1
|
Salgado-Parente A, Antolinos-Macho E, González-Huete A, García-Latorre R, Canales-Lachén E, González-Gordaliza MC. What do we see when we do not see the bladder? Review of the main urinary diversion techniques and their complications. RADIOLOGIA 2023; 65:554-567. [PMID: 38049254 DOI: 10.1016/j.rxeng.2023.11.001] [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: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To review the different types of urinary diversion surgeries (UDS) in order to recognize the expected findings in a postoperative study, using different imaging techniques. To recognize the main postoperative complications, both early and late. CONCLUSION UDS are surgical procedures whose purpose is to redirect urine flow after cystectomy, generally in an oncologic context. The imaging evaluation of urological surgeries is often a radiological challenge, with CT being the most commonly used image modality. Therefore, it is essential to know the main surgical techniques, the expected postoperative findings and the optimization of imaging techniques for early diagnosis and correct evaluation of postoperative complications.
Collapse
Affiliation(s)
- A Salgado-Parente
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - E Antolinos-Macho
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A González-Huete
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R García-Latorre
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Canales-Lachén
- Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | |
Collapse
|
2
|
Management of Bladder Pain Syndrome (BPS): A Practical Guide. Adv Urol 2022; 2022:7149467. [PMID: 35047038 PMCID: PMC8763550 DOI: 10.1155/2022/7149467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Bladder pain syndrome (BPS) is a prevalent and pervasive disease. The physical and psychological sequelae can be very burdensome for the patient, and the condition represents a real challenge for the clinician as well. With no simple pathognomonic test, finding harmony in navigating patient care can be demanding. Diagnosis and management rely upon a multidisciplinary and holistic approach. Treatment options include conservative measures and pharmacotherapies as well as bladder instillation therapies. Ultimately, surgery may be offered but only in cases of refractory disease. This article offers a pragmatic guide for clinicians managing this challenging disease.
Collapse
|
3
|
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]
|
4
|
Aminoltejari K, Black PC. Radical cystectomy: a review of techniques, developments and controversies. Transl Androl Urol 2020; 9:3073-3081. [PMID: 33457280 PMCID: PMC7807330 DOI: 10.21037/tau.2020.03.23] [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] [Indexed: 12/17/2022] Open
Abstract
Radical cystectomy (RC) with urinary diversion is considered the standard treatment for muscle invasive bladder cancer (MIBC). As one of the most challenging surgical techniques performed by urologists, RC was described many decades ago, and yet patient morbidity rates have remained stagnant over the years. This review outlines the most recent indications and techniques for RC and analyses the current landscape of complications after cystectomy. There is significant room for improvement with respect to both oncologic and functional outcomes after RC. Future efforts will need to focus on unifying reporting methodology, optimal patient selection criteria, enhanced surgical techniques and peri-operative care pathways, and technological advances to improve patient outcomes.
Collapse
Affiliation(s)
- Khatereh Aminoltejari
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Abstract
OBJECTIVE The article attempts to describe the indications, classification, and surgical anatomy of the commonly performed urinary diversion procedures, followed by the imaging protocol and radiological appearances of the normal postoperative anatomy and complications related to these procedures. CONTENTS Diversion procedures are used to reroute urine after cystectomy and in patients with refractory neurogenic or outlet obstruction of the urinary bladder. Broadly, these can be classified as continent and incontinent diversions. Patients with urinary diversions frequently undergo radiological investigations for the detection of complications. Commonly, a loopogram or pouchogram is performed few weeks after the surgery to look for leak, whereas CT or MRI is used for long-term follow-up. Postoperative complications can be early (within 30 days of the surgery) or delayed and include leaks, collections, strictures, calculi, parastomal hernia, small bowel obstruction, and oncologic recurrence. CONCLUSION A variety of urinary diversion procedures are commonly performed and interpretation of the postsurgical anatomy can be overwhelming for the general radiologist. This article provides a basic understanding of the normal anatomy as well as a thorough discussion on the imaging protocol and radiological appearances of the potential complications associated with these procedures.
Collapse
|
6
|
Abstract
Bladder cancer is the most common genitourinary cancer in the United States. Symptoms of bladder cancer mimic those of a urinary tract infection, which can delay timely diagnosis. Because of the high rate of bladder cancer, it is likely advanced practice registered nurses will be responsible for the care of patients with bladder cancer. This article reviews the signs and symptoms of bladder cancer along with management options to safely care for this patient population.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Deuker M, Roos FC, Großmann A, Faé P, Thüroff JW, Stein R. Long-term outcome after urinary diversion using the ileocecal segment in children and adolescents: Complications of the efferent segment. J Pediatr Urol 2016; 12:247.e1-7. [PMID: 27282550 DOI: 10.1016/j.jpurol.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/04/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Long-term outcomes are of special concern in children after urinary diversion. In a single institution study we evaluated retrospectively the long-term outcomes of urinary diversion in children, in whom the ileocecal segment had been used, in respect to complications of the efferent segment. METHODS The Mainz pouch was used in 107 children for continent urinary diversion. Indications were neurogenic bladder (53%, 57/107), exstrophy-epispadias complex (25%, 27/107), malignancy (13%, 14/107), and others (9%, 9/107). Continent cutaneous diversion was performed in 95 patients, and 12 patients received bladder augmentation/substitution with a continent cutaneous stoma. As efferent segment, we used the in situ submucosally embedded appendix in 55/107, and an intussuscepted ileal nipple valve in 45/107 patients, other in seven patients. Complication rates and degree of satisfaction with urinary diversion were evaluated by assessing medical records and using follow-up questionnaires. RESULTS AND DISCUSSION The median follow-up time was 15.9 years (0.4-27.6 years). There was a significant difference between the stenosis rates of appendical stoma and the intussuscepted ileal nipple valve. In general, 38% of patients (41/107) with a continent cutaneous stoma developed a stoma stenosis at the skin level, with 41% (17/41) of those having recurrent stenoses (2-6×). Of the patients with an appendix stoma, 49% (27/55) developed a stenosis, compared with 20% (9/45) of those with an intussuscepted ileal nipple valve (p < 0.001). In an attempt to reduce the incidence of stenosis, we implemented use of the ACE stopper during the last 2 years, but whether this is successful is subject to further investigations. For surgical treatment of stoma stenosis, reanastomosis of the efferent segment to the skin (n = 37, re-stenosis rate 37%, [14/37]) was superior to endoscopic scar incision (n = 44, re-stenosis rate 59% [26/44], OR 2.4). The overall continence rate was 85% (91/107). At the latest follow-up, 89% (49/55) of patients with an appendix stoma and 82% (37/45) of those with an intussuscepted ileal nipple valve were completely continent. CONCLUSION The in situ submucosally embedded appendix and the intussuscepted ileal nipple valve are reliable continence mechanisms in the long-term median follow-up of nearly 16 years. The stomal stenosis rate is approximately double for the submucosal appendix, likely because of its smaller diameter in comparison with the ileal valve. Although we encountered a high overall rate of complications, the satisfaction rate with the diversion was high (99% [88/89] satisfied or very satisfied patients).
Collapse
Affiliation(s)
- Marina Deuker
- Johannes Gutenberg University, School of Medicine, Department of Urology, Mainz, Germany.
| | - Frederik C Roos
- Johannes Gutenberg University, School of Medicine, Department of Urology, Mainz, Germany
| | - Allegra Großmann
- Johannes Gutenberg University, School of Medicine, Division of Pediatric Urology, Mainz, Germany
| | - Patrick Faé
- Johannes Gutenberg University, School of Medicine, Division of Pediatric Urology, Mainz, Germany
| | - Joachim W Thüroff
- Johannes Gutenberg University, School of Medicine, Department of Urology, Mainz, Germany
| | - Raimund Stein
- University Medical Center Mannheim, Department of Pediatric and Adolescent Urology, Germany
| |
Collapse
|
9
|
Sonobe HM, Ravena RS, Moreno FS, Buetto LS, Oliveira MS. Assistência de enfermagem perioperatória aos pacientes com câncer de bexiga. AVANCES EN ENFERMERÍA 2016. [DOI: 10.15446/av.enferm.v34n2.37465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: O planejamento daassistência de enfermagem perioperatóriapara pacientes com câncer debexiga requer conhecimento científicoe incorporação tecnológica. Esteestudo objetivou caracterizar o perfilde pacientes com câncer de bexigaem uma unidade cirúrgica de umhospital especializado em oncologiado interior paulista e analisar oscuidados de enfermagem realizadospara esta clientela.Metodologia: Estudo exploratórioretrospectivo, cujos dados foramcoletados em 80 prontuários depacientes submetidos ao tratamentocirúrgico urológico no período dejaneiro a setembro de 2008.Resultados: Houve predomíniodo sexo masculino, na faixa etária de60 a 80 anos, com formação fundamentalincompleta, de raça branca,estadiamento I e procedimentocirúrgico de Ressecção Transuretral.A assistência de enfermagemperioperatória abarca intervençõeseducativas de autocuidado, cuidadosprocedimentais como soroterapia,preparo colônico, administraçãode medicamentos, posicionamentodo paciente, monitorização de sinaisvitais, cuidados com sonda e drenos,controle hídrico, passagem de plantãoe encaminhamento de prontuárioe exames. No caso específico depacientes com urostomia, é importantea avaliação clínica e das condiçõesdo estoma; ensinar as açõesespecíficas do autocuidado; planejara alta hospitalar, fornecer equipamentose encaminhar aos recursosda comunidade.Conclusão: Para prestar assistênciaperioperatória para essaclientela é necessário um planejamentofundamentado em conhecimentoscientíficos, educaçãopermanente da equipe de enfermageme supervisão do trabalho peloenfermeiro.
Collapse
|
10
|
El-Taji OMS, Khattak AQ, Hussain SA. Bladder reconstruction: The past, present and future. Oncol Lett 2015; 10:3-10. [PMID: 26170968 DOI: 10.3892/ol.2015.3161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/26/2015] [Indexed: 12/28/2022] Open
Abstract
Ileal conduit urinary diversion is the gold standard treatment for urinary tract reconstruction following cystectomy. This procedure uses gastrointestinal segments for bladder augmentation, a technique that is often associated with significant complications. The substantial progression in the fields of tissue engineering and regenerative medicine over the previous two decades has resulted in the development of techniques that may lead to the construction of functional de novo urinary bladder substitutes. The present review identifies and discusses the complications associated with current treatment options post-cystectomy. The current techniques, achievements and perspectives of the use of biomaterials and stem cells in the field of urinary bladder reconstruction are also reviewed.
Collapse
Affiliation(s)
- Omar M S El-Taji
- Department of Surgical Oncology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Altaf Q Khattak
- Department of Urology, St. Helen's & Knowsley NHS Teaching Hospitals, University of Liverpool, Prescot L35 5DR, United Kingdom
| | - Syed A Hussain
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 3GA, United Kingdom
| |
Collapse
|