Ileal Conduit Diversion Research Articles

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury.

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.

Ileal Conduit Versus Continent Urinary Diversion in Radical Cystectomy: A Retrospective Cohort Study of 30-day Complications, Readmissions, and Mortality

ObjectiveTo quantify the short-term burden associated with continent diversion relative to ileal conduit creation. MethodsBladder cancer patients who underwent radical cystectomy in 2019 and 2020 were identified in the American College of Surgeons National Surgical Improvement Program database using current procedural terminology codes and pathology reports. Patients were grouped by urinary diversion performed: ileal conduit versus continent diversion (neobladder or cutaneous reservoir). Multiple logistic regression was used to examine the association between type of urinary diversion and 30-day outcomes, including postoperative complications, all-cause readmissions, and mortality, adjusting for baseline differences. ResultsOf 4,755 patients who underwent radical cystectomy, 677 underwent continent diversion (14.2%). These patients were significantly younger (median 62 vs 71 years, P <.01) and less likely to have diabetes (13.6% vs 20.1%, P <.01), COPD (3.7% vs 7.1%, P<0.01), and prior pelvic radiation (5.5% vs 13.1%, P <.01). A greater proportion of continent diversion patients experienced a postoperative complication (56.0% vs 48.9%, P <.01) and all-cause readmission (30.3% vs 20.4%, P <.0). After adjustment, continent diversion patients had 1.4 (95% CI: 1.1-1.7) and 1.7 (95% CI: 1.4-2.1) times the odds of experiencing a postoperative complication or all-cause readmission, respectively. There was no statistically significant difference in mortality (OR 1.2, 95% CI: 0.5-2.9). ConclusionCompared to ileal conduit creation, continent urinary diversion is associated with increased odds of postoperative complications and readmission to the hospital within 30 days of surgery. Bladder cancer patients undergoing cystectomy and seeking continent diversion should be counseled on the increased short-term morbidity associated with this specific type of diversion.

Cutaneous paraneoplastic presentation of colon cancer in a patient with history of ureterosigmoidostomy

Abstract Ureterosigmoidostomy was commonly utilized as a procedure for continent urinary diversion. However, ureterosigmoidostomy is associated with complications such as infection, electrolyte disturbances, and neoplasia development. A 40-year-old Caucasian male presented with acute left flank pain. Past medical history was significant for bladder exstrophy for which ureterosigmoidostomy urinary diversion was performed during childhood. On physical exam, multiple circular erythematous patches were scattered across the forearms that had been presented for 2 years. Cross-sectional imaging demonnttated an ill-defined mass at the site of ureteral implantation with associated severe left hydroureteronephrosis. Endoscopy revealed a mass at the site of ureteral implantation and biopsy demonstrated invasive, poorly differentiated adenocarcinoma. The dermatosis was diagnosed as interstitial granulomatous dermatitis, a rare inflammatory skin condition associated with underlying autoimmune disease or malignancy. Patient elected operative management with left nephrectomy, sigmoidectomy, and ileal conduit diversion. Ihis case demonnttates a rare presentation of cutaneous paraneoplastic syndrome after development of colon cancer after ureterosigmoidostomy. Ureterooolonic urinary diversion has a demonnttaaie risk of neoplasia development at the anastomotic site, requiring routine endoscopic surveillance.

Is it necessary to perform a retrosigmoid transposition of the left ureter in Bricker Ileal Conduit surgery?

BackgroundThe need for the left ureter to pass through the subsigmoid during ileal conduit diversion surgery has not been investigated in any studies. A modified technique is simply used in the ileal conduit with the left ureter straight over the sigmoid colon due to the possible damage and lack of scientifically validated advantages of this procedure. Our study aimed to investigate the feasibility of the suggested surgical technique, as well as to evaluate perioperative outcomes and postoperative complications with a focus on the prevalence of small bowel obstruction (SBO) and ureteroileal anastomotic stricture (UAS).MethodsA prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was conducted between January 2018 and April 2020. The incidence of SBO and UAS, perioperative outcomes, and postoperative complications were compared between a trial group of 30 patients receiving the modified procedure and a control group of 54 patients receiving the conventional Bricker ileal conduit.ResultsThe two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (< 90 days) postoperative complications between the two groups. There were no occurrences of UAS in the modified group, while there were two cases (3.70%) in the patients who received Bricker's ureteroileal anastomosis (p = 0.535).ConclusionIn the present study, a simple and feasible modified technique of ileal conduit is proposed. Compared with traditional techniques, our method has several advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation at long-term follow-up.

V05-05 REPAIR OF ENTERO-CONDUIT FISTULA USING ROBOT-ASSISTED LAPAROSCOPY

You have accessJournal of UrologyCME1 May 2022V05-05 REPAIR OF ENTERO-CONDUIT FISTULA USING ROBOT-ASSISTED LAPAROSCOPY Aeen Asghar, David Strauss, and Daniel Eun Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a case highlighting surgical management of an entero-conduit fistula (ECF), with robot-assisted laparoscopy (RAL). The patient is a 71-year-old male with a history of non-invasive high-grade urothelial carcinoma (UC) of the left distal ureter who underwent a RAL distal ureterectomy and ureteroneocystostomy and subsequent left RAL completion nephroureterectomy and eventual RAL radical cystoprostatectomy (RC) and intracorporeal ileal conduit (IC) diversion due to recurrence despite an induction course of intravesical BCG. Most recently, he developed metastatic disease to his right lung and underwent robot-assisted right lobectomy. Currently, the patient is disease-free. Nearly two years after RC, he presented with food particles and air per his urostomy. He also had a positive poppy seed test. Initially, pouchoscopy identified a pinpoint ECF tract at the proximal end of the IC. A 6-month trial of conservative management was unsuccessful with multiple episodes of pyelonephritis of his solitary right kidney requiring prophylactic antibiotics. Here, we demonstrate our approach to RAL ECF repair. METHODS: We began with pouchoscopy, which revealed a larger ECF, able to be cannulated by a 5 Fr open-ended catheter. Injection of contrast highlighted the ECF. A simultaneous pouchogram revealed reflux to the solitary right kidney. Access was obtained using a 5mm optical trocar without difficulty. We noted no significant intra-abdominal adhesions despite his past surgeries. Four 8mm robotic ports and a 5mm assistant port were used as outlined in the video. The ureteral anastomosis was easily identified, and further dissection revealed the ECF in proximity to the bowel-bowel anastomosis staple line. We upsized the left 8 mm robotic port to 12 mm to use a 45 mm robotic stapler. The ECF tract was stapled and oversewn using 4-0 silk sutures. Omentopexy and interposition flap was performed by mobilizing the omentum and fixating it in between the bowel and IC using 4-0 silk sutures to prevent recurrence. RESULTS: Operative console time was 98 minutes with 25 mL of blood loss. He was discharged on the same day. The red rubber catheter, which was secured to the IC, was removed at his 2-week post-operative visit. He remains symptom-free at the time of his 6 month follow up visit. CONCLUSIONS: First-line treatment of ECF is conservative management, with surgical repair reserved for rare failure. This case shows the feasibility of RAL ECF repair and revisions for urinary diversion-related complications. Additionally, it highlights a potential benefit of RAL given minimal adhesion development despite multiple prior major intra-abdominal surgeries done using the robotic approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e517 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar More articles by this author David Strauss More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP31-09 DECREASED URETERAL STENT DURATION AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION IS ASSOCIATED WITH DECREASED RATE OF 30 AND 90-DAY COMPLICATIONS

You have accessJournal of UrologyCME1 May 2022MP31-09 DECREASED URETERAL STENT DURATION AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION IS ASSOCIATED WITH DECREASED RATE OF 30 AND 90-DAY COMPLICATIONS David Miller, Danielle Sharbaugh, Cameron Jones, John Myrga, Jennifer Mihalo, Michelle Yu, Tatum Tarin, Robert Turner, Bishoy Gayed, Benjamin Davies, and Bruce Jacobs David MillerDavid Miller More articles by this author , Danielle SharbaughDanielle Sharbaugh More articles by this author , Cameron JonesCameron Jones More articles by this author , John MyrgaJohn Myrga More articles by this author , Jennifer MihaloJennifer Mihalo More articles by this author , Michelle YuMichelle Yu More articles by this author , Tatum TarinTatum Tarin More articles by this author , Robert TurnerRobert Turner More articles by this author , Bishoy GayedBishoy Gayed More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , and Bruce JacobsBruce Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The rate of complications for patients who undergo radical cystectomy and ileal conduit urinary diversion remains among the highest of all oncologic surgeries. An effort to reduce complication rates is decreased duration of indwelling ureteral stents after urinary diversion. Our objective was to examine the association of stent duration on 30 and 90-day complication and readmission rates among patients with bladder cancer undergoing radical cystectomy and ileal conduit urinary diversion. METHODS: We identified patients who underwent radical cystectomy and ileal conduit diversion for bladder cancer at our institution from February of 2020 to July of 2021. Variation in stent duration within our cohort reflects surgeon practice in addition to initiation of a bladder cancer care protocol for patients undergoing radical cystectomy. Stent duration was stratified into three groups: ≥10 days, <10 days, and no stents. 30 and 90-day readmissions and complications were recorded including urine leak, pyelonephritis, urosepsis, ileus, small bowel obstruction, and other. Kruskal-Wallis, Chi-square and Fisher’s exact tests were used to assess differences between groups. RESULTS: We identified 128 patients with bladder cancer who underwent radical cystectomy with ileal conduit urinary diversion, 45 patients were in the ≥10-day group, 73 in the <10 days group, and 10 in the no stents group. No significant difference in hospital length of stay was seen (p=.34). There was a significant decrease in overall 30-day complication rate (p=.03) and 90-day complication rate (p=.02) as time of stent duration decreased. Specifically, there was a significant decrease in the development of urosepsis (p=.02) and pyelonephritis (p=.05) as duration of stent decreased. There was a significant decrease in the rate of urine leak by stent duration between groups (p=.01), this is explained by ureteral stents remaining in place if a urine leak is identified. No significant differences in rate of the other complications nor rate of readmissions were seen between the groups. CONCLUSIONS: Decreased time of indwelling ureteral stents resulted in significantly decreased overall 30 and 90-day complications. Further research is needed to assess differences in long term complications. Source of Funding: Bruce Jacobs is supported in part by the Shadyside Hospital Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e525 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Miller More articles by this author Danielle Sharbaugh More articles by this author Cameron Jones More articles by this author John Myrga More articles by this author Jennifer Mihalo More articles by this author Michelle Yu More articles by this author Tatum Tarin More articles by this author Robert Turner More articles by this author Bishoy Gayed More articles by this author Benjamin Davies More articles by this author Bruce Jacobs More articles by this author Expand All Advertisement PDF DownloadLoading ...

Cost Effectiveness of the Use of Prophylactic Mesh To Prevent Parastomal Hernia After Urinary Diversion with an Ileal Conduit

BackgroundProphylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial. ObjectiveTo investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective. Design, setting, and participantsData on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020. Outcome measurements and statistical analysesThe primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs. Results and limitationsThe mean difference in total costs between the mesh and no-mesh groups was −€2047 (95% CI −€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group (p = 0.001). This indicates that mesh is less costly and more effective compared to no mesh from the health care provider perspective. Subgroup analyses showed that results were more advantageous for women and for patients younger than 71 yr and with less comorbidity than for their counterparts. ConclusionsThe use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective. Patient summaryIn patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.

Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion.

Parastomal hernia (PSH) is a common complication of ileal conduit diversion after radical cystectomy. Novel surgical techniques for preventing PSH formation are needed. We aimed to evaluate surgical technique of extraperitonealizing the ileal conduit (modified ileal conduit) for preventing PSH. A retrospective analysis of 375 consecutive patients who underwent ileal conduit after cystectomy at the Sun Yat-sen University Cancer Center between January 1, 2000 and June 31, 2019 was conducted. 214 patients had modified ileal conduit diversion and 161 patients conventional ileal conduit (Bricker) diversion. The demographic and clinicopathologic characteristics of patients in the 2 groups were compared using the t test and Chi square test. Univariable and multivariable Cox regression analyses were used to predict the risk of PSH formation. The 2 groups were comparable in regard to all demographic and clinicopathologic variables. The incidence of PSH diagnosed by CT scan was 7.5% in the modified group and 21.1% in the conventional group (P < 0.001). High BMI and history of prior abdominal surgery was identified by univariable analysis as risk factors of PSH formation. Multivariable analyses revealed that technique of extraperitonealizing ileal conduit significantly reduced incidence of PSH in patients with or without risk factors of PSH formation (OR = 0.29, 95% CI 0.16-0.54, P < 0.001). Technique of extraperitonealizing ileal conduit appeared to be effective in reducing PSH formation after ileal conduit diversion.

Robot-assisted radical cystectomy for bladder cancer: single-center experience

Abstract Objective Radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. Recently some surgeons have begun to describe outcomes associated with less invasive surgical approaches to this disease, such as laparoscopic or robotic assisted techniques. We report our maturing experience with 100 consecutive cases of robotic assisted laparoscopic radical cystectomy regarding perioperative results, pathological outcomes, and surgical complications. Methods A total of 100 consecutive patients (73 male and 27 female) underwent robotic radical cystectomy with intracorporeal urinary diversion at our institution from February 2018 to February 2021 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes, and complication rate. Results The mean age of this cohort was 60.4 years (range 38 to 82). Ninety-five patients underwent ileal conduit diversion, 5 received a neobladder). The mean operating room time for all patients was 184 min (min time was 160 min) and mean surgical blood loss was 286 ml. On surgical pathology, 2% of the cases were pT1, 35% were pT2, 51+12% were pT3/T4 disease and 17% were node positive. The mean number of lymph nodes removed was 16 (range 10 to 40). In no case was there a positive surgical margin. The mean days to flatus were 2.6, bowel movement 2.8 and discharge home 8.2. There were 21 postoperative complications in 20 patients with 4% having a major complication (Clavien grade 3 or higher) and 15% being readmitted within 30 days after surgery. At a mean follow-up of 12 months 3 patients had disease recurrence and died 4 of disease. Conclusions We report a relatively large cohort and maturing experience with robotic radical cystectomy for the treatment of bladder cancer, providing acceptable surgical and pathological outcomes. These results support continued efforts to refine the surgical management of muscle-invasive bladder cancer.

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

A novel tattooing technique for ureteric strictures in robotic ureteroureterostomy: a non-inferiority analysis.

Mini-laparotomy radical cystectomy with limited bowel externalization during ileal conduit urinary diversion reduces the rate of postoperative complications: a match-paired, single centered analysis

Objective To assess the feasibility and functional outcomes of mini-laparotomy radical cystectomy (RC) in association with limited bowel externalization during ileal conduit urinary diversion. Methods Between January 2018 and March 2020, 53 patients underwent RC plus pelvic lymph node dissection (PLND) for invasive carcinoma of the urinary bladder. This group of patients was intentionally treated utilizing the mini-laparotomy approach, with the addition of limited bowel externalization during conduit preparation and match-paired with 46 examinees from a historical series of patients who underwent conventional open RC plus PLND and ileal conduit diversion. Clinicopathological features and perioperative outcomes were examined from medical records, while postoperative pain was evaluated through the Visual Analog Scale for Pain (VAS). Mean pain scores were evaluated on postoperative days (POD) 1–3. Results There was no difference in specific intraoperative complications between groups, with a median (range) incision length of 8 (5–10) cm within the first group and 16.3 (12–22.6) cm within the second group. The first group had less postoperative pain compared with patients in the second group, with mean pain scores significantly lower across POD 1–3, 3.8 (IQR: 0–6) versus 6.7 (IQR: 3.8–8.1) and 2.5 (IQR: 1–3.7) versus 4.6 (IQR: 3–6), respectively (p = .012 and .002). Conclusions By using this technique, we were able to significantly reduce patients’ postoperative pain, time to bowel restitution, and hospital stay, which are major issues in minimizing short-term postoperative complications of conventional open surgery.

Bowel obstruction incidence in urinary diversion patients: A meta-analysis study.

Bowel obstruction is a common complication that occurs in patient who underwent urinary diversion with an incidence of 0.7%-11%. Although previous studies have published risk factors, prevention and management of postoperative paralytic ileus, and data on urinary postdiversion bowel obstruction in the literature are still scarce and thus require further investigation of the diversion technique which allegedly has differences in pathogenesis, management, and results. To that end, this study conducted a systematic review study to compare two different diversion techniques, namely ileal conduit and continent diversion, especially orthotopic neobladder. This study is a systematic review by searching study in online databases such as PubMed, EBSCOhost, and ProQuest. Inclusion criteria included are full-text articles, English language, and articles of the past 10 years. After searching, we analyzed quantitatively using the RevMan application for meta-analysis. From 3403 studies, we got 12 studies that were included in the analysis. In a study conducted from the study of van Hemelrijck et al. stated that intestinal obstruction has an incidence of 50.73-1000, the third-highest when compared with advanced complications such as death (145.07/1000 population) and urinary tract infections (127.03/1000 population). It was found that odds ratio was 0.64 (0.45-0.91). The ileal conduit and orthotopic neobladder methods have no significant difference in the incidence of intestinal obstruction.

High-Grade Non-Muscle Invasive Bladder Cancer: When to Move to Early Radical Cystectomy?

ObjectivesTo compare the outcomes of bladder preservation therapy with early or deferred radical cystectomy (RC) in high-grade non-muscle invasive bladder cancer.MethodsProspectively collected data were obtained for patients undergoing transurethral resection of bladder tumor (TURBT) at a tertiary care center between 2007 and 2018. Patients with a high-grade tumor (HGT1) were divided into three groups, depending on the treatment plan: conservative (GI), early RC (GII), or deferred RC (GIII). Kaplan-Meier analysis was performed to assess the cancer-specific survival (CSS).ResultsSeventy-one patients were included, and the patients had a median (range) age of 49 (32-72) years. The GI, GII, and GIII groups included 34 (47.9%), 14 (19.7%), and 23 (32.4%) patients, respectively. A significantly lower number of GII patients underwent >2 TURBTs (14.3% vs. 100%, p<0.001). Compared to GIII patients, GII patients had a shorter time to RC from the initial diagnosis (5.7 vs. 36.2 months, p=0.03). Ileal conduit and orthotropic bladder diversions were comparable between both groups, with significantly higher postoperative complications in GIII patients. The median (IQR) follow-up times for the groups were 84 (49-102), 82 (52-112), and 73 (36-89) months, respectively. The five-year and 10-year CSS for GII and GIII patients was 79% vs. 75% and 78% vs. 64%, respectively (log rank=0.19).ConclusionEarly RC should be considered an alternative treatment option in selected patients with HGT1 BC with expected longer life expectancy, which may significantly decrease postoperative complications and improve the CSS. However, selection bias in the current retrospective study may influence these outcomes.

Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases.

There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outcomes included recurrence-free survival (RFS) and overall survival (OS). Associations were assessed using univariable and multivariable models. In all, 70.9% of cases underwent open RC in the last decade, although trend for robot-assisted RC rose since 2009. While lymphadenectomy template remained consistent, nodal submission changed to anatomical packets in 2002 with increase in yield (p <0.001). Neoadjuvant chemotherapy (NAC) use increased with time with concomitant decrease in adjuvant chemotherapy; this was notable in the last decade (p <0.001) and coincided with improved pT0N0M0 rate (p=0.013). Median 5-year RFS and OS probabilities were 65% and 55%, respectively. Advanced stage, NAC, delay to RC, lymphovascular invasion and positive margins were associated with worse RFS (all, multivariable p <0.001). RFS remained stable over time (p=0.73) but OS improved (5-year probability, 1990-1999 51%, 2010-2018 62%; p=0.019). Among patients with extravesical and/or node-positive disease, those who received NAC had worse outcomes than those who directly underwent RC (p ≤0.001). Despite perioperative and surgical advances, and improved pT0N0M0 rates, there has been no overall change in RFS trend following RC, although OS rates have improved. While patients who are downstaged with NAC derive great benefit, our real-world experience highlights the importance of preemptively identifying NAC nonresponders who may have worse post-RC outcomes.

VE34 - Technique for an effortless urostoma creation during intracorporeal robot-assisted ileal conduit diversion

VE34 - Technique for an effortless urostoma creation during intracorporeal robot-assisted ileal conduit diversion

621 Robot-Assisted Radical Cystectomy: A Complete Audit Cycle of Our First 118 Cases

Abstract Aim There are 10,200 cases of bladder cancer diagnosed every year in the UK, accounting for 3% of all new cancer diagnoses. Robot-assisted radical cystectomy (RARC) is a minimally invasive treatment option for muscle invasive and high-risk bladder cancer with a rising uptake. Between 2017 and 2019, RARC accounted for 40.6% of all cystectomies performed in the UK, increasing to 52% in 2018 to 2019. We compared our outcomes with the best practice of RARC set by the Pasadena consensus panel in 2015. Method A review of the prospective database of all RARC performed by two surgeons at Royal Wolverhampton Hospital between May 2013 and October 2020 was conducted. Operative and oncological outcome data were collected from Clinical Web Portal and Somerset Cancer Register and analysed using Microsoft Excel. Results A total of 118 RARC were performed in the study period, 50 cases were analysed in the first audit loop and 68 cases in the second. The mean age was 69 years (44 – 82), 84% were men and 70% were ASA grade II or less. Median operating time was 376 minutes (210 – 555) and the median blood loss was 250mls. 79% of urinary diversion was intra-corporeal and 84% was ileal conduit diversion. Median length of stay was 8 days; complication rate with Clavien Dindo score of III or higher was 12.7%. 86% of our patients are still alive. Conclusions RARC is a safe option for the radical management of bladder cancer. Our outcomes are consistent with the Pasadena consensus recommendations.

Studying the electrolyte changes in ileal urine at the time of radical cystectomy and ileal conduit diversion.

To the Editor, Radical cystectomy (RC) for bladder cancer is a life-changing surgery, associated with high morbidity and mortality rate. Ileal neobladder seems as an attractive way for urine management post cystectomy but would carry the risk of retaining urine in the ileal pouch for a long time, resulting in serum electrolyte changes, that may add to the patients' morbidity. EAU guidelines recommend against ileal neobladder for patients with liver and renal disorders, as well as for patients > 80 years old [...].

Whole‑exome sequencing for high‑risk primary prostatic extra‑gastrointestinal stromal tumor: A case report

The low incidence rates of prostatic extra-gastrointestinal stromal tumors (EGIST), combined with the lack of published guidelines on its treatment, often results in its misdiagnosis and challenges in the treatment of patients, even in cases with high-risk factors. The present case study reported a 65-years-old Chinese male patient, who presented with intermittent hematuria and lower urinary tract symptoms for three months. The colonoscopy results revealed no gastrointestinal lesions; however, a core biopsy diagnosed an EGIST, which subsequently underwent radical prostatocystotomy, standard pelvic lymph node resection, and bricker ileal conduit diversion. The postoperative pathological results suggested a high-risk primary prostatic EGIST, according to the aggressive behavior of the GIST. The immunohistochemistry results revealed the positive expression of CD117, DOG1, CD34, androgen receptor AR, prostate-specific antigen (PSA), a 2% Ki-67 index and a positive surgical margin. The whole exome sequencing (WES) results revealed that the patient harbored a single nucleotide mutation in 121 genes and copy number variations in 601 genes, including a defect in c-Kit (in-frame deletion in p.Q556-V560; fold, 17.5%). By compiling the data obtained from the ConsensusPathDB and the drug-gene interaction databases and expert opinions, the patient was prescribed with the personalized drugs (400 mg per day imatinib mesylate and 50 mg per day bicalutamide, which were stopped when the PSA levels remained stable below 0.01 ng/ml) for 18 months follow-up and there were no signs of recurrence. In conclusion, WES identified multiple genomic alterations and the underlying genetic defect in the rare case enabled the evaluation of the prognosis and the decision of potential drug candidates. The underlying mechanism of the substantial genetic variations in the primary prostatic EGIST, as well as the malignant behaviors of the tumor, remain to be investigated.

PD51-01 EVOLVING TRENDS IN SURGICAL AND ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY: LONG-TERM EXPERIENCE AT THE UNIVERSITY OF SOUTHERN CALIFORNIA

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-01 EVOLVING TRENDS IN SURGICAL AND ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY: LONG-TERM EXPERIENCE AT THE UNIVERSITY OF SOUTHERN CALIFORNIA Anirban P. Mitra, Jie Cai, Gus Miranda, Sumeet Bhanvadia, Monish Aron, Mihir M. Desai, David I. Quinn, Anne K. Schuckman, Hooman Djaladat, Inderbir S. Gill, and Siamak Daneshmand Anirban P. MitraAnirban P. Mitra More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Monish AronMonish Aron More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , David I. QuinnDavid I. Quinn More articles by this author , Anne K. SchuckmanAnne K. Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are conflicting reports on outcome trends after radical cystectomy (RC) for bladder cancer (BC). Recent univariate results of a large single-center RC series reported improved outcomes coinciding with neoadjuvant chemotherapy (NAC) use. We assessed management and outcome trends following RC at the University of Southern California across historical and contemporary patient groups where management paradigms evolved over time. METHODS: BC patients who underwent RC with intent to cure between 1971 and 2018 at our institution were analyzed. Clinical course, perioperative management and pathologic characteristics were evaluated using univariable and multivariable models. Trends were assessed across decades. RESULTS: The cohort included 3,347 patients (80% males; median age, 68 years; median follow up, 10 years). Open RC was performed in 71% of cases in the last decade although the trend for robotic RC rose since 2009. There was an overall downtrend in ileal conduit diversion and higher proportion of neobladders (p<0.001). While our pelvic lymphadenectomy template has been the same since 1980s, specimen submission changed to anatomic packets in 2002 with consequent increase in nodal yield (p<0.001). NAC use increased with time with concomitant decrease in adjuvant chemotherapy (AC); this was notable in the last decade (p<0.001) that coincided with improved ypT0 rate (p=0.013). Patients receiving NAC and AC were younger and had more advanced disease (p≤0.005). NAC was associated with longer time to RC (median, 6.2 versus 2.7 months; p<0.001), and not associated with margin status (p=0.46). Median 5-year recurrence-free (RFS) and overall survival (OS) probabilities were 65% and 55%, respectively. Advanced stage, NAC, AC, delay to RC and positive margins were univariably associated with poor outcomes (all, p<0.001; confirmed by multivariable analysis). RFS did not change across decades (p=0.73) but OS improved with time (5-year probability, 1990-99 51%, 2010-18 62%; p=0.019). Among patients with extravesical and/or node-positive disease at RC, those who previously received NAC had worse RFS and OS than those who directly underwent RC (p≤0.001). CONCLUSIONS: Despite recent increase in NAC use and improved ypT0 rates, there has been no overall change in RFS after RC over time, although OS rates have improved. Our stable RFS rates mirror contemporary outcomes at large academic centers. While patients who are downstaged after NAC derive great benefit, it is critical to identify those who may not respond and may have worse outcomes after RC. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e905-e905 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anirban P. Mitra More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Sumeet Bhanvadia More articles by this author Monish Aron More articles by this author Mihir M. Desai More articles by this author David I. Quinn More articles by this author Anne K. Schuckman More articles by this author Hooman Djaladat More articles by this author Inderbir S. Gill More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Loading ...

MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES Mei Tuong, and Tracey Krupski Mei TuongMei Tuong More articles by this author , and Tracey KrupskiTracey Krupski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract access is necessary to treat diseases in the ureter or kidney after urinary diversion. Access through the insensate conduit is more cost-effective versus percutaneous kidney access. However, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink (ink) into bowel mucosa near UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing and ability to facilitate retrograde upper tract access. METHODS: After IRB approval, patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections, a control group to assess safety of ink. Injections were placed 1 cm from UEA in a triangular configuration with a 19-gauge needle. Follow-up minimized cost and radiation exposure to assess patency and location of UEA. 1-month loopogram assessed for ureteral reflux (UR). If there was any absent UR, looposcopy was performed to assess for occult UEA stricture (UEAS). Ability to visualize UEA and/or ink tattooing was recorded at time of looposcopy. RESULTS: 42 renal units (21 patients) undergoing IC were randomized to ink (20 renal units) or NS (22 renal units). Overall median age was 65 (IQR 60, 73) years with ink patients being older (72 vs 61 years old, p=0.04). Ink patients also had a higher Charlson Comorbidity Index (5 vs 2, p=0.01). Loopogram and looposcopy protocol data are shown in Figure 1. 20 renal units had no UR on loopogram (12/16 ink vs 8/20 NS). Of patients who returned for looposcopy, 14 non-UR renal units were assessed (6/12 ink vs 8/8 NS). Visualization of UEA was achieved in 6 (100%) and 4 (50%) in ink versus NS patients, respectively (p=0.26). Follow up of the cohort revealed a higher than expected UEAS rate in the ink group (N=3, 30%) compared to NS (N=1, 9%). The ink vs NS cohorts underwent 6 vs 1 surgeries respectively for UEAS (p=0.28). 2 ink and 1 NS patients were managed with either endoscopic dilation, percutaneous nephrostomy tube, or ureteral stent. 1 ink patient required open reimplantation of UEA. CONCLUSIONS: Our pilot study demonstrates ink is well-visualized following injection near UEA during IC. However, the ink cohort had more UEAS than our prior rates of UEAS (6%) and in the literature. While this study sample is small, the higher development of UEAS after ink leads to question the utility and safety of ink injection following IC. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e942-e942 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mei Tuong More articles by this author Tracey Krupski More articles by this author Expand All Advertisement Loading ...