1147 PERI-OPERATIVE MORBIDITY RELATED TO BOWEL PREPARATION BEFORE ILEAL USE FOR LOWER URINARY TRACT RECONSTRUCTIVE PROCEDURES: A RANDOMIZED PROSPECTIVE STUDY

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20111147 PERI-OPERATIVE MORBIDITY RELATED TO BOWEL PREPARATION BEFORE ILEAL USE FOR LOWER URINARY TRACT RECONSTRUCTIVE PROCEDURES: A RANDOMIZED PROSPECTIVE STUDY Mohamed Mohie Eldin Hashad, Amr Khattab, Ahmad Elabbady, Souzan Elfikky, and Mohamed Adel Atta Mohamed Mohie Eldin HashadMohamed Mohie Eldin Hashad Alexandria, Egypt More articles by this author , Amr KhattabAmr Khattab Alexandria, Egypt More articles by this author , Ahmad ElabbadyAhmad Elabbady Alexandria, Egypt More articles by this author , Souzan ElfikkySouzan Elfikky Alexandria, Egypt More articles by this author , and Mohamed Adel AttaMohamed Adel Atta Alexandria, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.746AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bowel preparation is unnecessary before lower urinary tract reconstructive procedures using ileal segments but it is a routine measure whenever large bowel use is anticipated or prefered by the surgeon. However, surgeons may finally resort to small bowel use. In these situations, added morbidity of the unnecessary bowel preparation has been questioned. This study prospectively evaluate the perioperative morbidity inflicted by bowel preparation before ileal reconstructive procedures of the lower urinary tract. METHODS Forty patients were prepared for ileal urinary diversion after getting informed consent. They were prospectively randomized into 2 groups. Group (I) was subjected to standard 3-days bowel preparation (using laxatives, enemas and antibiotics). Group (II) was subjected to over-night fasting before surgery. Pre- and post operative serum electrolytes levels, kidney function tests, hemodynamic and fluid charts were monitored for each patient. A 1 ml of ileal secretions was collected intra-operatively for aerobic and anaerobic cultures. A tissue specimen from the ileum was sent for histopathology. Postoperative complications concerning wound and tissue healing were reported. RESULTS Thirteen patients (65%) of Group (I) were scheduled for ileal diversion due to malignant pathologies versus 16 patients (85%) of group (II). All reconstructive surgeries used the ileum and varied between cutaneous continent reservoir, ileal conduit, ileocystoplasty and ileal orthotopic bladder. No significant change was observed between both groups regarding Pre- and post-operative serum electrolytes levels, kidney function tests, hemodynamic and fluid charts. Under aerobic and anaerobic conditions, 10 cultures of ileal secreta (50%) of group (I) yielded gram negative bacilli versus none of group (II) cultures (p=0.007). Ninety per cent of cultures of group (II) were sterile (8 cultures in group I versus 18 cultures in group II, p=0.007). Histopathological examination of ileal biopsies revealed mucosal edema and submucosal congestion in 8 cases (40%) of group (I) versus 2 patients (10%) in group (II) (p=0.028). Postoperative wound complications were more in group (I): 7 patients (35%) versus 4 patients (20%) in group (II) while thirteen patients (65%) in group (II) led uneventful postoperative course. (p=0.031). CONCLUSIONS Bowel preparation before ileal use for lower urinary tract reconstructive procedures adds significant morbidity. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLarge M, Kiriluk K, DeCastro G, Patel A, Prasad S, Jayram G, Weber S and Steinberg G (2018) The Impact of Mechanical Bowel Preparation on Postoperative Complications for Patients Undergoing Cystectomy and Urinary DiversionJournal of Urology, VOL. 188, NO. 5, (1801-1805), Online publication date: 1-Nov-2012. Volume 185Issue 4SApril 2011Page: e460 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Mohie Eldin Hashad Alexandria, Egypt More articles by this author Amr Khattab Alexandria, Egypt More articles by this author Ahmad Elabbady Alexandria, Egypt More articles by this author Souzan Elfikky Alexandria, Egypt More articles by this author Mohamed Adel Atta Alexandria, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...