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Sasaki Y, Fukuta K, Kadoriku F, Daizumoto K, Shiozaki K, Tomida R, Kusuhara Y, Fukawa T, Yanagihara Y, Nakanishi R, Yamaguchi K, Yamamoto Y, Izaki H, Takahashi M, Okamoto K, Furukawa J. Retroperitoneal cutaneous ureterostomy following radical cystectomy: A multicenter comparative study of robotic versus open surgery. Int J Urol 2024. [PMID: 39253871 DOI: 10.1111/iju.15580] [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: 06/28/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot-assisted surgery (robot-assisted radical cystectomy, RARC), including the stent-free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function. METHODS Between 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups. RESULTS The patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high-risk cases with ASA-PS ≥3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent-free rate were comparable between the ORC and RARC groups. Throughout a median follow-up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3-year survival rates were similar across both groups. CONCLUSIONS CUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent-free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.
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Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kyotaro Fukuta
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Fumiya Kadoriku
- Department of Urology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yutaka Yanagihara
- Department of Urology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Ryoichi Nakanishi
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirofumi Izaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenjiro Okamoto
- Department of Urology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Junya Furukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Thakker PU, Refugia JM, Wolff D, Casals R, Able C, Temple D, Rodríguez AR, Tsivian M. Ileal Conduit versus Cutaneous Ureterostomy after Open Radical Cystectomy: Comparison of 90-Day Morbidity and Tube Dependence at Intermediate Term Follow-Up. J Clin Med 2024; 13:911. [PMID: 38337606 PMCID: PMC10856161 DOI: 10.3390/jcm13030911] [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: 12/31/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien-Dindo (C.D.) complication rates (Minor C.D. I-II, Major C.D. III-V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any-69% vs. 77%; minor-61% vs. 73%; major-46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.
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Affiliation(s)
- Parth U. Thakker
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Justin Manuel Refugia
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Dylan Wolff
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Randy Casals
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Corey Able
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Davis Temple
- Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Alejandro R. Rodríguez
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Matvey Tsivian
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
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Li M, Fu X, Zu X, Chen J, Chen M. Modified Tubeless Ureterocutaneostomy in High-Risk Patients After Radical Cystectomy and its Long-Term Clinical Outcomes. Technol Cancer Res Treat 2023; 22:15330338231192906. [PMID: 37807703 PMCID: PMC10563461 DOI: 10.1177/15330338231192906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES This work aimed to prevent stoma stenosis and achieve tubeless cutaneous ureterostomy in elderly and high-risk patients with our modified cutaneous ureterostomy. METHODS We retrospectively analyzed 40 and 49 patients (176 renal units) who underwent Toyoda (group 1) and modified cutaneous ureterostomy (group 2) between 2012 and 2021. The average follow-up period was 44 months. The primary results of our study were the catheter-free rate and clinical outcomes, especially renal function and urinary diversion-related complications. Significant differences in catheter-free rate and urinary diversion-related complications were found between our modified method and the Toyoda technique. RESULTS A total of 56 (71.8%) of 78 renal units in group 1 and 89 (90.8%) of 98 renal units in group 2 remained catheter free. Compared with group 1, group 2 had a higher catheter-free rate (P = .001). Multivariate analysis indicated that the surgical procedure (HR = 0.268; P = .001) and body mass index (HR = 3.127; P = .002) were the predictors independently associated with catheter insertion. During follow-up, renal deterioration was observed in 32 (36.0%) patients. Patients with catheter insertion were more likely to suffer from renal deterioration (P < .001), postoperative pyelonephritis (P < .001), and urolithiasis (P < .001) than their counterparts. CONCLUSION Our modified cutaneous ureterostomy method may provide an effective and simple approach to tubeless cutaneous ureterostomy in elderly and high-risk patients.
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Affiliation(s)
- Mingyong Li
- Urology Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Xiaowen Fu
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Xiongbing Zu
- Urology Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jinbo Chen
- Urology Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Minfeng Chen
- Urology Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Korkes F, Fernandes E, Gushiken FA, Glina FPA, Baccaglini W, Timóteo F, Glina S. Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review. Int Braz J Urol 2022; 48:18-30. [PMID: 33861058 PMCID: PMC8691241 DOI: 10.1590/s1677-5538.ibju.2020.0892] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. MATERIALS AND METHODS A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. RESULTS The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. CONCLUSIONS CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Eduardo Fernandes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Arakaki Gushiken
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Placco Araujo Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Willy Baccaglini
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Frederico Timóteo
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Sidney Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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Huang S, Chen H, Li T, Pu X, Liu J, Bi X. Comparison of survival in elderly patients treated with uretero-cutaneostomy or ileal conduit after radical cystectomy. BMC Geriatr 2021; 21:49. [PMID: 33441098 PMCID: PMC7807694 DOI: 10.1186/s12877-020-01861-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background In bladder cancer patients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancer patients with age ≥ 80 years old. Patients and methods Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancer patients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. Results Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867–1.257] and 1.012 [0.748–1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16–24] months and 19 [15–26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610–7.875] vs 1.730 [1.375–2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047–1.898] vs 0.941 [0.658–1.344] vs 1) and age (1.067 [1.032–1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046–7.959] vs 2.476 [1.651–3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645–3.804] vs 1.062 [0.590–1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057–2.412] vs 1). Our analysis obtained 0.707 power for overall survival. Conclusion Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancer patients after radical cystectomy to avoid associate complications.
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Affiliation(s)
- Shang Huang
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Hanzhong Chen
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Teng Li
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Xiaoyong Pu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Jiumin Liu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Xuecheng Bi
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China.
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Creta M, Fusco F, La Rocca R, Capece M, Celentano G, Imbimbo C, Imperatore V, Russo L, Mangiapia F, Mirone V, Russo D, Longo N. Short- and Long-Term Evaluation of Renal Function after Radical Cystectomy and Cutaneous Ureterostomy in High-Risk Patients. J Clin Med 2020; 9:E2191. [PMID: 32664517 PMCID: PMC7408808 DOI: 10.3390/jcm9072191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 12/04/2022] Open
Abstract
Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.
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Affiliation(s)
- Massimiliano Creta
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Ferdinando Fusco
- Department of Urology, Luigi Vanvitelli University of Naples, 80131 Naples, Italy;
| | - Roberto La Rocca
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Marco Capece
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Giuseppe Celentano
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Ciro Imbimbo
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Vittorio Imperatore
- Urology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy;
| | - Luigi Russo
- Nephrology Unit, Ospedale del Mare; 80131 Naples, Italy;
| | - Francesco Mangiapia
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Vincenzo Mirone
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
| | - Domenico Russo
- Nephrology Unit, Department of Public Health; University of Naples Federico II, 80131 Naples, Italy;
| | - Nicola Longo
- Urologic Section, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (R.L.R.); (M.C.); (G.C.); (C.I.); (F.M.); (V.M.); (N.L.)
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2019; 45:1090-1093. [PMID: 31808395 PMCID: PMC6909864 DOI: 10.1590/s1677-5538.ibju.2019.05.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Fernando Korkes
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Juan Palou
- Fundacion Puigvert Universitat Autonoma de Barcelona, Espanha
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2019. [PMID: 31808395 PMCID: PMC6909864 DOI: 10.1590/s1677-5538.ibju.2019.06.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Juan Palou
- Universitat Autonoma de Barcelona, Espanha
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Yadav P, Mittal V, Gaur P, Srivastava D, Sureka SK, Mandhani A. A modified cutaneous ureterostomy provides satisfactory short and midterm outcomes in select cases. Turk J Urol 2018; 44:399-405. [PMID: 29799401 DOI: 10.5152/tud.2018.51437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We present the outcomes of modification of cutaneous ureterostomy by extreme lateralization of the stoma and use of skin flap for formation of ureterostomy. MATERIAL AND METHODS Between June 2012 and June 2016, 36 patients had modified cutaneous ureterostomy for ureteral obstruction due to pelvic malignancy or genitourinary tuberculosis. Transureteroureterostomy was made with cutaneous stoma at anterior axillary line between iliac crest and lower rib cage, instead of spinoumbilical line. To prevent stenosis a 'V' shaped skin was fed into the stoma. Double J stents were used in all patients for 6 weeks. Perioperative morbidity and mortality were evaluated. All patients were followed up at 3 month intervals. RESULTS Of 36 patients, 22 had radical cystoprostatectomy (including nephroureterectomy in 2 patients) and 7 had palliative cystectomy. Others had locally advanced prostate cancer (n=1), locally advanced cervical cancer (n=3), ovarian cancer (n=1) and genitourinary tuberculosis with small capacity bladder along with a large vesicovaginal fistula (n=1). One patient developed ureteral necrosis requiring conversion to ileal conduit. Three patients developed stomal stenosis: two were managed by self-dilatation while one required revision of stoma. Thirteen patients died of the disease at a median follow up of 6 months with functioning stoma. Remaining 19 patients survived without any complications at a median follow-up of 20.5 months (5.5-43.5 months). None of the patients had any problem related to ureterostomy bag application. CONCLUSION Modified lateral cutaneous ureterostomy provides relatively straighter and shorter retroperitoneal course of ureter with acceptable morbidity and avoids use of bowel in selected patients.
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Affiliation(s)
- Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
| | - Varun Mittal
- Kidney and Urology institute, Medanta, the Medicity, Gurugram, Haryana, India
| | - Pankaj Gaur
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
| | - Devarshi Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, India
| | - Anil Mandhani
- Urology and Kidney Transplant, Medanta The Medicity, Gurugram, Haryana, India
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