoma occurred. A 24 to 30 cm segment of ileum was isolated. The proximal 8 to 10 cm were tapered and seroserosally embedded in the U-shaped 2 x 8 to 10 cm long remainder of the segment. After excising the insufficient efferent limb this ileal segment was anastomosed to the pouch and the umbilicus with tapered ileum acting as the continence mechanism. In a fifth patient such a segment was used for ileocystoplasty with an umbilical stoma after bladder neck closure. RESULTS At a median followup of 6 months (range 5 to 64) all 5 patients were fully continent with regular, easy self-catheterization via the umbilicus. CONCLUSIONS The introduced method seems to be a promising continence mechanism for various forms of catheterizable pouches, not only for troubleshooting.
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Affiliation(s)
- Tilman Kälble
- Departments of Urology and Pediatric Urology, Fulda Clinic, Fulda and University Witten-Herdecke, Helios Clinic Wuppertal, Wuppertal, Germany.
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Fisch M. [Development of continent reservoirs]. Urologe A 2008; 47:25-6, 28-32. [PMID: 18210062 DOI: 10.1007/s00120-007-1608-y] [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: 11/26/2022]
Abstract
Continent reservoirs represent an alternative to urostomy. Various operation techniques are available and the historical development will be described here with respect to the use of different parts of the intestine.
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Affiliation(s)
- Margit Fisch
- Abteilung für Urologie und Kinderurologie, Urologisches Zentrum Hamburg (UHZ), Asklepios Klinik Harburg, Hamburg, Deutschland.
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Seifert HH, Obaje A, Müller-Mattheis V, Müller M, Grimm MO, Ackermann R. Clinical and Functional Results after Continent Cutaneous Urinary Diversion with the Ileal Double-T-Pouch. Urol Int 2008; 80:8-12. [DOI: 10.1159/000111722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 01/16/2007] [Indexed: 11/19/2022]
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Simultaneous Augmentation Ileo-Cystoplasty in Renal Transplantation. Urology 2007; 70:1211-4. [DOI: 10.1016/j.urology.2007.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/31/2007] [Accepted: 09/20/2007] [Indexed: 11/24/2022]
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Wiesner C, Pahernik S, Stein R, Hähn K, Franzaring L, Melchior SW, Thüroff JW. Long-term follow-up of submucosal tunnel and serosa-lined extramural tunnel ureter implantation in ileocaecal continent cutaneous urinary diversion (Mainz pouch I). BJU Int 2007; 100:633-7. [PMID: 17511765 DOI: 10.1111/j.1464-410x.2007.06991.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess upper urinary tract complications and renal function in patients with a submucosal tunnel and serosa-lined extramural tunnel ureter implantation during the long-term follow-up of ileocaecal continent cutaneous urinary diversion (Mainz pouch I). PATIENTS AND METHODS In all, 458 patients who had diversion with the ileocaecal pouch were analysed in a retrospective follow-up study. Uretero-intestinal implantation was done using a submucosal tunnel (ST) in 809 reno-ureteric units (RUs) and by the serosa-lined extramural tunnel (ET) technique in 74 RUs. The median age of the patients at the time of surgery was 47.1 years, and the median follow-up was 89.0 months. RESULTS For the ST, there was anastomotic obstruction in 59 RUs (7.3%) at a median of 16.8 months after diversion; the obstruction-free intervals at 1, 5 and 10 years were 97%, 93% and 91%, respectively. Obstruction rates were 13.9% for previously dilated upper tracts and 17.1% in patients with a neurogenic bladder. Serum creatinine levels were < or =1.6 mg/dL in 97% of the patients at the latest follow-up. For ET, there was anastomotic obstruction in three RUs (4.1%) at a median of 17.2 months after diversion. Obstruction-free intervals at 1, 5 and 10 years were 100%, 96% and 96%. Preoperative dilation of the upper tracts did not reduce the obstruction rate (3.1%), but it was 7.1% in patients with a neurogenic bladder. Serum creatinine levels were < or =1.6 mg/dL in 98% of the patients at the latest follow-up. CONCLUSIONS The ET gives lower obstruction rates than the ST, especially when upper tracts are dilated and in patients with a neurogenic bladder. Renal function remained stable with both techniques in the long term.
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Affiliation(s)
- Christoph Wiesner
- Department of Urology, Johannes Gutenberg-University, School of Medicine, Mainz, Germany.
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Abdallah MM, Bissada NK, Hamouda HM, Bissada AN. Long-Term Multi-Institutional Evaluation of Charleston Pouch I Continent Cutaneous Urinary Diversion. J Urol 2007; 177:2217-20. [PMID: 17509324 DOI: 10.1016/j.juro.2007.01.142] [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] [Received: 11/05/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Charleston pouch I continent cutaneous urinary diversion has been used since 1989. We evaluated the long-term results of this procedure in 201 consecutive patients. MATERIALS AND METHODS The records of patients treated with the Charleston pouch I between 1989 and 2005 at 3 university hospitals were reviewed. Available data on age, sex, indications for diversion, comorbidity, followup duration, continence status, short-term and long-term complications, quality of life issues, and laboratory, radiological and urodynamic data were recorded. Patients were followed at 6-month intervals. RESULTS Followup was 14 to 136 months. Seven adults died in the 90-day postoperative period, and 21 (10.8%) and 51 (26%) patients had early and late complications, respectively. The interval between clean intermittent catheterizations was 2 to 8 hours. Mean capacity was 470 ml (range 250 to 1,300). At 12 months diurnal continence was achieved in 98% of the patients. A total of 98 patients (50.5%) needed night catheterization to stay dry. Of 342 ureters 17 (5%) became obstructed, requiring open or endoscopic management. Urolithiasis developed in 16 patients (8%). Vesicoureteral reflux was noted in 15 renal units (4.4%). Stomal complications developed in 8.2% of cases. Modest vitamin B12 supplementation was empirically used to avoid long-term deficiency. No detrimental effects on vitamin B12 concentrations were noted for up to 10 years. CONCLUSIONS Long-term multi-institutional followup of the classic Charleston pouch I reveals that it provides adequate continence with an acceptable complication rate and satisfactory patient acceptance.
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Affiliation(s)
- M M Abdallah
- University of Arkansas for Medical Sciences, Arkansas Children Hospital, 4301 W. Markham Street, Little Rock, AR 72205, USA
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Bissada NK, Abdallah MA. Technique for pure transverse colon continent cutaneous urinary diversion. Urology 2007; 69:173-4. [PMID: 17270644 DOI: 10.1016/j.urology.2006.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 08/31/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022]
Abstract
We describe a new method for constructing a pure transverse colon reservoir with two short segments of transverse colon fashioned as Monti tubes that are placed in a serous-lined extramural tunnel for construction of the efferent segment and for ureteral reimplantation, respectively.
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Affiliation(s)
- Nabil K Bissada
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Bissada NK, Abdallah MM, Aaronson I, Hammouda HM. Continent cutaneous urinary diversion in children: experience with Charleston pouch I. J Urol 2006; 177:307-10; discussion 310-1. [PMID: 17162072 DOI: 10.1016/j.juro.2006.08.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Complete continent urinary diversion not incorporating the bladder is not commonly used in children. We evaluated the short and long-term outcome of a form of continent cutaneous urinary diversion (Charleston pouch I) in children. MATERIALS AND METHODS A total of 17 children underwent Charleston pouch I continent cutaneous urinary diversion between 1988 and 2005. Patient records were reviewed for age, sex, indications for diversion, preoperative and postoperative laboratory and radiological studies, continence, patient and family acceptance, complications and long-term functional status. RESULTS Patient age ranged from 6 to 16 years. The main indication for diversion was bladder exstrophy in 8 patients (47%), neurogenic bladder in 6 (35%) and cloacal abnormalities in 3 (18%). Mean followup was 87.5 months. One patient was lost to followup. With moderate fluid intake the other patients were dry with a mean catheterizing time of 3.4 hours (range 2 to 6). Catheterization intervals were adjusted for individual patients. Generally, the patients became damp or leaked if they did not catheterize at recommended intervals. Continence was achieved at variable postoperative intervals, with some patients attaining continence soon after and others at 3 to 12 months before pouch maturation. Patients irrigated the pouch a mean of 4 times weekly (range 0 to 14). Three patients (18%) had bladder stones. Ultrasound and/or other upper tract studies revealed no deterioration of the upper urinary system. No patient experienced clinical pyelonephritis or acidosis. Family and patient acceptance was satisfactory. CONCLUSIONS Continent cutaneous urinary diversion with Charleston pouch I was satisfactory in this group of children. It provided preservation of the upper urinary tract, and achieved acceptable continence rates while allowing leakage when catheterization was not performed at recommended intervals. In addition, patient and parent acceptance was good, and complication rates were acceptable.
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Affiliation(s)
- N K Bissada
- Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Abol-Enein H, Ghoneim MA. Surgical Atlas A continent cutaneous ileal neobladder using the serous-lined extramural valves. BJU Int 2006; 98:1125-37. [PMID: 17034621 DOI: 10.1111/j.1464-410x.2006.06467.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wiesner C, Bonfig R, Stein R, Gerharz EW, Pahernik S, Riedmiller H, Thüroff JW. Continent cutaneous urinary diversion: long-term follow-up of more than 800 patients with ileocecal reservoirs. World J Urol 2006; 24:315-8. [PMID: 16676186 DOI: 10.1007/s00345-006-0078-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 03/14/2006] [Indexed: 10/24/2022] Open
Abstract
We report the clinical outcome of more than 800 patients, who underwent continent cutaneous urinary diversion with an ileocecal reservoir (Mainz-pouch I) in two urological tertiary referral centers at a mean follow-up of 7.6 years. Complications related to the continence mechanism (intussuscepted ileal nipple vs. submucosally embedded in situ appendix) and the antirefluxive uretero-intestinal anastomosis (submucosal tunnel vs. serosa-lined extramural tunnel) were recorded retrospectively. Stomal stenosis was observed in 23.5% of the patients with appendix stoma and in 15.3% of the patients with intussuscepted ileal nipple. The incidence of calculi was 10.8% in reservoirs with intussuscepted ileal nipple and 5.6% in reservoirs with appendix stoma. Eleven patients (eight with appendix, three with ileal nipple) required reoperation because of ischemic degeneration of the continence mechanism. The overall continence rate (day and night) was 92.8%. Anastomotic strictures of the afferent limb occurred in 6.5% of renal units (RUs) with a submucosal tunnel and in 5.0% of RUs with a serosa-lined extramural tunnel. Continent cutaneous urinary diversion with an ileocecal pouch is a highly satisfactory and safe option for patients, in whom orthotopic urinary diversion is impossible or contraindicated.
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Affiliation(s)
- Christoph Wiesner
- Department of Urology, Johannes Gutenberg University Medical School, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Burkhard FC, Kessler TM, Mills R, Studer UE. Continent urinary diversion. Crit Rev Oncol Hematol 2006; 57:255-64. [PMID: 16325414 DOI: 10.1016/j.critrevonc.2005.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 05/30/2005] [Accepted: 06/03/2005] [Indexed: 11/22/2022] Open
Abstract
During the last decade continent urinary diversion, especially orthotopic bladder substitution has become increasingly popular following radical cystectomy for bladder cancer. In general, if sphincter sparing surgery is possible, orthotopic bladder substitution is performed, if not then continent catheterisable reservoirs are a viable option. Strict patient selection criteria and improved surgical technique have had a positive influence on outcome, not only on survival but also on quality of life issues. It is becoming increasingly obvious, that a nerve sparing surgical technique not only improves sexual function but also continence. In addition, the length of the intestinal segment has an influence on continence and the degree of metabolic consequences, which are discussed in detail. Postoperative surveillance and instruction of patients is of utmost value for good functional results. Overall patient satisfaction and quality of life seem comparable in the various types of continent urinary diversions, and improved when compared to a urinary stoma. Continent urinary diversion offers a good quality of life with few long-term complications and should be considered the treatment of choice in the majority of patients, independent of sex.
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Affiliation(s)
- Fiona C Burkhard
- Department of Urology, University of Bern, 3010 Bern, Switzerland
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000188972.91538.be] [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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Abstract
PURPOSE OF REVIEW Uretero-intestinal reimplantation is a crucial component of urinary diversion. Several techniques for refluxing and nonrefluxing uretero-intestinal reimplantation have been established and modified to minimize anastomotic complications and preserve renal function. We review current experience with uretero-intestinal reimplantation in different types of urinary diversion. RECENT FINDINGS The basic principles of uretero-intestinal reimplantation are still controversially discussed. Several studies have focused on complications of urinary reflux from direct end-to-side or end-to-end anastomosis, such as pyelonephritis and calculus formation. Strictures at the anastomotic site of nonrefluxing tunneled ureteral reimplantation resulting in hydronephrosis and renal deterioration have led some to question the need for an antirefluxive anastomosis, at least in "low pressure urinary diversion". Alternative surgical procedures aim to avoid reflux and minimize the risk for anastomotic strictures by direct ureteral reimplantation into an intact isoperistaltic afferent ileal segment or the prevalvular ileum, with the ileocaecal valve functioning as an antireflux mechanism. SUMMARY A "gold standard" for uretero-intestinal anastomosis in urinary diversion does not yet exist. Further prospective randomized studies are required to identify the best anastomotic techniques for different types of urinary diversion.
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Affiliation(s)
- Christoph Wiesner
- Department of Urology, Johannes Gutenberg-University, School of Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany.
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