Form Of Urinary Diversion Research Articles

Percutaneous nephrolithotomy in a patient with a ureterosigmoidostomy diversion

In patients with bladder cancer, ureterosigmoidostomy has been used as a form of urinary diversion, and urinary lithiasis has been reported as a complication. A patient with a large bilateral kidney stone and ureterosigmoidostomy diversion is described. In 2012, a 61-year-old man had a cystectomy due to bladder cancer. He was lost to follow-up after presenting to the emergency department in 2016 with right flank pain and fever. Computed tomography (CT) scan reveals bilateral staghorn calculus. A bilateral percutaneous nephrostomy was performed. The patient was planned for bilateral percutaneous nephrolithotomy (PCNL). He declined, therefore we proposed External Shock Wave Lithotripsy (ESWL). The right kidney stone was removed, but the left kidney stone did not alter after 7 ESWL sessions, thus PCNL was scheduled. The middle calyx was punctured under fluoroscopic guidance through the nephrostomy in Valdivia’s modified position. Two 0.035” hydrophilic guide wires were passed down the renal pelvis and ureter until it ureterosigmoidostomy union was reached. Dilation was carried out with Nephromax. An Amplatz 30 Ch was placed. The holed stone was then fragmented with Laser Holmium. PCNL tubeless was performed. He was discharged two days after surgery. PCNL tubeless was performed. The hospital stay was two days. CT control two months later: Lower pole 5 cm hematoma, the residual stone of 4 mm in the upper calyx. After resolving the renal hematoma, the residual stone will be dealt with ESWL.

MP23-07 PREVALENCE AND IMPACT OF FEAR OF RECURRENCE ON BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP23-07 PREVALENCE AND IMPACT OF FEAR OF RECURRENCE ON BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Justin Badal, Brady Miller, Nora Ruel, Airybelle Uchida, Kelly Franklin, Sumanta Pal, and Bertram Yuh Justin BadalJustin Badal More articles by this author , Brady MillerBrady Miller More articles by this author , Nora RuelNora Ruel More articles by this author , Airybelle UchidaAirybelle Uchida More articles by this author , Kelly FranklinKelly Franklin More articles by this author , Sumanta PalSumanta Pal More articles by this author , and Bertram YuhBertram Yuh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The recurrence rate for bladder cancer is high. Over 30% of those with muscle invasive bladder cancer have a recurrence within 5 years representing a source of persistent anxiety and distress. Fear of cancer recurrence (FCR) is well characterized in other malignancies such as breast, thyroid, and brain cancers. It has been characterized in prostate, renal, and testis cancer. This study describes the prevalence and impact of FCR among patients with bladder cancer who have had cystectomy. METHODS: A phone survey was conducted using the Fear of Cancer Recurrence-7 index in patients who had previously undergone radical cystectomy for bladder cancer. From the period of 2015 to 2020, 145 patients were eligible to undergo the phone survey. 75 patients agreed to being surveyed. We evaluated patients based on factors such as time since surgery, clinical and pathologic stage, receipt of neoadjuvant chemotherapy, ASA status, and length of stay. RESULTS: The median age for participants was 70. 83% of respondents were male. 84% of respondents were white. 39 patients had muscle invasive disease at presentation and 17 patients had muscle invasive disease on pathologic staging. Median time since surgery was 28 months. 17% of patients had high (FCR7 ≥17) scores. Those with lower clinical and pathologic stage disease had higher FCR7 scores. 12/58 (21%) patients with ≤PT1 reported a high FCR while only 1/17 (6%) of patients with ≥pT2 disease reported high FCR (p=0.11). Their FCR7 score was more likely to be ≥17 in the 2nd or 3rd year from surgery. Patients who underwent Indiana Pouch urinary diversion were more likely to have a FCR7≥17 when compared to ileal conduit or Studer neobladder (44.4% vs 13.6%, p=0.022). CONCLUSIONS: Fear of cancer recurrence in patients with bladder cancer is a phenomenon that should be considered when counseling patients in the preoperative as well as surveillance stages of their cancer care. Even after several years, patients who have FCR continue to exhibit persistent fear. Patients with certain forms of urinary diversion may also have differing FCR. Though not statistically significant, patients with lower stage disease may require closer psychologic monitoring through their cancer treatment journey. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e383 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Badal More articles by this author Brady Miller More articles by this author Nora Ruel More articles by this author Airybelle Uchida More articles by this author Kelly Franklin More articles by this author Sumanta Pal More articles by this author Bertram Yuh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Do's and Dont's for radical cystectomy and urinary diversion - how to minimise postoperative complications

Radical cystectomy (RC) with urinary diversion is a challenging surgical intervention. There is significant risk of postoperative complications, particularly linked to urinary diversion and the patient's comorbidities. The surgeon and the multidisciplinary team need to be familiar with all potential complications. In order to achieve optimal oncological and functional outcomes, multiple factors have to be considered during perioperative management, including the adherence to evidence-based guidelines, standardised concepts of enhanced recovery and best surgical practice for RC and urinary diversion. All measures should aim to minimise complication rates after RC and to accelerate recovery. We summarise essential Dos and Don'ts when performing RC with different forms of urinary diversion.

Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management.

Since their introduction into clinical practice in the 1950s, ileal conduits have been the most common type of urinary diversion used after radical cystectomy worldwide. Although ileal conduits are technically simpler to construct than other forms of urinary diversion, a variety of complications can occur in the early and late postoperative periods. Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit. Interventional radiologists can play a pivotal role in diagnosis and management of these complications by performing image-guided minimally invasive procedures. In this article, the authors review the surgical anatomy of an ileal conduit and the underlying pathophysiology of and diagnostic workup for complications related to ileal conduits. The authors also discuss and illustrate current approaches to interventional radiologic management of these complications, with emphasis on a collaborative approach with urologists or endourologists to best preserve patients' renal function and maintain their quality of life. ©RSNA, 2020.

PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-03 MORE THAN 30 YEARS OF EXPERIENCE WITH THE ILEAL NEOBLADDER: FUNCTIONAL AND METABOLIC OUTCOMES Bjoern Volkmer*, Kassel Germany, and Richard Hautmann Bjoern Volkmer*Bjoern Volkmer* More articles by this author , Kassel GermanyKassel Germany More articles by this author , and Richard HautmannRichard Hautmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ileal neobladder (INB) has now been performed on a regular basis for more than 30 years at our institution. This study aims to assess the long term functional outcomes including near normal voiding function, continence, incidence of UTI and metabolic requirements. METHODS: From our consecutive series of 893 male patients who underwent radical cystectomy (RC) and urinary diversion with the INB from 1986 to 2009 we only included those with minimum follow-up of 5 years. We excluded patients with previous irradiation therapy of abdomen or pelvis, with previous other forms of urinary diversion, and with postoperative tumor recurrence. Between 10/08 and 03/09 questionnaires were sent to the remaining 303 patients, with telephone-interviews in those, who did not respond. 44 patients were not available: Death with NED in n=43, living abroad n=6, and n=5 with Alzheimer’s. The remaining 259 patients formed the study population. Continence was defined as use of not more than 1 pad/daytime or nighttime. Patients were asked for the number of feverish UTI within the last 5 years, problems with mucus production, and requirement of (self)catheterization. RESULTS: The mean age at the time of surgery was 60.6±10y ranging from 23y to 81y. The mean time of follow-up in this series was 131±56mon ranging from 60mon to 267mon. The mean age at the time of the survey was 73±10y ranging from 43y to 92y. While the risk of urinary retention and bicarbonate therapy decreased over time, the changes in the rate of daytime and nighttime incontinence seemed to be attributed more to age than to the length of follow-up (Table 1). Transurethral catheters were required in 1 case after 12, in 2 cases after 16 and 17 years postoperatively. Three patients are on substitution of vitamin B12, one patient is on colestyramine therapy for short bowel syndrome. One patient developed end stage renal failure 5 years after surgery. CONCLUSIONS: INB patients who survived more than 5 years after RC and diversion enjoy acceptable urinary continence and retain their ability to void spontaneously in >90 % of patients. The percentage of recurrent UTI and the need of bicarbonate therapy are not negligible. Especially in young patients with favourable pathologic findings an ileal neobladder provides excellent results even after 20 years and more. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e822 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bjoern Volkmer* More articles by this author Kassel Germany More articles by this author Richard Hautmann More articles by this author Expand All Advertisement PDF downloadLoading ...

Constructing artificial urinary conduits: current capabilities and future potential

ABSTRACTIntroduction: Intestinal segments are currently used in reconstructive urology to create urinary diversion after cystectomy. Ileal conduit (IC) is the dominant type of urinary diversion. Nevertheless, IC is not an ideal solution as the procedure still requires entero-enterostomy to restore the bowel continuity. This step is a source of relevant complications that might prolong recovery time. Fabrication of artificial urinary conduit is a tempting idea to introduce an alternative form of urinary diversion which might improve cystectomy outcomes.Area covered: The aim of this review is to discuss available research data about artificial urinary conduit and identify major challenges for future studies.Expert opinion: Fabrication of artificial urinary conduit is in range of current tissue engineering technology but there are still many challenges to overcome. There is an urgent need for studies to be conducted on large animal models with long follow up to expose the limitation of experimental strategies and to gather data for translational research.

Choice of urinary diversion after radical cystectomy in minimally invasive era

Urinary diversion is one of the most important parts during radical cystectomy for bladder caner, which also associated significantly to postoperative complications. The choice of an appropriate urinary diversion plays an important role in improving the quality of life and reducing complications after radical cystectomy. With the application of laparoscopy and robot surgery in radical cystectomy, urinary diversion changes gradually and has formed its own characteristics in the era of minimally invasive surgery. This article represents an overview of several different forms of urinary diversion which are used currently and tries to improving selection of appropriate urinary diversion following radical cystectomy. Key words: Radical cystectomy; Urinary diversion; Minimally invasive surgery

3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes

BackgroundAfter radical cystoprostatectomy (RC), postoperative erectile dysfunction (ED) is a common consequence with multiple contributing etiologies. The inflatable penile prosthesis (IPP) offers patients a definitive treatment option when ED is refractory to medical therapies. Because of the hostile postoperative anatomy of these patients, a careful surgical approach is necessary for successful outcomes and to avoid adjacent organ injury. To date, there is no series describing the outcomes of 3-piece IPP placement in patients with urinary diversions. AimTo present contemporary outcomes and a description of our technique in placing a 3-piece IPP for postoperative ED in patients with a history of RC with orthotopic neobladder, ileal conduit, or continent cutaneous diversion. MethodsWe retrospectively reviewed 80 patients who underwent primary placement of a 3-piece IPP (AMS 700; American Medical Systems Inc, Minnetonka, MN, USA) after RC and urinary diversion from 2003 through 2016. 79 patients underwent RC in their treatment of urologic malignancy (71 for bladder cancer, 8 for prostate cancer) and 1 underwent RC for refractory interstitial cystitis. An infrapubic approach was used in most patients, with reservoir placement in the lateral retroperitoneal space through a counterincision medial to the anterior superior iliac spine. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. OutcomesRates of device infection, revision surgery, and reservoir complications. ResultsAfter mean follow-up of 53.9 months (6.5–150.7 months), 4 patients developed infection of the prosthesis that required explantation. 3 of those patients underwent successful IPP reimplantation. 5 patients required revision surgery (pump replacement, n = 3; pump relocation, n = 1; cylinder replacement for cylinder aneurysm, n = 1) for mechanical failure. No statistically significant associations were found between infection and comorbidities, urinary diversion, exposure to chemotherapy, radiation, or presence of an artificial urinary sphincter. Clinical ImplicationsThe 3-piece IPP is an effective treatment option for medication-refractory ED that can be placed safely in patients with all forms of urinary diversion. Strengths and LimitationsThis study represents the 1st series that describes a successful technique and long-term outcomes of patients with urinary diversion. It is limited by its single-surgeon, single-center experience and lacks validated patient satisfaction data in follow-up. ConclusionsThe 3-piece IPP, with reservoir placement in the lateral retroperitoneum, can be implanted successfully in patients with all forms of urinary diversion without a significant increase in infectious complications, reservoir erosion, or mechanical failure.Loh-Doyle J, Patil MB, Sawkar H, et al. 3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes. J Sex Med 2018;15:907–913.

Role of percutaneous nephrostomy in end of life prostate cancer patients: a systematic review of the literature.

IntroductionProstate cancer is the most common cancer amongst men in the UK. Treatments for malignant ureteric obstruction consist of percutaneous nephrostomy, ureteric stent insertion, or occasionally other forms of urinary diversion. Our aim was to look at the outcomes of percutaneous nephrostomy (PCN) in patients with advanced prostate cancer and to look at the impact on patient's general health, quality of life, life expectancy and complications after PCN insertion.Material and methodsA systematic review of the literature was done for all prospective English language articles on PCN in patients with prostate cancer using PubMed, MEDLINE, EMBASE, Scopus, CINAHL, Cochrane library, Clinicaltrials.gov, Google Scholar and individual urological journals from inception to August 2017. While studies involving prostate cancer patients were included, studies on all other mixed pelvic malignancies were excluded.ResultsSeven articles met the inclusion criteria. There were 184 patients, with a mean age of 70 years (range: 51–94 years). PCN was performed for ureteric obstruction due to advanced prostate cancer, patients underwent unilateral (n = 66) or bilateral PCN (n = 118) with conversion to an antegrade stent in 25 patients. Their post-PCN survival varied between 4–31 months and this was longer if they were hormone naïve or showed a good recovery in their renal function. Although the complication rates were low (1–3%), patients spend a high proportion of their lives in the hospital.ConclusionsPCNs should only be pursued after thoughtful counselling regarding further treatment options and prognosis as these patients with advanced malignancies seem to have reduced survival duration and spend a significant amount of time in hospital.

MP06-19 A MULTI-CENTER INTERNATIONAL STUDY ASSESSING THE IMPACT OF DIFFERENCES IN BASELINE CHARACTERISTICS AND PERIOPERATIVE CARE FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2016MP06-19 A MULTI-CENTER INTERNATIONAL STUDY ASSESSING THE IMPACT OF DIFFERENCES IN BASELINE CHARACTERISTICS AND PERIOPERATIVE CARE FOLLOWING RADICAL CYSTECTOMY Takahiro Osawa, Cheryl T. Lee, Takashige Abe, Norikata Takada, Khaled S. Hafez, Jeffrey S. Montgomery, Alon Z. Weizer, Brent K. Hollenbeck, Ted A. Skolarus, Sachiyo Murai, Nobuo Shinohara, and Todd M. Morgan Takahiro OsawaTakahiro Osawa More articles by this author , Cheryl T. LeeCheryl T. Lee More articles by this author , Takashige AbeTakashige Abe More articles by this author , Norikata TakadaNorikata Takada More articles by this author , Khaled S. HafezKhaled S. Hafez More articles by this author , Jeffrey S. MontgomeryJeffrey S. Montgomery More articles by this author , Alon Z. WeizerAlon Z. Weizer More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , Ted A. SkolarusTed A. Skolarus More articles by this author , Sachiyo MuraiSachiyo Murai More articles by this author , Nobuo ShinoharaNobuo Shinohara More articles by this author , and Todd M. MorganTodd M. Morgan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2180AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To identify potential avenues for quality improvement, we compared the variations in clinical practice and their association with perioperative morbidity and mortality following radical cystectomy (RC) for bladder cancer in the United States (US) and Japan. METHODS We reviewed our retrospectively collected database of 2240 patients who underwent RC for bladder cancer at the University of Michigan (n=1427) and in 21 Japanese institutions (n=813) between 1997 and 2014. We performed a systematic comparison of clinical factors and perioperative factors and assessed predictors of perioperative morbidity and mortality. Death within 90 days of surgery was the primary outcome. RESULTS There were a number of apparent differences in between the two study populations (Table 1). Notably, patients treated at the US institution had a significantly greater BMI and higher ASA score. The median postoperative hospital stay was significantly higher at the Japanese institutions (40 days vs. 7 days, p<0.001), and 90-day readmission rates were also significantly lower at the Japanese institutions (0.6% vs. 26.8%, p<0.001). There were a total of 1372/2240 patients (61.2%) with complications within 90 days and 66/2240 patients (2.9%) deaths. Significant predictors of 90-day mortality were older age (OR 1.04, CI 1.01-1.07), higher body mass index (OR 1.07, CI 1.02-1.12), node-positive disease (OR 3.14, CI 1.78-5.47), increased blood loss (OR 1.02, CI 1.01-1.03), and major (Clavien-grade 3 or greater) complication (OR 3.29, CI 1.88-5.71). Significant predictors of major complications were higher body mass index (OR 1.04, CI 1.02-1.07), higher ASA score (OR 1.35, CI 1.02-1.80), greater number of comorbidities (OR 1.33, CI 1.04-1.69), form of urinary diversion (p=0.001), increased estimate blood loss (OR 1.02, CI 1.01-1.03) and treatment at the US institution (OR 0.47, CI 0.34-0.65). CONCLUSIONS Despite major differences in baseline characteristics and care of cystectomy patients between the two study populations, peri-operative mortality rates proved to be comparable. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e74-e75 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Takahiro Osawa More articles by this author Cheryl T. Lee More articles by this author Takashige Abe More articles by this author Norikata Takada More articles by this author Khaled S. Hafez More articles by this author Jeffrey S. Montgomery More articles by this author Alon Z. Weizer More articles by this author Brent K. Hollenbeck More articles by this author Ted A. Skolarus More articles by this author Sachiyo Murai More articles by this author Nobuo Shinohara More articles by this author Todd M. Morgan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD9-02 HEALTH RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY IN WOMEN: ORTHOTOPIC NEOBLADDER VERSUS ILEAL LOOP CONDUIT AND IMPACT OF INCONTINENCE

INTRODUCTION AND OBJECTIVES: Orthotopic neobladder reconstruction arguably represents the gold standard form of urinary diversion following radical cystectomy. However, no contemporary continence information is available. Herein, we evaluate the continence outcomes in patients undergoing orthotopic neobladder following radical cystectomy using a validated pad usage questionnaire. METHODS: Using our IRB approved database, we identified 1545 patients that underwent open radical cystectomy from 2000 to 2014. Orthotopic neobladder was constructed in 1057 (68%) patients, of whom 892 (84%) were male. Starting in 2012, these patients were prospectively followed, and completed a validated, pictorial pad usage questionnaire during their follow up visits assessing the number, size, and wetness of pads, and mucus leakage. Continence was defined as reporting no pad usage, or pads as “almost dry,” and questionnaires were stratified into distinct postoperative time intervals. For patients who completed multiple questionnaires within an interval, the most recent was used in the analysis. Patients with artificial urinary sphincters or a history of radiation therapy were excluded. RESULTS: A total of 180 male patients with available pad usage questionnaires were followed from August 2012 to October 2014. A total of 284 pad usage questionnaires were collected, with 243 interval distinct pad usage questionnaires identified and separated into intervals of < 3 months, 3e6 months, 6e12 months, 12e18 months, 18e36 months, and more than 36 months after surgery (n1⁄4 42, 39, 41, 34, 45, and 42, respectively). Daytime continence rates were 55%, 69%, 78%, 88%, 87%, and 81%, respectively. The corresponding numbers for nighttime continence rates were 26%, 38%, 46%, 44%, 58%, and 45%, respectively. In the 18e36 month range, 53% of patients reported both day and nighttime continence. CONCLUSIONS: Following orthotopic urinary diversion, there is significant improvement in continence by 6 months, and 88% of patients achieved daytime continence by 12 months. There is a plateau in continence rates at one year. Orthotopic diversion represents an excellent functional option for urinary diversion.

Urinary diversion: long-term functional aspects.

Functional aspects and quality of life (QOL) of patients with a urinary diversion (UD) represent important issues in Urology. Any form of UD has its specific problems. In experienced hands and with regular long-term follow-up, serious complications can be avoided and excellent long-term results can be achieved. Thus, the selection of an appropriate UD is critical to patient's long-term satisfaction. Patients must be fully counseled in all types of UD and should have ready access to all options. There are 3 kinds of factors to be considered in the selection of UD: patient, physician, and general factors. In the pre-operative counseling, it is mandatory to explain all factors that over time may contribute to affect the patient's urinary tract function and QOL, mainly linked to long-term complications of UD. One of the most important requirements for any bladder substitution is that it should not jeopardize the renal function. There are many urological and non-urological potential reasons for deterioration in renal function following UD. Continence results after neobladder (NB) are difficult to compare between series published in the literature because of a lack of consensus of definitions, varied follow-up periods, and different mechanisms of data collection. In up to 22% of patients with NB, significant residual urine volumes were observed. The overall patients' QOL reported in most articles was good, irrespective of the type of UD. QOL of patients with a well functioning NB seems to be significantly better than other forms of diversion. Well-designed randomized prospective trials are warranted to render definitive conclusions.

Comparison of two Wallace’s technique of implantation of the ureter to the ileal conduit: Five year experience

At the Clinic of Urology, at the Clinical Centre of Serbia, within the formation of ileal conduit as a form of urinary diversion, we apply three techniques of implantation of the ureter. A technique Nesbit-Bricker is the oldest technique described, and it sovereign occupies deserved place as a form of implantation of the ureter into an isolated segment of the intestinal tract. Technique by Wallace is the second technique which is applied at the Clinic of Urology, and has undergone some changes during the time, so that in the current practice we offer two modes of this technique. This paper present the postoperative results these two techniques, trying to answer the question which one of these two techniques is superior.

Measuring quality of life after radical prostatectomy from the patient’s perspective

In recent years, there have been an increasing number of reports in the urologic literature on health-related quality of life (HRQoL) issues, such as the comparison of HRQoL in various forms of urinary diversion after cystectomy for bladder cancer and, more recently, the effects of radical prostatectomy on HRQoL and comparison of HRQoL of various treatment modalities for prostate cancer. Most of these reports deal with specific domains affected by the treatment instead of the effects on the overall patient well-being or “global HRQoL,” as gauged by the patient’s utility. Moreover, the studies often tend to report more of a snapshot at a given time after therapy, rather than a longitudinal chronicling of changes in the various domains. Urologists often refer to the post-radical prostatectomy “Holy Grail” or “Tri-fecta” of biochemical disease-free status, perfect urinary continence and recovery of sexual function; each of these 3 parameters acts as a binary function, essentially from the health-provider’s viewpoint. In this issue, Ku and colleagues1 make an important contribution to the uro-oncologic literature with their utility-based report before radical prostatectomy and several subsequent time points; they analyze several domains from the patient’s own viewpoint and individual “value scale.” Not surprisingly, the symptom scores and global health utility status dropped markedly in the early postoperative recuperation period. A noteworthy finding was the persistence, to a lesser extent, of these health status deficits well beyond the “physical recovery” period. These findings are relevant and important in counselling patients on management options and in ensuring that patients do not have unrealistic postoperative expectations, especially those patients with low-risk disease where over-treatment is a possibility. It would be of interest to compare the results in patients undergoing external beam radiotherapy,2,3 and to duplicate the study in patients undergoing minimally invasive forms of intervention, such as brachytherapy, cryoablation and high-intensity focused ultrasound (HIFU). The results of these studies would be useful in treatment decisions. Also of interest would be similar longitudinal studies conducted in jurisdictions with different cultural backgrounds and different ethnic composition.

1418 THE RISK OF TUMOR-RELATED COMPLICATIONS IN PATIENTS WITH ILEAL-NEOBLADDERS

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (II)1 Apr 20131418 THE RISK OF TUMOR-RELATED COMPLICATIONS IN PATIENTS WITH ILEAL-NEOBLADDERS Bjoern Volkmer, Karen Czeloth, Regina Stredele, and Richard Hautmann Bjoern VolkmerBjoern Volkmer Kassel, Germany More articles by this author , Karen CzelothKaren Czeloth Kassel, Germany More articles by this author , Regina StredeleRegina Stredele Kassel, Germany More articles by this author , and Richard HautmannRichard Hautmann Ulm, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy is a standard therapy for invasive bladder cancer. The choice of urinary diversion is often affected by the surgeons' fear of tumor complications. Since an ileal neobladder is the form of urinary diversion that is located exactly at the former tumor site, it is important to evaluate the real extent of this risk in a neobladder population. METHODS This study is based on the cystectomy series of the University of Ulm 01/86 - 12/08 and of the Kassel General Hospital 01/00 - 12/08. We included all patients with a cystectomy performed for urothelial bladder cancer. The tumor stage was non-organ confined (at least pT3a), or lymph-node positive or metastatic (M1). We excluded those cases with age > 75y and those with macroscopic residual tumor in the true pelvis (R2). We obtained a complete follow-up until 12/08. The mean follow-up was 35 months. RESULTS We included 540 patients (Ulm: 471, Kassel: 69). The 5- and 10-year overall survival was 27.6% and 16.2%, respectively. 284 patients had an ileal neobladder (NBL), 256 other forms of urinary diversion (OTH). The rates of lymph-node metastases and distant metastases were: NBL: 63% and 6%, OTH: 56% and 13%. After 10 years the overall survival was better in the NBL group for pT3b-4b pN0/1 tumors (28.6% vs. 17.6%) and for pN2-3 or M1 tumors (8.0% vs. 3.7%).The rate of local recurrence was 17.3% in the NBL-group, but only 18/49 patients developed tumor-related neobladder complications (6.3% of all neobladder patients in this group): hydronephrosis (n=8), subneovesical obstruction (n=4), hematuria (n=4), neovesico-intestinal fistula (n=5). In all cases the storage function of the neobladder could be maintained. No neobladder was removed. In the cases with a fistula, the affected intestinal segment was bypassed. In subneovesical obstruction, a TUR-BT was successfull in 2, chemotherapy in 1 case. 1 patient had an undiversion to a continent pouch. CONCLUSIONS Patients with ileal neobladders were younger, had a lower comorbidity and better tumor stages than patients with other forms of urinary diversion. The risk of tumor-related neobladder complications remained low and could be handled with preservation of the neobladder in almost all cases. Ileal neobladders can be safely offered to patients even with advanced tumor stages, as long as there is no residual tumor visible in the true pelvis at the end of cystectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e580-e581 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bjoern Volkmer Kassel, Germany More articles by this author Karen Czeloth Kassel, Germany More articles by this author Regina Stredele Kassel, Germany More articles by this author Richard Hautmann Ulm, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Quality of life after radical cystectomy for bladder cancer in men with an ileal conduit or continent urinary diversion: A comparative study

Aim:To investigate quality of life (QoL) domains with three forms of urinary diversions, including ileal conduit, MAINZ pouch, and orthotopic ileal neobladder after radical cystectomy in men with muscle-invasive bladder cancer.Materials and Methods:In a prospective study, 149 men underwent radical cystectomy and urinary diversion (70 ileal conduit, 16 MAINZ pouch, and 63 orthotopic ileal neobladder). Different domains of QoL, including general and physical conditions, psychological status, social status, sexual life, diversion-related symptoms, and satisfaction with the treatment were assessed using an author constructed questionnaire. Assessment was performed at three months postoperatively.Results:In questions addressing psychological status, social status, and sexual life, patients with continent diversion had a more favorable outcome (P = 0.002, P = 0.01, and P = 0.002, respectively). The rate of erectile dysfunction did not differ significantly between the three groups (P = 0.21). The rate and global satisfaction was higher with the MAINZ pouch (68.7%) and ileal neobladder (76.2%) as compared with the ileal conduit group (52.8%) (P = 0.002).Conclusion:Continent urinary diversion after radical cystectomy provides better results in terms of QoL as compared with ileal conduit diversion.

Procena stepena bubrezne insuficijencije kod pacijenata podvrgnutih ilealnom konduitu kao vidu derivacije urina u odnosu na vrstu insercije uretera

Ileal conduit as a form supravesical derivaton, is still one of most popular method of urinary diversion, in daily urological practice. Bearing in mind this fact, this type of diversion, rightfully so, is also called the "gold standard" in the derivation of urine. Considering the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that, in time, this type of diversion lead to some degree of renal insufficiency. Some authors, this effect on renal function, attribute to specific type of ureterointestinal anastomosis during formation of ileal conduit. A very important part of the surgical technique of creating ileal conduit is precisely a step of implantation ureters into the intestinal segment. The ultimate goal is to enable a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the quality of renal function. Numerous authors describes a quite number of techniques of ureteral implantation into the intestinal segment (Wallace A, Wallace B, Nesbit-Bricker, Le Duc ...). Each of these techniques has its own strengths and weaknesses, and the decision witch technique will be applied is still in the hand of urologist--operator, individually.Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure. To determine the most appropriate type ureterointestinal anastomosis in forming ileal conduit, as a form of supravesical urinary diversion, to ensure adequate renal function postoperatively as an important parameter of quality of life. This is a retrospective study, which covered a population of 193 patients treated at the Department of Urology, Clinical Center of Serbia, who underwent creation of ileal conduit as a form of urinary diversion. The study was conducted 2007-2011. Postoperative follow-up lasts up to 48 months. The assess of the level of renal insufficiency were analyzed by monitoring parameters which determine the degree of anemia, and biochemical parameters of renal function. We have investigated three techniques of insertion of the ureters into the ileal conduit, which are used in the daily practice (Wallace A, Wallace B, Nesbit-Bricker). Kidney failure occurs equally often in all patients who underwent urinary diversion by ileal conduit, ignoring the type of insertion of the ureters to the intestinal segment.

Half Century of Followup After Ureterosigmoidostomy Performed in Early Childhood

We studied clinical outcomes, especially regarding colorectal adenocarcinoma, in patients who underwent ureterosigmoidostomy in early childhood between 1944 and 1961. A total of 25 consecutive patients underwent ureterosigmoidostomy at a mean age of 3.1 years. The most common indication for ureterosigmoidostomy was bladder exstrophy-epispadias complex. The study period ended in 2010. Patient files were retrospectively evaluated, personal telephone interviews were performed and colorectal histology was reevaluated. One girl who died 4 days postoperatively was excluded. Of the 24 patients 17 were alive in 2010 with a mean age of 59 years (range 48 to 67), and 2 still had a functioning ureterosigmoidostomy. A total of 20 patients with a mean age of 33 years had undergone re-diversion at a mean of 30 years postoperatively. Invasive colorectal adenocarcinoma developed in 7 patients and colorectal adenocarcinoma in situ in 1. Five patients died due to generalized colorectal adenocarcinoma. Mean time from ureterosigmoidostomy to diagnosis of invasive colorectal adenocarcinoma was 38 years (range 23 to 55). Three cases were diagnosed at 1, 21 and 25 years after re-diversion. One patient with colorectal adenocarcinoma in situ was 22 years old at polyp resection, which was 20 years after re-diversion. A carcinoid tumor developed in 1 patient. Of the 7 cases of invasive colorectal adenocarcinoma 6 were low differentiated. After a half century of followup in 25 individuals undergoing ureterosigmoidostomy during childhood 17 were still alive and 20 had undergone re-diversion. Compared to the general Swedish population, the risk of colorectal adenocarcinoma was increased 42 times and the incidence of low differentiation was extremely high.

Urinary Diversions and Bladder Replacement Surgery: Evolution, Current Situation and Long-Term Outcomes

Nowadays, radical cystectomy represents the first choice of therapy for muscle invasive bladder cancer. The first choice after radical cystectomy, both in male and in female patients, is no more urinary diversion, but bladder replacement surgery through orthotopic reconstruction. The ileal conduit is considered a safe procedure and the gold standard to which newer forms of urinary diversion should be compared, although few long-term results are known. Currently, neobladder is the most important urinary diversion in the world, followed by Bricker's ileal conduit. We evaluated the long-term results of the most important forms of urinary diversions, analyzing some data available in the Literature. Then, we focused our attention on long-term outcomes of our "Y Neobladder": functional outcome and long-term complications. At last, we critically examined the widely accepted notion that patients undergoing "Y Neobladder" experience superior quality of life outcomes than patients receiving an ileal conduit.

Sekundärmalignome in Harnableitungen

In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.