Neovesicovaginal fistula due to a retained double-J stent in an ileal neobladder: surgical management and clinical considerations

THE ORTHOTOPIC KOCK ILEAL NEOBLADDER: FUNCTIONAL RESULTS, URODYNAMIC FEATURES, COMPLICATIONS AND SURVIVAL IN 166 MEN

FUNCTIONAL RESULTS OF ORTHOTOPIC ILEAL NEOBLADDER WITH SEROUS-LINED EXTRAMURAL URETERAL REIMPLANTATION: EXPERIENCE WITH 450 PATIENTS

25 Years of Experience With 1,000 Neobladders: Long-Term Complications

Long-Term Functional Outcomes of Ileal and Sigmoid Orthotopic Neobladder Procedures

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

Aim: To report the experience of vesicovaginal fistula repair among patients attending Khairpur Medical College. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Khairpur Mir’s and Department of Obstetrics & Gynaecology, GMMC, Sukkur from 1st February 2018 to 20th November 2020. Methodology: Thirty five known case of vesicovaginal fistula presenting with continuous leakage of urine were consecutively included. Patients with failed previous repair were also included. After pre-operative work-up, fistula repair was done either through abdominal or vaginal route in two layers tension free and watertight with absorbable suture. All patients were called for follow-up visits at two weeks initially and then depending on the presence of symptoms later on. Results: Transabdominal repair was observed in 18 (51.4%) patients whereas transvaginal vesicovaginal repair in 17 (48.6%) patients. The mean operative time was significantly higher among patients with transabdominal repair than transvaginal repair (p<0.001). Similarly, mean estimated blood loss was significantly higher in transabdominal repair than transvaginal repair (p<0.001). Success was found in majority of the patients 30 (85.7%). Success was found significantly higher among patients with transabdominal repair as compared to transvaginal repair, 18(100%) vs 12(70.6%) (p=0.013). Conclusion: Success rate of vesicovaginal repair was reported in majority of the patients. Though, success rate was remarkably higher in transabdominal repair, less estimated blood loss and operative time was reported in transvaginal repair. Keywords: Vesicovaginal repair, Success rate, Transabdominal repair, Estimated Blood Loss, operative time,

Objective: The objective of this study was to determine whether the quality of life (QOL) in patients who underwent orthotopic bladder replacement after radical cystectomy was affected by the intestinal segment used for the creation of a neobladder. Materials and Methods: A total of 52 patients who underwent radical cystectomy for bladder cancer were included in this study; i.e., 24 patients with an ileal neobladder and 28 patients with a sigmoid neobladder. QOL was evaluated using the SF-36 health-related QOL survey and a questionnaire designed to evaluate the continent status. Results: The mean follow-up periods for patients with an ileal and a sigmoid neobladder was 40.2 and 43.1 months, respectively. The SF-36 survey revealed that patients with colon neobladder had a significantly higher score for role-emotional functioning than those with ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders; however, general health and social functioning in patients with both types of neobladder appeared to be significantly lower than those in the general population in the United States. The results of the questionnaire analyzing the continent status were also similar between these two groups, including the desire to urinate, the incidence of both day- and nighttime urinary leakage, the frequency of pad exchange, and the concern of urine odor. Conclusions: Six of the eight scales concerning health-related QOL were favorable with both patients with ileal and colon neobladders, and the health-related QOL in orthotopic neobladder patients except for role-emotional functioning was not affected by the segment of the intestine used for neobladder construction. Moreover, no significant differences were observed in the QOL associated with continent status between these two groups. Therefore, patients with both types of orthotopic neobladder were generally satisfied with their health-related as well as disease-specific QOL.

Voiding Function in Women with Orthotopic Neobladder Urinary Diversion

Ileal versus sigmoid neobladder as bladder substitute after radical cystectomy for bladder cancer: A meta-analysis

Objective. To evaluate and compare noncontinent and continent urinary diversion after radical cystectomy in patients with bladder cancer. Methods. A total of 301 patients submitted to radical cystectomy at the Charité-University Hospital Berlin from 1993 to 2007 including 146 with an ileal conduit and 115 with an ileal neobladder. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. Quality of life was analyzed using the EORTC QLQ-C30 and BLM30 questionnaires. Results. 69.1% and 69.6% of all patients who received an ileal conduit and ileal neobladder, respectively, developed early complications. The two groups differed significantly concerning the occurrence of postoperative ileus (P = 0.02) favoring patients who received an ileal conduit but not with regard to any other early-onset complication evaluated. Patients with ileal neobladder had a significantly better global health status and quality of life (P = 0.02), better physical functioning (P = 0.02), but also a higher rate of diarrhoea (P = 0.004). Conclusion. Cystectomy with any type of diversion remains a complication-prone surgery. Even if the patient groups are not homogeneous in all respects, there are many arguments in favor of the ileal neobladder as the urinary diversion of choice.

PurposeTo present surgical methods and outcomes in women with bladder cancer (BCa) requiring correction of neobladder-vaginal fistula (NVF) after radical cystectomy (RC) with ileal orthotopic neobladder (IONB).Materials and MethodsThe medical records of 163 women who underwent RC with IONB for BCa between January 2010 and December 2018 were retrospectively reviewed. The presence of NVF was confirmed by cystoscopy and/or voiding cystography. NVF repair was performed using a transvaginal approach, which included circumferential incision of the fistula tract, creation of a plane between the neobladder serosa and the vaginal epithelium, and multi-layered transvaginal closure.ResultsDuring a median follow-up of 47.9 months, NVF was identified in 12 (8.8%) of the 163 included women. Eight (66.7%) fistulas were located in the proximal anterior vaginal wall and four (33.3%) in the vaginal apex. Median time from RC to NVF repair was 3.4 months (range, 2.1–5.6 months), median NVF size was 6.0 mm (range, 4.0–22.0 mm), and median duration of urethral Foley catheter indwelling was 24.0 days (range, 15.0–43.0 days). Initial repair of NVF was successful in ten (83.3%) patients. Two (16.7%) patients who relapsed retained IONB through the subsequent operation. Two (16.7%) patients developed severe urinary incontinence after NVF repair, requiring anti-incontinence surgery with a synthetic transobturator mid-urethral sling.ConclusionThe transvaginal approach for NVF repair is feasible, yielding successful surgical outcomes. However, women should be counseled about the risks of relapse and urinary incontinence.

We describe a novel technique of ureteral Double-J stent placement during laparoscopic pyeloplasty. A ureteropelvic junction (UPJ) occlusion balloon catheter is inserted retrograde into the ureter cystoscopically, under fluoroscopic guidance. Before insertion, a Foley catheter is calibrated and marked to indicate the point on its external surface to which the distal end of the Double-J ureteral stent pusher must reach to position the proximal end of the pusher at the midportion of the Foley catheter balloon (inside the bladder). The Foley and occlusion catheters (OC) are prepped into the operative field. The renal pelvis is distended by injecting saline through the OC to aid with dissection of the UPJ. After pyelotomy, the balloon is deflated, and the OC is withdrawn into the proximal ureter. After completion of the posterior suture line of the dismembered pyeloplasty, a guidewire is inserted through the OC and grasped within the renal pelvis. The OC is removed and the ureteral stent advanced until it is positioned in the renal pelvis and the distal end of the pusher has reached the calibrated mark on the Foley catheter. On removal of the guidewire, the lower end of the stent accurately lies in the bladder. The anastomosis is then completed. Ten patients who underwent robot-assisted laparoscopic pyeloplasty between January 2005 and July 2006 at our institution had ureteral stenting using this technique. The stent was positioned accurately in all 10 patients without any stent-related complications. All patients had resolution of their UPJ obstruction on follow-up imaging. Our technique of ureteral stent placement facilitates identification of the distended renal pelvis, ensures an unencumbered operative field with less chance of stent damage/migration during laparoscopic pyeloplasty, and permits accurate positioning of the ureteral stent.

Ileal conduit and neobladder urinary diversions are frequently performed after radical cystectomy. However, complications after radical cystectomy may be different according to the type of urinary diversion. Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. This study was performed to compare the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy.All consecutive patients who underwent radical cystectomy in 2004 to 2014 in a single tertiary care center were identified. The patients were divided into the ileal conduit and ileal neobladder groups. Preoperative variables, including demographics, cancer-related data and laboratory values, as well as intraoperative data and postoperative outcomes, including AKI, intensive care unit admission rate, and the duration of hospital stay, were evaluated between the groups. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcome criteria. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences.After performing 1:1 propensity score matching, the ileal conduit and ileal neobladder groups each included 101 patients. The overall incidence of AKI after radical cystectomy was 30.7% (62 out of 202) and the incidences did not significantly differ between the groups (27 [26.7%], ileal conduit group vs 35 [34.7%], ileal neobladder group, P = 0.268). Intraoperative data, intensive care unit admission rate, and the duration of hospital stay were not significantly different between the groups.Postoperative AKI did not significantly differ between ileal conduit and neobladder urinary diversions after radical cystectomy. This finding provides additional information useful for appropriate selection of the urinary diversion type in conjunction with radical cystectomy.

Step-by-step robotic intracorporeal orthotopic neobladder formation

Minimally Invasive Management of Concomitant Vesicovaginal and Ureterovaginal Fistulas After Transabdominal Hysterectomy: Laparoscopic Vesicovaginal Fistula Repair With Ureteroneocystostomy Using a Boari Flap