Ileal Conduit Diversion Research Articles

Response to editorial comment "A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion".

We thank the authors for their interest in our recent article describing the surgical technique and early functional results of a retrosigmoid ileal conduit diversion after radical cystectomy (RC) (1). In a single-centre single-surgeon comparative study with a short-term follow-up, we observed a significantly reduced rate of ureteroileal anastomotic stricture (UAS) and no increase in intra- or postoperative complications with the retrosigmoid versus traditional Wallace ileal conduit. In details, no cases of UAS were detected in 30 patients who had received a retrosigmoid ileal conduit with a direct end-to-side ureteroileal anastomosis after a mean follow-up time of 10.8 months.

Hospitalisation and readmission costs after radical cystectomy in a nationally representative sample: does urinary reconstruction matter?

To investigate the impact of continent urinary diversion on readmissions and hospital costs in a nationally representative sample of radical cystectomies (RCs) performed in the USA. The 2010-2014 Nationwide Readmissions Database was queried for patients with a diagnosis of bladder cancer who underwent RC. We identified patients undergoing continent (neobladder or continent cutaneous reservoir) or incontinent (ileal conduit) diversions. Multivariable logistic regression models were used to identify predictors of 90-day readmission, prolonged length of stay, and total hospital costs. Amongst 21 126 patients identified, 19 437 (92.0%) underwent incontinent diversion and 1 689 (8.0%) had a continent diversion created. Continent diversion patients were younger, healthier, and treated at high-volume metropolitan centres. Continent diversions resulted in fewer in-hospital complications (37.3% vs 42.5%, P = 0.02) but led to more 90-day readmissions (46.5% vs 39.6%, P = 0.004). In addition, continent diversion patients were more often readmitted for infectious complications (38.7% vs 29.4%, P = 0.004) and genitourinary complications (18.5% vs 13.0%, P = 0.01). On multivariable logistic regression, patients with a continent diversion were more likely to be readmitted within 90 days (odds ratio [OR] 1.55, 95% confidence interval [CI]: 1.28, 1.88) and have increased hospital costs during initial hospitalisation (OR 1.99, 95% CI: 1.52, 2.61). Continent diversion led to a $4 617 (American dollars) increase in initial hospital costs ($36 640 vs $32 023, P < 0.001), which was maintained at 30 days ($48 621 vs $44 231, P < 0.001) and at 90 days ($56 380 vs $52 820, P < 0.001). In a nationally representative sample of RCs performed in the USA, continent urinary diversion led to more frequent readmissions and increased hospital costs. Interventions designed to address specific outpatient issues with continent diversions can potentially lead to a significant decrease in readmissions and associated hospital costs.

Retrosigmoid Versus Traditional Ileal Conduit for Urinary Diversion After Radical Cystectomy

BackgroundUreteroileal anastomotic stricture (UAS) after ileal conduit diversion occurs in a non-negligible proportion of patients undergoing radical cystectomy (RC). Surgical techniques aimed at preventing this potential complication are sought. ObjectiveTo describe our surgical technique of retrosigmoid ileal conduit, and to assess perioperative outcomes and postoperative complications with a focus on UAS rate. Design, setting, and participantsA prospective single-centre, single-surgeon cohort of 67 consecutive patients undergoing open RC with ileal conduit urinary diversion between July 2013 and April 2017 was analysed. A study group of 30 patients receiving retrosigmoid ileal conduit was compared with a control group of 37 patients receiving standard Wallace ileal conduit. Surgical procedureRetrosigmoid versus Wallace ileal conduit diversion after open RC. MeasurementsOperative room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-d postoperative complications were recorded and compared between the two groups. In particular, rate of UAS, defined as upper collecting system dilatation requiring endourological or surgical management, was assessed and compared. Results and limitationsThe two groups were comparable with regard to all demographic, clinical, and pathological variables. No differences were observed in terms of OR time (p=0.35), EBL (p=0.12), and transfusion rate (p=0.81). Ninety-day postoperative complications were observed in 11 (36.7%) patients who underwent a retrosigmoid ileal conduit and 20 (54.1%) patients who received a traditional ileal conduit (p=0.32). Major complications (grade 3–4) were observed in three (10%) cases in the former group and in 12 (32.4%) cases in the latter group (p=0.08). Mean (standard deviation) follow-up time was 10.8±4.0 mo in the study group and 27.5±9.5 mo in the control group (p<0.001). No single case of UAS was observed in the study group, whereas six (16.2%) cases of UAS occurred in the control group (p=0.02). The main limitation is a nonrandomised comparison of a relatively small cohort with short-term follow-up. ConclusionsIn our study, we observed a significantly reduced rate of UAS and no increase in postoperative complications with the retrosigmoid ileal conduit diversion compared with standard Wallace ileal conduit diversion after open RC. Patient summaryWe describe our surgical technique of retrosigmoid ileal conduit as urinary diversion after open radical cystectomy. Compared with traditional techniques, our technique for ileal conduit was found to be safe and reduce the risk of ureteric strictures.

Comparison of health-related quality of life (HRQoL) between ileal conduit diversion and orthotopic neobladder based on validated questionnaires: a systematic review and meta-analysis.

The question of whether orthotopic neobladder (ONB) reconstruction is superior to ileal conduit diversion (ICD) with respect to health-related quality of life (HRQoL) remains controversial. The goal of this study is to perform a meta-analysis to compare post-ICD and post-ONB HRQoL in patients with bladder cancer. A systematic search of Medline, Embase, the Cochrane Central Register of Controlled Trials, and the annual congress abstracts of the European Association of Urology (EAU), the American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) up to June 2017 was conducted to identify all relevant clinical trials using validated questionnaires to assess HRQoL. A systematic review and meta-analysis were then performed. A total of 2507 patients from 26 eligible studies were included. Meta-analyses showed significant differences favouring ONB patients in global health status (WMD + 9.13, p = 0.004), physical functioning (WMD + 11.57, p = 0.0001), role functioning (WMD + 9.64, p = 0.002), and social functioning (WMD + 6.81, p = 0.03) based on the EORTC-QLQ-C30 questionnaire and in the total score of FACT questionnaire (WMD + 6.80, p = 0.001). However, ONB patients were more likely to have postoperative urinary symptoms than ICD patients (WMD - 22.19, p = 0.0001). ONB patients are more likely to have a better global health status than ICD patients. Regardless of the type of urinary diversion (UD) surgery, a gradual improvement in HRQoL over preoperative status tended to stabilise after 12months postoperatively.

MP49-13 THE INCIDENCE OF PYOCYSTIS AND SUBSEQUENT REQUIREMENT FOR REMNANT BLADDER CYSTECTOMY FOLLOWING ILEAL CONDUIT URINARY DIVERSION FOR BENIGN AETIOLOGY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2018MP49-13 THE INCIDENCE OF PYOCYSTIS AND SUBSEQUENT REQUIREMENT FOR REMNANT BLADDER CYSTECTOMY FOLLOWING ILEAL CONDUIT URINARY DIVERSION FOR BENIGN AETIOLOGY George Mankaryous, Rachel Barratt, Mahreen Pakzad, Rizwan Hamid, Jeremy Ockrim, and Tamsin Greenwell George MankaryousGeorge Mankaryous More articles by this author , Rachel BarrattRachel Barratt More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1604AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pyocystis is a recognised complication of the remnant bladder after ileal conduit urinary diversion for benign disease. We assessed our cohort of patients with defunctionalised bladders following ileal conduit urinary diversion to assess the incidence, risk factors and need for subsequent cystectomy for pyocystis. METHODS We retrospectively analysed the outcomes for patients with remnant bladders following ileal conduit urinary diversion (benign aetiology) under our institution between 1997 and 2004. Data analysed included: demographics, co-morbidities, indication for ileal conduit diversion, development and treatments for pyocystis and requirement for subsequent cystectomy. RESULTS 66(81%) female and 15 (19%) male patients underwent ileal conduit diversion in the time period studied. Mean patient age was 46 years (range 2-78). Mean follow-up was 49 months (range 6-252 months). Aetiology for conduit formation included: End-stage complex urinary incontinence, bladder pain syndrome, atonic bladder and Fowler's syndrome. 19 patients (24%) developed pyocystis and treatments for pyocystis included antibioics, remnant bladder ISC or washout and simple cystectomy. The risk factors, identified from our cohort, for pyocystis and requirement for cystectomy are detailed in Table 1. 18/19 patients (95%) with pyocystis eventually required cystectomy. 1/19 required cystectomy but had multiple co-morbidities and the risks of surgery were too high to proceed. There was no correlation between aetiology of conduit formation, or any other co-morbidity/patient factor, and the subsequent development of pyocystis. CONCLUSIONS 24% of patients with remnant bladders following ileal conduit diversion for benign aetiology develop pyocystis. Conservative management is ineffective and 95% require eventual simple cystectomy. Risk factors for the development of pyocystis identified in our cohort include prior SPC insertion and male gender. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e671 Advertisement Copyright & Permissions© 2018MetricsAuthor Information George Mankaryous More articles by this author Rachel Barratt More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP49-08 IS THE HYBRID ILEO-URETERIC ANASTOMOSIS A BETTER ALTERNATIVE THAN THE BRICKER OR WALLACE ANASTOMOSIS FOR ILEAL CONDUIT URINARY DIVERSION?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2018MP49-08 IS THE HYBRID ILEO-URETERIC ANASTOMOSIS A BETTER ALTERNATIVE THAN THE BRICKER OR WALLACE ANASTOMOSIS FOR ILEAL CONDUIT URINARY DIVERSION? Dixon T.S. Woon, Chinniv Vidyasagar, Athina Pirpiris, Jaime O. Herrera-Cáceres, Thenappan Chandrasekar, Hanan Goldberg, Zachary Klaassen, and Matthew Harper Dixon T.S. WoonDixon T.S. Woon More articles by this author , Chinniv VidyasagarChinniv Vidyasagar More articles by this author , Athina PirpirisAthina Pirpiris More articles by this author , Jaime O. Herrera-CáceresJaime O. Herrera-Cáceres More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , Hanan GoldbergHanan Goldberg More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , and Matthew HarperMatthew Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, the Bricker or the Wallace ileo-ureteric anastomosis is performed for ileal conduit diversion. A perceived disadvantage with the Bricker technique is the increased potential for stricture. As for the Wallace technique, it has been suggested that it is associated with an increased risk of bilateral ureteral obstruction at the site of anastomosis secondary to poor surgical technique, tumour recurrence or stone. In this study, we explore the feasibility and safety of the hybrid ileo-ureteric anastomosis. In this technique, the left ureter is spatulated and then anastomosed to the proximal end of an open ileal segment; and the right ureter to the side of the ileal conduit. The advantages include: (1) The two ureters are not in continuity, hence cancer recurrence in one ureter is unlikely to affect the other side; (2) Potentially lower left ureteric stricture rate (wider anastomosis, less mobilization); (3) Easier endoscopic access of the left ureter for surveillance. We aim to compare the complication rates, in particular, the stricture rates of the three types of anastomosis. METHODS This was a retrospective analysis of all patients who underwent a radical cystectomy and ileal conduit diversion at Monash Health, Australia, between 2011-2016. Patient's demographic, methods of the ileo-ureteric anastomosis, length of stay, readmission rate, and complication rates and management were reviewed. RESULTS Sixty-nine patients were identified. The mean age, and length of stay were 66.2 years and 9.9 days respectively. There were 57 men and 12 women. 20 (29%) of patient underwent a Bricker, 20 (29%) a Wallace and 29(42%) a hybride ileo-ureteric anastomosis. No patient in the hybrid group developed a ureteric stricture. Three patients (15%) in the Bricker group and one (5%) in the Wallace group were found to have uretero-anastomotic stricture requiring endoscopic surgical intervention. When compared to the hybrid technique, there was a statistically significant difference in the number of strictures (p=0.031, t test). CONCLUSIONS The hybrid method is a safe alternative to both the Bricker and the Wallace ileo-ureteric anastomosis. It has a statistically significant lower risk of anastomotic stricture than the Bricker's technique, and with the advantage over the Wallace that the two ureters are separated. Furthermore, it may potentially be easier to access ureters endoscopically with this method of anastomosis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e669 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dixon T.S. Woon More articles by this author Chinniv Vidyasagar More articles by this author Athina Pirpiris More articles by this author Jaime O. Herrera-Cáceres More articles by this author Thenappan Chandrasekar More articles by this author Hanan Goldberg More articles by this author Zachary Klaassen More articles by this author Matthew Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP47-13 ROBOT-ASSISTED RADICAL CYSTECTOMY IN OCTOGENARIANS AND THE EFFECT OF AN ENHANCED RECOVERY PATHWAY ON PERI-OPERATIVE INDICES

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2018MP47-13 ROBOT-ASSISTED RADICAL CYSTECTOMY IN OCTOGENARIANS AND THE EFFECT OF AN ENHANCED RECOVERY PATHWAY ON PERI-OPERATIVE INDICES Avinash Chenam, Justin Emtage, Nora Ruel, Patrick Kilday, Juzar Jamnagerwalla, Clayton Lau, Jonathan Yamzon, Ali Zhumkhawala, Bertram Yuh, and Kevin Chan Avinash ChenamAvinash Chenam More articles by this author , Justin EmtageJustin Emtage More articles by this author , Nora RuelNora Ruel More articles by this author , Patrick KildayPatrick Kilday More articles by this author , Juzar JamnagerwallaJuzar Jamnagerwalla More articles by this author , Clayton LauClayton Lau More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Ali ZhumkhawalaAli Zhumkhawala More articles by this author , Bertram YuhBertram Yuh More articles by this author , and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1492AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of aggressive bladder cancer poses a unique challenge due to the often-advanced age at diagnosis. This is becoming more common with the increasing longevity of the general population and incidence of bladder cancer as a whole. Robot-assistance may offer decreased peri-operative morbidity in comparison to open surgery, especially important in the elderly. Further, enhanced recovery protocols can offer added benefits on operative outcomes in this population. Thus, we present our experience with robot-assisted radical cystectomy in a strictly octogenarian population and the effect of the City of Hope Cystectomy Pathway on peri-operative indices. METHODS We identified all patients who were >80 years at the time of their robot-assisted radical cystectomy performed at our institution between October 2003 to present. Demographic and peri-operative data were collected in an IRB-approved database. Patients were then stratified by whether or not they were subject to the City of Hope Cystectomy Pathway that was instituted in April 2014 and these cohorts were compared. RESULTS A total of 87 octogenarians underwent robot-assisted radical cystectomy during our study period. 20 of these were subject to the pathway. The total mean age was 83.9 years, and the vast majority were unhealthy with 91.9% of the cohort having an ASA score of 3 or higher. Most patients (85.1%) underwent ileal conduit diversions. Median estimated blood loss was 250 cc. 63.2% of patients required blood transfusions. There were 3 (3.4%) open conversions. Median length of stay was 10 days. 31.0% of patients experienced major complications at 90 days. The 30 and 90-day mortality rate was 3.4% and 12.6%, respectively. The 30 and 90-day readmission rate was 32.2% and 42.5%, respectively. Pathway patients had a higher ASA and lower estimated blood loss. Use of the pathway reduced length of stay by 3 days. There was no difference observed in the rate of complications, peri-operative mortality or early readmission. CONCLUSIONS Robot-assisted radical cystectomy is safe and feasible in octogenarians with an acceptable peri-operative morbidity profile that can potentially be an improvement when compared to open surgery. The City of Hope cystectomy pathway was not associated with a reduction in the rates of early complications, mortality or readmissions but a shorter length of stay was observed. Larger randomized, prospective trials are needed to further investigate our findings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e620-e621 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Avinash Chenam More articles by this author Justin Emtage More articles by this author Nora Ruel More articles by this author Patrick Kilday More articles by this author Juzar Jamnagerwalla More articles by this author Clayton Lau More articles by this author Jonathan Yamzon More articles by this author Ali Zhumkhawala More articles by this author Bertram Yuh More articles by this author Kevin Chan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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.

The effects of training and the use of cranberry capsule in preventing urinary tract infections after urostomy

PurposeThe study was conducted to investigate the effects of training provided by researcher and the use of cranberry capsule in preventing late term UTIs after urostomy. MethodsThe study included 60 patients who underwent ileal conduit diversion between June 2013 and November 2014. The participants were randomly divided into three groups. First group used cranberry capsule, second group received training about UTIs and the other control group. The patients were assessed for a UTI by laboratory analysis at 2, 3, and 4 months after discharge. ResultsWhen the effect of cranberry capsule use and training on the prevention of urinary tract infections were compared, we found that there was a significant difference between the group that used and didn’t use cranberry capsules, favoring the cranberry capsule (log-rank test; p < 0.05). ConclusionWe found that the use of cranberry capsules is effective in the prevention of urinary tract infections.

Disparities in the Use of Continent Urinary Diversions after Radical Cystectomy for Bladder Cancer.

Background:Radical cystectomy (RC) with ileal conduit (IC) or continent diversion (CD) is standard treatment for high-risk non-invasive and muscle-invasive bladder cancer.Objective:Our aim is to study contemporary trends in the utilization of ICs and CDs in patients undergoing RC.Methods:Using the National Inpatient Sample 2001–2012, we identified all patients diagnosed with a malignant bladder neoplasm who underwent RC followed by IC or CD. Patient demographics, comorbidities, length of stay (LOS), and in-hospital complications, mortality, and costs were compared. Multivariable logistic regression analysis, Chi square, and t-tests were used for analysis.Results:Between 2001–2012, approximately 69,049 ICs and 6,991 CDs were performed. CDs increased from 2001 to 2008, but declined after 2008 (p < 0.0001). Patients of all ages received ICs at a higher rate than CDs (40–59 years: 79.5% vs. 20.5%; 60–69 years: 88.0% vs. 12.0%; p < 0.0001). There was a difference in males vs. females (10.2% vs. 4.0%; OR 2.36) and Caucasians vs. African Americans (9.0% vs. 6.7%; OR 1.49) when comparing CD rates. CD rates were highest in the West, urban teaching centers, and large hospitals (p < 0.001). ICs were associated with higher rates of overall postoperative complications (p = 0.0185) including infection (p = 0.002) and mortality (p < 0.0001). In-hospital costs were greater for the CD group.Conclusions:The number of CDs has declined recently. Patients of all ages are more likely to receive ICs than CDs. Gender, racial, and geographic disparities exist among those receiving CDs. CDs are associated with lower rates of in-hospital complications and mortality, but higher in-hospital costs.

Prospective evaluation of quality-of-life outcomes following orthotopic neobladder and ileal conduit diversion after radical cystectomy

Prospective evaluation of quality-of-life outcomes following orthotopic neobladder and ileal conduit diversion after radical cystectomy

Surgical robots for radical cystectomies in a medium‐volume hospital

AimThe use of surgical robots for radical cystectomies is increasing. In the present study, we evaluated the surgical outcomes after the transition from open radical cystectomy (ORC) to robot‐assisted radical cystectomy (RARC) in a medium‐volume hospital.Patients and MethodsThe present study was a retrospective review of radical cystectomies undertake at a university hospital. Ninety radical cystectomies were identified between 2006 and 2014, and divided into three cohorts of 30 cases. The surgical approach changed gradually from ORC to RARC. Patients’ demographic data, length of hospital stay and surgical outcomes were reviewed and compared across the three periods.ResultsIn cohorts 1, 2 and 3, radical cystectomies were robot assisted in 13.3, 33.3 and 83.3 per cent of cases, respectively. The overall length of stay (LOS) was similar in all cohorts. The median LOS after cystectomy with ileal conduit diversion reduced significantly from 19 to 12 days (P &lt; 0.0005). The rate of positive surgical margins was 20, 3.3 and 3.3 per cent in cohorts 1, 2 and 3, respectively, which was statistically significant (P = 0.046). There was no difference in the rate of severe complications (Clavien grades 3–5) at 30 and 90 days.ConclusionRARC can be safely applied in medium‐volume hospitals. Further investigation is needed to evaluate the advantages of RARC over ORC and laparoscopic approaches.

Health-related Quality of Life After Radical Cystectomy: A Cross-sectional Study With Matched-pair Analysis on Ileal Conduit vs Ileal Orthotopic Neobladder Diversion

To examine the different and health-related quality of life (HR-QoL) outcomes between ileal conduit (IC) and ileal orthotopic neobladder (IONB) in patients who underwent radical cystectomy (RC), by using validated self-reported cancer-specific instruments. This retrospective, cross-sectional, multicenter cohort study included 148 and 171 patients with either IC or IONB. HR-QoL was evaluated with Quality of Life Core Questionnaire and bladder module (BLM)-30 European Organisation for Research and Treatment of Cancer questionnaires. Baseline HR-QoL scores were dichotomized at the median to give "good" or "poor" score profiles. A matched-pair analysis compared HR-QoL aspects between 79 IC patients and 79 IONB patients. At univariate analysis IONB resulted favorable for physical functioning, emotional functioning, cognitive functioning (CF), fatigue, dyspnea, appetite loss, constipation (CO), and abdominal bloating flatulence (AB). At multivariate analyses, IONB showed better scores for emotional functioning (85 vs 79, P = .023), CF (93 vs 85, P <.001), CO (16 vs 31, P <.001), and AB (12 vs 25, P <.001). A significant worsening of sexual and urinary function was observed for IONB patients in the long-term. At matched-pair analysis, global health status was similar (65 vs 62, P = .385). Significantly better scores were observed in the IONB group for the following items: CF (P = .007), fatigue (P = .003), pain (P = .019), dyspnea (P = .016), CO (P = .001), and AB (P = .00). IONB and IC after RC were similar in terms of global health status. IONB provides better results in some aspects of HR-QoL related to bowel function, but a worsening of urinary and sexual functions. Further randomized controlled trials are needed to confirm these data.

MP52-18 EVALUATION OF A NOVEL THREE-DIMENSIONAL FUNNEL MESH FOR PARASTOMAL HERNIA REPAIR AFTER ILEAL CONDUIT DIVERSION

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2017MP52-18 EVALUATION OF A NOVEL THREE-DIMENSIONAL FUNNEL MESH FOR PARASTOMAL HERNIA REPAIR AFTER ILEAL CONDUIT DIVERSION Karl Tully, Florian Roghmann, Jobst Pastor, Rein Jüri Palisaar, Joachim Noldus, and Christian von Bodman Karl TullyKarl Tully More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Jobst PastorJobst Pastor More articles by this author , Rein Jüri PalisaarRein Jüri Palisaar More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Christian von BodmanChristian von Bodman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Using cross-sectional imaging parastomal hernia (PSH) is detected with a frequency of up to 65% in patients treated with cystectomy and ileal conduit (IC) diversion. While many patients initially remain asymptomatic, up to 30% need surgical repair due to clinical symptoms impacting quality of life. Common repair methods to treat this most frequent complication after IC diversion using native tissue show unacceptable high recurrence rates (>70%), which has led to mesh based repair techniques. Effective and safe surgical techniques and outcomes need to be reported in the urologic literature. We report our open surgical technique and results using an intraperitoneal onlay mesh with a central funnel for the conduit aiming to minimize mesh penetration and PSH recurrence. METHODS Between 1/2004 and 12/2015, 643 patients were treated with ileal conduit urinary diversion at our institution. Subsequently 40 Patients (6,2%) underwent open PSH repair between 2/2009 and 3/2016 using a novel intraperitoneal-onlay-mesh with a central hole (2cm diameter) and funnel for intestinal parts (DynaMesh IPST). As surgical access we used a 4 cm longitudinal incision below and above the stoma. The mesh was placed intraperitoneally as an onlay and fixed at four corner points with non-absorbent sutures. Patients received clinical and ultrasound follow-up to monitor treatment success and effectiveness. While perioperative data was available for 40 patients, 13 could not be followed at our institution, leading to 27 patients with follow-up data. RESULTS Of the 40 patients perioperatively only one patient developed a wound infection, which was managed with multiple surgical debridements keeping the mesh in place.27 Patients (16 male, 11 female) with a median age of 74 years and a median BMI of 29.4 kg/m2 (IQR 25; 31) could be followed with a median follow up of 29 months (IQR 16; 63). Two patients developed a stoma stenosis (7%) with consecutive dilation of the renal pelvis which needed to be drained with a nephrostomy. Only two patients (7%) developed a PSH recurrence after mesh implant with one of them being in need of revision at last follow-up. No patient showed a penetration of the mesh into the intestine, stoma necrosis or stoma prolapse. CONCLUSIONS The described open surgical technique shows a low perioperative complication rate and a promising low PSH recurrence rate of only 7%. A specifically designed 2-component mesh with a central funnel implanted as an intraperitoneal onlay seems to provide an effective treatment option for PSH repair after ileal conduit diversion. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e711 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Karl Tully More articles by this author Florian Roghmann More articles by this author Jobst Pastor More articles by this author Rein Jüri Palisaar More articles by this author Joachim Noldus More articles by this author Christian von Bodman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotic Intracorporeal Continent Cutaneous Diversion

Robotic intracorporeal urinary diversion has mostly been done for ileal conduit or orthotopic neobladder diversion. We present what is to our knowledge the initial series, detailed technique and outcomes of the robotic intracorporeal Indiana pouch with a minimum 1-year followup. Ten patients underwent robotic radical cystectomy, pelvic lymphadenectomy and intracorporeal Indiana pouch urinary diversion for cancer in 9 and benign disease in 1. Data were collected prospectively. Baseline demographics, pathology data, and 1-year complication rates and functional outcomes were assessed. All 10 cases were successfully completed intracorporeally without open conversion. Median total operative time was 6 hours, including 3.5 hours for pouch creation. Median blood loss was 200 cc and median hospital stay was 10 days. Four Clavien grade 1-2 and 3 Clavien 3-5 complications occurred. None of the patients had a bowel leak. One noncompliant patient requested undiversion to an ileal conduit. The remaining 9 patients successfully catheterized the ileal channel and were completely continent at the last followup at a median of 13.7 months (range 12.3 to 15.2). Study limitations include small sample size and short followup. We present what is to our knowledge the initial series of robotic completely intracorporeal Indiana pouch diversion. Early perioperative data indicate acceptable operative efficiency and complication rates. Longer followup is required to assess the functional outcomes of this less commonly performed diversion.

Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing uretero-ileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required.

Utilization Trends and Short-term Outcomes of Robotic Versus Open Radical Cystectomy for Bladder Cancer

To compare utilization trends and short-term outcomes of robotic versus open radical cystectomy for bladder cancer since the introduction of the robotic modifier (ICD-9 17.4x). Using the Statewide Planning and Research Cooperative System database, an all-payer administrative system on all hospital discharges in New York State, we identified patients undergoing radical cystectomy (57.71) with a diagnosis of bladder cancer (188.0-188.9, 233.7, 236.7) from October 2008 to December 2012. Primary outcomes were inpatient complications and mortality at index stay. Of the 2525 patients, 24.2% (610 of 2525) underwent robotic and 75.8% (1915 of 2525) underwent open radical cystectomy. The proportion of robotic cases increased from 19.9% (119 of 597) in 2009 to 28.9% (173 of 598) in 2012 (P < .05). From 2009 to 2012, the number of open surgeons decreased from 117 to 109, and that of robotic increased from 56 to 66. Robotic patients had lower approach-specific surgeon and hospital volume, and more likely underwent lymph node dissection, ileal conduit diversion, blood transfusion, and prolonged length of stay. On multivariate analysis, robotic approach conferred a reduced risk of blood transfusion (odds ratio: 0.600, 95% confidence interval: 0.492-0.732, P < .0005) but had no association with prolonged length of stay. There were no significant differences in inpatient complications or mortality at index stay, parenteral nutrition, length of stay, hospital charges, readmission rates up to 90 days, or mortality up to 90 days between the surgical approaches. Despite the rapid dissemination and more recent experience of robotic radical cystectomy, we report lower rates of blood transfusion and otherwise similar short-term outcomes with open radical cystectomy.

Kidney Stone in a Patient with an Ileal Conduit

The advantage of a retrograde over an antegrade approach in ileal conduit diversion is the lower morbidity. Furthermore, in cases in which there are bone deformities and no ureteral reflux from the reservoir into the upper tract, percutaneous access can be challenging. Thus, a retrograde approach should be considered as the first-line option for the treatment of renal stones in patients with an ileal conduit, but the urologist should keep in mind that an antegrade or combined approach may be possible in the case of failure.

Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review.

The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to systematically review the frequency and risk factors of PH following ileal conduit diversion. A systematic review of literature was performed and the Cochrane, EMBASE and PubMed databases were searched from 1st January 1985 to 30th April 2016. All articles reporting occurrence of PH following cystectomy and ileal conduit diversion were analysed. The primary outcome measure was the frequency of development of PH. Secondary outcome measures were risk factors for PH development, complications of PH, frequency of PH repair and recurrence of PH. Twelve articles of the 63 originally identified were analysed. Sample sizes ranged from 36 to 1057 patients with a pooled total of 3170 undergoing ileal conduit surgery. Age at the time of surgery ranged from 31 to 92years. Of the 3170 patients who underwent ileal conduit surgery, 529 patients (17.1%) developed a PH based on either clinical examination or cross sectional imaging. Female gender, high BMI, low preoperative albumin and previous laparotomy were significantly associated with the development of PH in two studies. Repair of PH was offered to 8-75% of patients. The rate of recurrence following repair of PH was reported to range from 27 to 50%. A PH is frequent following cystectomy and ileal conduit urinary diversion. The diagnosis of a PH depends upon duration of clinical follow-up and the use of cross-sectional imaging. The recurrence rates following the repair of a PH remain substantial.

The Prostate in Female? Clear Cell Adenocarcinoma in a Female Urethral Diverticulum

Urethral diverticular clear cell adenocarcinoma in a female patient is extremely rare. This tumor sometimes displays a characteristic image on magnetic resonance imaging, surrounding the urethra like the prostate does in men. We report a patient with this tumor who underwent cystourethrectomy and ileal conduit diversion. We think that imaging studies could be useful to make the appropriate diagnosis.