Continent Cutaneous Urinary Diversion Research Articles

The use of urodynamic to assess the mechanism of incontinence in patients with Yang-Monti based catheterizable cutaneous stomas.

To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma. 76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure. Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group. Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.

V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE Albert Kim and Kevin Chan Albert KimAlbert Kim More articles by this author and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continent urinary diversion after radical cystectomy is an underutilized option even at high-volume centers with studies demonstrating socio-economic, geographical, and gender disparities. Efforts to optimize utilization of continent diversion must concentrate on changing perceptions regarding feasibility and accurate reporting of complications.The objective of this study is to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. METHODS: After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. Complications at 30- and 90-days were recorded according to the Clavien-Dindo classification. Continence rates were recorded by manual chart review. RESULTS: A total of 97 patients were included with a median follow-up of 93 months. Clinically, 91.8% had £T2 disease and 29.9 % received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3 days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-days respectively. Most complications were low grade (Clavien I or II). Acute blood loss anemia and symptomatic urinary tract infection were the most common low grade complications. The major complication rate was 17.5% at 30-days and 22.7% at 90-days. The most common major complications were abdominal infection requiring percutaneous drain placement, Clavien Grade III, and uretero-colonic stricture requiring percutaneous nephrostomy tube placement and surgical revision, Clavien Grade III. The readmission rate was 21.4% and median overall survival was 108 months. CONCLUSIONS: CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. Source of Funding: NONE Disclosures: NONE © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert Kim More articles by this author Kevin Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Quality of life after radical treatment for muscle invasive bladder cancer: A systematic review and meta-analysis.

489 Background: Radical cystectomy (RC) with or without perioperative chemotherapy is considered the standard treatment option for Muscle invasive bladder cancer (MIBC), despite poor oncological outcomes. However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve the postoperative QoL, but real benefit of these approaches is questioned. Bladder sparing approach, such as trimodal therapy (TMT) emerged as an alternative to surgery. Aiming to assess the impact of these treatment options from the patients’ perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies specifically reporting QoL data about each of the above mentioned approaches. Main purpose of this review is to compare available treatment options from the QoL point of view and highlight the potential advantage of a bladder sparing approach if compared to different postoperative urinary diversion methods. Methods: A systematic review was carried out including all prospective and retrospective studies enrolling patients treated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement Results: Fifty studies were included in the final analysis, assessing QoL after RC followed by ICUD or ONB in 6 and 15 cases, respectively. Six studies addressed QoL after TMT. ICUD vs ONB and TMT vs ICUD/ONB comparisons were carried out in 21 and 1 studies, respectively. Pooled analysis for EORTC QLQ- C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage if compared to ICUD only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 =93%) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 =0%). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Conclusions: Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach if compared to both reconstructive scenarios. These data should be used in clinical practice to help well informed patients decision about local treatment choice.

Recrudescent pouch calculi in cutaneous continent diversion

Reservoir pouch calculi are the most common complication following continent urinary diversion. The presence of calculi in the neobladder can be silent or provoke flank pain, hematuria, and urinary tract infections. Minimal invasive interventions like endoscopic or percutaneous retrieval in smaller calculi to open surgical approaches in large calculi is some of the treatment modalities. Here we present a 34-year-old patient who is a known case of exstrophy-epispadias complex, underwent bladder closure at one year of age and continent cutaneous urinary diversion (Modified Indiana pouch) 26 years ago. Plain and contrast computerized tomography showed multiple large calculi six in number, inside the pouch. In this case, the calculi were successfully managed through an open surgical approach.

Continent cutaneous urinary diversion with an ileal pouch with the Mitrofanoff principle versus a Miami pouch in patients undergoing cystectomy for bladder cancer: results of a comparative study.

Radical cystectomy (RC) is currently the standard of care for non-metastatic muscle invasive bladder cancer. Few studies compare methods of cutaneous continent urinary diversion (CCUD) following RC. Theobjectivewas to compare perioperative morbidity and functional outcomes of CCUD using an ileal pouch with aMitrofanoff efferent versus a Miami ileocolic pouch in patients undergoing cystectomy of pelvic exenteration for bladder cancer. This retrospective two-centre study included all consecutive patients who underwent radical cystectomy or pelvic exenteration with CCUD for bladder cancer between 2001and 2020in two academic French hospitals with a median follow-up time of 5.4years. Patients were divided into two groups according to the type of urinary diversion: Miami ileocolonic pouch (group A) and ileal pouch with Mitrofanoff/Monti principle (group B). Continence rate, ability to perform intermittent self-catheterisation, complications and health-related quality of life (HRQoL) measured by the bladder cancer index were evaluated. Thirty-one patients were included. Continence was achieved in 11 out of 14 patients (79%) in group A versus 12 out of 17 patients (71%) in group B (P = 0.3). A significantly higher rate of cutaneous tube stenosis was reported in group B compared to group A (eight (47%) vs. one (7%) patient, respectively; P = 0.02). HRQoL outcomes were similar in both groups except less digestive discomfort observed in group A. When comparing the ileal pouch with Mitrofanoff/Monti's principle with a Miami pouch, no significant differences were found regarding continence rate, ability to self-catheterise, long-term complication rate and overall patient satisfaction.

V01-09 ROBOTIC-ASSISTED CONTINENT CUTANEOUS DIVERSION: FEASIBILITY OF A ROBOTIC SPIRAL MONTI TECHNIQUE IN A PATIENT WITH INCOMPLETE EMPTYING

INTRODUCTION AND OBJECTIVE:The spiral Monti technique to continent cutaneous urinary diversion allows for maximal length of the catheterizable channel without multiple anastomoses that increase the...

Outcomes of pregnancy and delivery in women with continent lower urinary tract reconstruction: systematic review of the literature.

The aim of this systematic review of the literature was to pool all the existing data regarding pregnancy and delivery in women with neurogenic bladder or bladder exstrophy who had undergone previous lower urinary tract reconstruction (LUTR). We conducted a systematic review of the literature from PubMed/MedLine, ClinicalTrials.gov and the Google Scholar database, from 1972 to July 2020. Fifty articles were included, of which 25 contained data that could be pooled (229 women representing 292 pregnancies). Ninety-eight women had bladder exstrophy (43%), 58 had spinal dysraphism (25%), 14 had spinal cord injury (6%), and 59 presented other pathological conditions. Of these, 138 have had an augmentation cystoplasty (61%), 42 (18%) had a continent cutaneous urinary diversion, and 31 had an artificial urinary sphincter (14%). During their pregnancy, 97 women (33%) experienced at least one febrile urinary tract infection. Thirty-one women (11%) required ureteral stenting or nephrostomy placement for upper urinary tract dilatation. Forty-six pregnancies ended with premature delivery (16%). Delivery mode was by C-section for 108 patients (62%) and vaginal delivery for 104 (36%). Twenty complications were reported during delivery (mainly urological), of which 19 occurred during C-section. Nine women experienced postpartum urinary incontinence (4%); in 5 of then this was due to urinary fistulae secondary to complicated C-section. Pregnancy and vaginal delivery are possible for women with LUTR who have no obstetric or medical contraindications, except for some particular cases of bladder exstrophy. However, these high-risk pregnancies and deliveries should be managed by a specialist multidisciplinary team.

Simulation Based Educational Intervention for Enhancing Irrigation Skills of Nurses Caring for Patients With Cutaneous Continent Urinary Diversions and Orthotopic Neobladders.

The purpose of this study was to investigate the effect of a nurse practitioner-led simulation-based education program on nursing knowledge and confidence in the care of patients with a cutaneous continent urinary diversion (Indiana pouch) or orthotopic neobladder. Single-group, before-after study. The sample comprised 11 RNs practicing at New York Presbyterian Hospital in New York City. Subjects were predominantly female, ethnically diverse, and held a bachelor's degree. About half of the subjects had less than 3 years of experience, and more than half reported prior experience caring for patients with a urinary diversion. Participants completed a demographic survey, and a continent urinary diversion confidence survey and pretest measuring knowledge of nursing care of patients with a urinary diversion. Following baseline data collection, an educational session focused on the irrigation of a continent urinary diversion was made available for participants to review. An onsite simulation experience was scheduled several weeks later. Investigators provided education on proper irrigation of a continent urinary diversion and observed participants' skills when irrigating a continent urinary diversion on a high-fidelity simulated patient mannequin. The simulation intervention was followed by video replay and debrief providing feedback on each participant's performance. At the conclusion of the onsite simulation intervention, participants completed a postintervention confidence survey and a knowledge posttest related to the care of a continent urinary diversion. The Wilcoxon signed rank test was used to analyze baseline and postintervention changes in nursing knowledge and confidence. Participants achieved significant improvements in knowledge (P = .005) and confidence (P = .009) following the simulation-based educational intervention. A nurse practitioner-led simulation-based educational program for RNs caring for patients with continent urinary diversions demonstrates enhanced nursing knowledge and confidence caring for patients with continent urinary diversions. We anticipate this experience will enhance care we provided to patients undergoing cystectomy and continent cutaneous urinary diversion or orthotopic neobladder construction.

Application of the Monti procedure in Adult Continent Cutaneous Urinary Diversion.

Introduction; Monti and co. described in 1997 is a continent catheterizable conduit using short segments of the ileum (1). The use of this technique allows us to obtain 2 to 2.5 cm segment of the ileum to achieve a tabularized segment of 7-8 cm. The 15 cm of terminal ileum was not routinely used for this type of procedure. After the reconstruction of a tunnel, anastomosis was performed on the superior part of the posterio-lateral junction of the bladder.
 Objectives: To report 6 cases using the Monti procedure with ileum for adult continent cutaneous urinary diversion, from different etiologies.
 Materials and Methods: From 2007 to 2020 we treated 6 patients with different conditions with this procedure. First case was a middle-aged woman with a big vesico-vaginal fistula (fig.3) It was unappropriated to be closed with satisfactory functional results in terms of continence, because a part of the sphincter was destroyed also. The reason of damage was auto mutilation as a result of borderline personality.
 Discussion: Monti procedure associating Mitrofanoff principle was mainly used in pediatric patients (1,2,3) That’s because of the relatively easy execution of the “Mitrofanoff principle” and the high degree of continence obtained with its use (4). But can we use the same principle to resolve some difficult cases in adult urology also?
 Conclusion: The Monti tunnel is a valid option for continent intermittent catheterisation. It’s also an alternative to be adjunct with Mitrofanoff procedure when needed. We used it when the appendix was not appropriate to be used as a tunnel or when it was missing. It has a good continent percentage and it can be done rather easily. Of course, ours is a small series of cases to represent more important conclusions.

Prognostic significance of serum lactate dehydrogenase in patients undergoing radical cystectomy for bladder cancer

BackgroundTo investigate the prognostic significance of preoperative serum lactate dehydrogenase (LDH) in patients undergoing radical cystectomy for bladder cancer (BCa). Patients and methodsA cohort of 263 patients undergoing open or laparoscopic radical cystectomy between 2011 and 2016 was studied. Baseline characteristics, hematological variables, follow-up data were collected. Kaplan-Meier curves and Cox proportional hazard regression model were applied to assess the relationship between LDH and overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). ResultsAfter a median 34.2 (22.9–45.8) months follow-up, all-cause death, cancer-specific death, and disease recurrence occurred in 66 patients, 50 patients, and 91 patients. The elevation of serum LDH was associated with several unfavorable parameters, including advanced age, continent cutaneous urinary diversion, increased neutrophil-to-lymphocyte ratio, decreased lymphocyte-to-monocyte ratio. Patients with a higher serum LDH (> 220 U/L) had a worse OS (P < 0.001), CSS (P < 0.001) and DFS (P < 0.001). Multivariate Cox analysis suggested that elevated LDH was an independent predictor for OS (hazard ratio [HR]: 3.113, 95% confidence interval [CI]: 1.524–6.358; P = 0.002), CSS (HR: 4.564, 95% CI: 2.008–10.373; P < 0.001), DFS (HR: 2.051, 95% CI: 1.125–3.739; P = 0.019). Medical history of diabetes, high pT stage, and positive lymph node also were adverse predictors for oncological outcomes of BCa patients in multivariate analysis. ConclusionsPreoperative serum LDH is an independent prognostic biomarker for OS, CSS, and DFS in patients undergoing radical cystectomy for BCa, which can be incorporated into prognostic models.

V061 - Robot-assisted laparoscopic continent cutaneous urinary diversion (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 8 adult patients. Surgical technique and initial outcomes: A Mitrofanoff with bladder augmentation procedure

V061 - Robot-assisted laparoscopic continent cutaneous urinary diversion (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 8 adult patients. Surgical technique and initial outcomes: A Mitrofanoff with bladder augmentation procedure

Failed repair of isolated female epispadias: Insights and outcome of single stage repair

Female epispadias without exstrophy is a very rare entity and occurs one in 480,000 female population. Early surgical reconstruction of the bladder neck,urethra and external genitalia is important in establishing urinary continence and to reduce psychological stress on the parents and child.In this case report we present a 25 year unmarried female presented with failure to achieve continence after bladder neck reconstruction at age 4year by urologist. Due to previous surgical failure, Patient developed psychological problems with poor esteem and wants a procedure which makes her life socially acceptable. A continent cutaneous urinary diversion was done at a single procedure with a follow up of 02 year. Patient is continent with pouch capacity about 400ml and emptying her pouch every 4hrly and actively involving in social activities, enjoying an excellent lifestyle, accepted body image and good personal satisfaction.

SC210 - Update on stoma and efferent channel complications of the continent cutaneous urinary diversion turin pouch

SC210 - Update on stoma and efferent channel complications of the continent cutaneous urinary diversion turin pouch

PT010 - The Turin pouch: A continent cutaneous urinary diversion with very low stoma stenosis rate at long term follow up

PT010 - The Turin pouch: A continent cutaneous urinary diversion with very low stoma stenosis rate at long term follow up

937 - Refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion: A propensity-scored comparison regarding long-term renal, metabolic and functional outcomes

937 - Refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion: A propensity-scored comparison regarding long-term renal, metabolic and functional outcomes

MP49-05 STOMA COMPLICATIONS AND QUALITY OF LIFE IN INDIANA POUCH URINARY DIVERSION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2018MP49-05 STOMA COMPLICATIONS AND QUALITY OF LIFE IN INDIANA POUCH URINARY DIVERSION Kai Wen Cheng, Ankeet Shah, Gus Miranda, Anne Schuckman, and Hooman Djaladat Kai Wen ChengKai Wen Cheng More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Gus MirandaGus Miranda More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Indiana Pouch (IP) is a subtype of Continent Cutaneous Urinary Diversion (CCUD) for which quality of life and CCUD-specific complications have not been well studied. We sought to evaluate the IP diversion using the aforementioned variables. METHODS A retrospective review of an IRB-approved IP database was conducted for perioperative and outcome data. To assess quality of life, the EORTC QLQ-C30 questionnaire was mailed to patients who agreed to be contacted. All responses were dated >6 months after IP surgery. RESULTS A total of 33 patients who received the IP diversion under 2 fellowship-trained urologic oncologists were included in this study (2010-2016). Patient characteristics, diversion-specific complications, and outcome data are shown in Table 1. After a median follow up of 18 months (range: 2.7-72.8), Low-grade diversion-related Clavien complications (including related GI complications) were reported in 28 patients (85%), but high-grade in 8 patients (24%). Stoma complications were seen in 10 patients (30%), 5 low-grade and 5 high-grade; 7 had stenosis at skin/fascia level that needed outpatient dilation or superficial revision and 3 needed deeper level revision for difficult catheterization. Median time to stoma revision was 12 months (range: 5-22). A higher BMI (29 vs. 26) was associated with stoma complication (p =0.01), but stoma size, measured as size of catheter used to taper the ileal segment, was not (p=0.4). All patients achieved continence within 90 days after surgery; coaptite injection was indicated for 1 patient. 14 responses were recorded for the EORTC questionnaire: >70% of patients reported little to no disturbance of daily functions and rated overall health and quality of life as ≥70% (Table 2). CONCLUSIONS The Indiana Pouch diversion is associated with high rates of continence and patient satisfaction. Stoma complication is common; however, most of them are superficial and managed with outpatient/minor procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e667-e668 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kai Wen Cheng More articles by this author Ankeet Shah More articles by this author Gus Miranda More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Serous-lined, stapled pouch wall plication: initial results of a simple and quick novel continence mechanism in troubleshooting secondary to continent cutaneous urinary diversion.

To report a novel and straightforward technique of a secondary continent outlet for continent cutaneous urinary diversion (CCUD) reservoirs without the need for further bowel resection, reducing operating time and length of hospitalization. From 2015 to 2017, six patients with unreconstructable, incontinent outlets (out of a total pool of 595 patients with CCUD) have undergone the technique described in the present paper at our department. The technique relies on the Mitrofanoff principle, using a stapled full-thickness pouch wall plication, which creates a flap-valve continence mechanism. All patients enjoyed full continence with ease of clean intermittent catheterization (CIC) in the postoperative period and on follow-up to a mean (range) of 12.4 (7-18) months. No major complications were encountered in any patient and the average capacity of the reservoirs was not compromised by the procedure (540mL preoperatively vs 500mL in further follow-up). In revisional surgery for secondary CCUD incontinence,especially if the patient has already lost asignificant amount of bowel or has previously undergoneradiation therapy, the technique described here represents a safe and effective alternative to restore continence.

PD38-07 ROBOT-ASSISTED INTRACORPOREAL RIGHT COLON CONTINENT CUTANEOUS URINARY DIVERSION AND AUGMENTATION CYSTOPLASTY: A SINGLE INSTITUTION EXPERIENCE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2017PD38-07 ROBOT-ASSISTED INTRACORPOREAL RIGHT COLON CONTINENT CUTANEOUS URINARY DIVERSION AND AUGMENTATION CYSTOPLASTY: A SINGLE INSTITUTION EXPERIENCE Spencer Craven, John Sigalos, Rose Khavari, and Alvin Goh Spencer CravenSpencer Craven More articles by this author , John SigalosJohn Sigalos More articles by this author , Rose KhavariRose Khavari More articles by this author , and Alvin GohAlvin Goh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1721AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Continent cutaneous diversion (CCD) is a less commonly utilized diversion choice following open or robotic cystectomy. We have previously described a novel technique for robotic intracorporeal CCD. Meanwhile, continent cutaneous augmentation cystoplasty (CCAC) is a viable option for patients with neurogenic bladder. There is limited worldwide experience performing intracorporeal CCD and no studies describing intracorporeal CCAC. Principles developed in robotic CCD can be readily applied to robotic CCAC. We share our experience with these novel robotic procedures. METHODS Robotic cystectomy was performed in patients undergoing CCD using a standard 6-port technique. The patient and robot were then repositioned for intracorporeal bowel mobilization and segmentation, ileocolonic anastomosis, uretero-colonic anastomoses, pouch construction, tapering of catheterization channel, reinforcement of ileocecal valve, and stoma creation. All patients were placed on an evidence-based Enhanced Recovery after Surgery protocol postoperatively. Operative times, intraoperative blood loss (EBL), length of stay (LOS), and complications occurring within 90 days of surgery were reviewed. RESULTS Ten robotic intracorporeal right colon urinary diversions, including four robotic intracorporeal CCAC and six robotic intracorporeal CCD, were performed. Mean total operative times for cystectomy and intracorporeal urinary diversion were 7.8 and 10 hours for CCAC or CCD respectively (5.4-9.5; 7.9-12.9). Mean EBL was 181ml (75-300) for CCAC and 250ml (100-500) for CCD. Mean LOS for CCAC and CCD groups was 10 and 8.8 days respectively (5-18, 4-18). A single CCAC patient required transfusion postoperatively. Two high grade complications (Clavien III or greater) were reported in the CCAC group (50%). One high grade complication was reported in the CCD group (17%). Within 30 days of surgery, no CCAC and two CCD patients required readmission (0%, 33%). With a median follow up of 17 months, no incontinence was reported and all patients were able to catheterize without difficulty. CONCLUSIONS We demonstrate that robotic intracorporeal CCD and CCAC are technically feasible and safe with good functional outcomes. Further evaluation of these novel surgical techniques along with comparative studies are needed. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e742 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Spencer Craven More articles by this author John Sigalos More articles by this author Rose Khavari More articles by this author Alvin Goh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Technique of Suprafascial Anastomosis With Reduced Risk of Stenosis of the Efferent Outlet in Continent Catheterizable Urinary Diversion

To describe our technique and long-term experience with a technique of a suprafascial anastomosis for the efferent continent segment in continent cutaneous urinary diversion, which aims to reduce the rate of stomal strictures. Between 1998 and 2013, up to 191 patients underwent continent cutaneous urinary diversion with a suprafascial anastomosis technique at our institution. A complete follow-up was achievable in 82 patients. The retrospective analysis included continence rates, stomal complications, and other complications related to the urinary diversion such as anastomotic insufficiencies, fistulas, or hernias. The study population consisted of 82 patients with 67 (82%) women and 15 (18%) men with a median age of 58 years. The median length of follow-up was 82 months (range 13-203) with a median survival time of 46 (range 13-193) months. At the time of the analysis, 46 patients (57%) were still alive. Five out of 82 patients (6%) presented with a relevant stenosis in umbilical stoma that required surgical revisions. Nine patients (12%) with functional stenosis could be treated conservatively. Continence was achieved in 74 of 82 patients (90%). Only 8 patients reported some degree of incontinence. The technique of a suprafascial stoma is a simple and safe technique that may help prevent the incidence of stomal complications.

La dérivation cutanée continente après cystectomie pour cancer, une alternative fiable ? Étude rétrospective monocentrique

Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies. We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index. Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients. The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence. 5.