Ileal Reservoir Research Articles

Pouchitis: pathophysiology and management.

Pouchitis is an acute or chronic inflammatory disease of the ileal reservoir. It is common after restorative proctocolectomy with ileal pouch-anal anastomosis, and treatment of chronic antibiotic-refractory pouchitis has proven challenging. Most cases of acute pouchitis evolve into chronic pouchitis. The aetiology of acute pouchitis is likely to be partly related to the gut microbiota, whereas the pathophysiology of chronic pouchitis involves abnormal interactions between genetic disposition, faecal stasis, the gut microbiota, dysregulated host immunity, surgical techniques, ischaemia and mesentery-related factors. Pouchoscopy with biopsy is the most valuable modality for diagnosis, disease monitoring, assessment of treatment response, dysplasia surveillance and delivery of endoscopic therapy. Triggering or risk factors, such as Clostridioides difficile infection and use of non-steroidal anti-inflammatory drugs, should be modified or eradicated. In terms of treatment, acute pouchitis usually responds to oral antibiotics, whereas chronic antibiotic-refractory pouchitis often requires induction and maintenance therapy with integrin, interleukin or tumour necrosis factor inhibitors. Chronic pouchitis with ischaemic features, fistulae or abscesses can be treated with hyperbaric oxygen therapy.

Commentary to Macedo ileal catheterizable reservoir adding the scissors maneuver to improve urinary channel continence: Long term follow-up

Commentary to Macedo ileal catheterizable reservoir adding the scissors maneuver to improve urinary channel continence: Long term follow-up

Normative Data of Liquid Gastric Emptying and Small-bowel Transit: A Prospective Cross-sectional Study.

The primary objective was to establish the reference values for liquid gastric emptying and small bowel. The secondary objectives encompassed comparing the anterior view and geometric mean methods, assessing gender differences, and exploring potential correlations with age. Thirty-five consecutive healthy participants (28 females and 7 males) with a mean age of 42 ± 11 years (median, 42; range, 23-65) underwent liquid gastric emptying scintigraphy at five intervals (0, 0.5, 1, 2, and 4 h), with optional additional imaging at 24 h. Liquid gastric emptying was evaluated using percent retention and half-time (T1/2). Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Reference values were established based on percentiles or mean and standard deviation (SD). Rapid small-bowel transit was determined through visual inspection. Statistical analysis involved paired Samples t-test or Wilcoxon signed-rank test for comparing imaging methods, independent Samples t-test or Mann-Whitney U-test for gender comparison, and Spearman's rank correlation for assessing age-related associations. A 2-tailed P < 0.05 indicated significance. Rapid liquid gastric emptying based on the geometric mean method was defined as percent retention <8% at 30 min, while delayed emptying as percent retention >33%, >20%, and >4% at 1, 2, and 4 h, respectively. The reference range of T1/2 of gastric emptying was 10-60 min. The reference value for small-bowel transit using the geometric mean method was established as ISBT >30% at 4 h, while rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 1 h. Parameters for liquid gastric emptying and small-bowel transit were notably higher in the anterior view method compared to the geometric mean method (P ≤ 0.019), except for percent retention at 2 h (P = 0.510). Nevertheless, the obtained reference values, whether based on percentiles or mean and SD, showed no notable variance between the two methods to warrant clinical significance. Gender did not display an impact on liquid gastric emptying or small-bowel transit in either method (P ≥ 0.173), and age demonstrated no significant moderate or strong correlations (Spearman's ρ ≤ 0.397). The study determined reference values for liquid gastric emptying and small-bowel transit through a standard gastric emptying scintigraphy protocol, avoiding additional complex procedures or extended imaging sessions. The established normative data can apply to individuals of both genders aged ≥18 years. While advocating the geometric mean method as the primary choice, the study acknowledges that in busy centers handling multiple studies with limited resources and a single-head gamma camera catering to multiple studies, the anterior view method remains a feasible alternative.

Assessment of Small-bowel and Colonic Transit on Routine Gastric Emptying Scintigraphy: Establishment of Reference Values.

The primary objective was to establish the reference values for small-bowel and colonic transit within the context of the routine standard solid meal gastric emptying scintigraphy (GES). The secondary objective was to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. Twenty-nine healthy controls underwent routine GES, with additional imaging at 24 h if feasible. Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Colonic transit was evaluated using the colonic geometric center (CGC) by dividing the large bowel into four segments, with an additional fifth segment accounting for the eliminated counts. Reference values were established based on the fifth percentile or mean ± 1.96 standard deviations. Rapid small-bowel transit was visually determined. Paired Samples t-test or Wilcoxon signed-rank test, as applicable, was used to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. For comparing small-bowel and colonic transit between females and males, the Independent samples t-test or Mann-Whitney U-test was applied, as appropriate. The correlation between age and small-bowel and colonic transit was assessed using Spearman's rank correlation analysis. The reference value for small-bowel transit using the geometric mean method was established as ISBT >37% at 4 h, whereas rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 2 h. For colonic transit, the reference range was established as CGC 2.8-4.4 at 24 h. Comparing the anterior view and geometric mean methods, there were no significant differences in ISBT and CGC values (P ≥ 0.125). Gender did not affect small-bowel and colonic transit in both methods (P ≥ 0.378), and age showed no significant correlations (P ≥ 0.053). This study determined the reference values for small-bowel and colonic transit in the Indian population using routine GES, avoiding the need for additional complex procedures. The results may be generalized to the Indian population, emphasizing the importance of assessing small-bowel and colonic transit in patients with normal gastric emptying parameters to enhance gastrointestinal transit evaluation.

Ileal Conduit Necrosis Secondary to Spontaneous Retroperitoneal Hematoma

Case Presentation: A fifty-nine years old woman with previous muscle-invasive bladder cancer treated five years prior in another medical center with radical cystectomy and Bricker’s ureteroileostomy diversion, presented to the Emergency Room (ER) describing general discomfort, diarrhea, arterial hypotension and tachycardia. After conducting an imaging test, ileal conduit ischemia and mesenteric ischemia was diagnosed secondary to retroperitoneal hematoma. Ileal reservoir resection, resection of the ischemic intestine, and bilateral cutaneous ureterostomy were performed. Relevance: In patients with previous urinary diversion and acute abdominal pain, it is imperative to dismiss conduit involvement. Clinical Implications: In cases of acute abdomen with history of urinary diversion, physical examination and imaging tests can detect if the ileal reservoir has been compromised and, therefore, guide the adequate therapeutic approach. Conclusions: Identifying the complications of the urinary diversion in early stages in order to treat the underlying cause is advisable.

Parks retractor.

The use of a surgical speculum (latin for mirror, from specere: to watch) or retractor has been described since ancient times. An anal speculum (catopter) for haemorrhoids, abscesses, and fistulas was mentioned in Hippocrates’ dissertations from around 400 BC1. Many years followed without further advances in transanal surgery owing to pain, limited anaesthesia, morbidity, and even death2. Perhaps the most famous fistulotomy in history (1685) necessitated the development of new instruments, when King Louis XIV had an anal fistula treated by the ‘barber surgeon’ Charles-Francois Felix. He spent months developing new instruments and refining his technique by undertaking ‘surgical training’ on guinea pigs and less well-to-do patients. Among these instruments was a three-bladed self-retaining anal retractor (Fig. 1a), a predecessor of the retractor described in this article. The evolving interest in, and optimization of, transanal excisions of anal and rectal tumours at the beginning of the 20th century demanded improved access to, and visualization of, the rectum. In Benign Tumours of the Rectum3, Alan Guyatt Parks (1920–1988) described and illustrated the use of a two-bladed self-retaining speculum for excision of rectal adenomas. A three-bladed version (Parks retractor) (Fig. 1b) was described in a later article in 19734. It formed the basis of two principles essential for peranal excision: that the anal canal could be opened to achieve exposure with the retractor, and that submucosal injection facilitated dissection. As Parks stated, the key to optimal surgery is ‘good exposure, good exposure, good exposure’5. Parks had many other innovations and contributions from the aetiology and classification of anal fistula to pelvic floor physiology, haemorrhoid surgery, and ileal reservoir with ileoanal anastomosis6.

Complicaciones asociadas al reservorio ileal en colitis ulcerativa versus poliposis familiar adenomatosa: Impacto en la calidad de vida del paciente

BackgroundProctocolectomy with ileal reservoir is the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. ObjectivesTo evaluate long-term postoperative complications (1994-2019) in patients operated for familial adenomatous polyposis (FAP) and ulcerative colitis (UC) and the degree of satisfaction with the procedure. MethodsObservational study based on the analysis of a retrospective database with prospective follow-up in 115 consecutive patients: 79 with UC and 36 with FAP. A total of 88 patients were followed up, 60 with UC and 28 with PFA. Results48 males (54.4%) with a mean age of 44.8 ± 10.6 years were evaluated. Indications for surgery were intractable disease in 54 patients (47%), dysplasia/cancer in 43 (37%), severe bleeding in 4 (4%) and perforation in 3 (3%). A proctectomy and mucosectomy of the rectal stump was performed in 67 (76.1%), and a double stapling technique in 21. A protective ileostomy was performed in all patients with UC and FAP. No differences were found in early complications between the two groups. Late complications showed a higher rate of reservoritis in UC patients compared to FAP (44.9 vs. 14.3%, p = 0.001), with more refractory reservoritis in the UC group (13.3 vs. 0%, p = 0.04) with no differences in bowel obstruction, strictures, or anastomotic fistulas. Overall satisfaction and adaptation were considered good in 87% of UC patients and only 57% in the FAP group (p < 0.01). ConclusionsProctocolectomy with ileal reservoir has comparable morbidity and mortality, except for the higher rate of reservoritis in patients with a history of UC, despite this contingency there is a better quality of life and greater acceptance of surgery in UC patients than in FAP patients.

PD55-09 SEMINAL VESICAL SPARING CYSTECTOMY IN BLADDER CANCER PATIENTS IS FEASIBLE WITH GOOD FUNCTIONAL RESULTS WITHOUT IMPAIRING ONCOLOGICAL OUTCOMES: A LONGITUDINAL LONG-TERM PROPENSITY-MATCHED SINGLE CENTER STUDY

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD55)1 Sep 2021PD55-09 SEMINAL VESICAL SPARING CYSTECTOMY IN BLADDER CANCER PATIENTS IS FEASIBLE WITH GOOD FUNCTIONAL RESULTS WITHOUT IMPAIRING ONCOLOGICAL OUTCOMES: A LONGITUDINAL LONG-TERM PROPENSITY-MATCHED SINGLE CENTER STUDY Gallus Beatus Ineichen, Marc Andre Furrer, Brigitta Gahl, Bernhard Kiss, Silvan Boxler, Beat Roth, and George Niklaus Thalmann Gallus Beatus IneichenGallus Beatus Ineichen More articles by this author , Marc Andre FurrerMarc Andre Furrer More articles by this author , Brigitta GahlBrigitta Gahl More articles by this author , Bernhard KissBernhard Kiss More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Beat RothBeat Roth More articles by this author , and George Niklaus ThalmannGeorge Niklaus Thalmann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002089.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Seminal-vesicle-sparing radical cystectomy (SVS-RC) has been reported to improve short-term functional results without compromising oncological outcomes. There is a lack of data on long-term outcomes after SVS-RC. The aim of this study was to compare oncological and functional outcomes in patients after SVS-RC vs. non-SVS-RC METHODS: Oncological and functional outcomes of 470 consecutive patients after RC and orthotopic ileal reservoir from 2000 to 2017 were evaluated. Stratification included six groups according to nerve-sparing (NS) and SVS status: no sparing (n=55), unilateral NS (n=159), bilateral NS (n=132), unilateral SVS and unilateral NS (n=30), unilateral SVS and bilateral NS (n=45), bilateral SVS and bilateral NS (n=49). Propensity modelling was applied to adjust for preoperative differences. RESULTS: Median follow-up among the entire cohort was 64 months. Among the six groups, our analysis showed no difference in local recurrence-free survival (p=0.173). However, progression free, cancer-specific and overall survival were more favorable in patients with SVS-RC (p<0.001, p=0.006, and p<0.001, respectively). Proportions of patients with erectile function recovery were higher in the SVS-groups at all time points in all analyses, respectively, with pronounced earlier recovery in patients with bilateral SVS. Importantly, patients with SVS were significantly less in need of erectile aids to achieve erection and intercourse. Over the whole observation period, daytime urinary-continence was significantly better in the SVS groups (OR 2.64 to 5.21). CONCLUSIONS: In a highly selected group of patients, SVS-RC is oncologically safe and results in excellent functional outcomes that are reached at an earlier timepoint after surgery and remain superior over a longer period of time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1000-e1001 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gallus Beatus Ineichen More articles by this author Marc Andre Furrer More articles by this author Brigitta Gahl More articles by this author Bernhard Kiss More articles by this author Silvan Boxler More articles by this author Beat Roth More articles by this author George Niklaus Thalmann More articles by this author Expand All Advertisement Loading ...

Successful Treatment of Prepouch Ileitis with Oral Mesalamine in Barnett Continent Ileal Reservoir

Barnett Continent Ileal Reservoir is rarely performed in patients with ulcerative colitis who require colectomy. Prepouch ileitis occasionally occurs in patients with ileal pouches. The role of oral mesalamine in the treatment of prepouch ileitis has not been established. We describe a case in which prepouch ileitis in Barnett Continent Ileal Reservoir was successfully treated with oral mesalamine. This is the first case in the literature showing that mesalamine is safe and effective in the treatment of prepouch ileitis in a patient with a continent ileostomy.

Long-term outcome and quality of life after continent ileostomy for ulcerative colitis: A systematic review.

The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC) when a restorative option is not suitable or has not succeeded and the patient does not want a conventional end ileostomy. Continent ileostomy types include the Kock pouch, Barnett continent intestinal reservoir and T-pouch. All of the published evidence on the long-term outcome and quality of life after continent ileostomy for UC was systematically reviewed. A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2020 were included. A descriptive synthesis was used due to the clinical heterogeneity. The search returned 1655 abstracts and after screening of abstracts and full text review, 19 were included in the final review, involving 1602 patients. Operative mortality is low (0%-3.6%) after all types of continent ileostomy but reoperation rates are high (20.8%-65%) because of valve mechanism failures. Rates of fistulae (0%-25.5%) and stomal stenosis (0%-25%) can be relatively high postoperatively. Quality of life scores improve for most patients undergoing continent ileostomy, especially for patients converted from ileal pouch anal anastomosis. Overall, continent ileostomy retention is high in the long-term. In the long-term, patients report high satisfaction and a good quality of life with continent ileostomy, despite high reoperation rates and complications. Newer technologies may reinvigorate interest in the continent ileostomy for this population.

Pouchitis: Clinical Features, Diagnosis, and Treatment.

Procto-colectomy with an ileal pouch anal anastomosis is the procedure of choice for ulcerative colitis patients that require colectomy. Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ulcerative colitis. The aetiology is still unknown, but many risk factors have been individuated. Pouchitis can be classified based on aetiology, duration, clinical course, and response to antibiotic therapy. Accurate diagnosis and classification is the key factor for an adequate management, and exclusion of secondary causes of pouchitis is pivotal. Most of the patients consistently respond to antibiotic therapy, but management of the subgroup of patients with chronic-antibiotic-resistant-pouchitis is still challenging, being this entity one of the major causes of pouch failure.

Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study.

Seminal vesicle-sparing radical cystectomy has been reported to improve short-term functional results without compromising oncological outcomes. However, there is still a lack of data on long-term outcomes after seminal vesicle-sparing radical cystectomy. The aim of this study was to compare oncological and functional outcomes in patients after seminal vesicle-sparing vs nonseminal vesicle-sparing radical cystectomy. Oncological and functional outcomes of 470 consecutive patients after radical cystectomy and orthotopic ileal reservoir from 2000 to 2017 were evaluated. They were stratified into 6 groups according to nerve-sparing and seminal vesicle-sparing status as attempted during surgery: no sparing at all (55), unilateral nerve sparing (159), bilateral nerve sparing (132), unilateral seminal vesicle-sparing and unilateral nerve sparing (30), unilateral seminal vesicle sparing and bilateral nerve sparing (45), and bilateral seminal vesicle sparing (49) and used propensity modeling to adjust for preoperative differences. Median followup among the entire cohort was 64 months. Among the 6 groups, our analysis showed no difference in local recurrence-free survival (p=0.173). However, progression-free, cancer-specific and overall survival were more favorable in patients with seminal vesicle-sparing radical cystectomy (p <0.001, p=0.006 and p <0.001, respectively). Proportions of patients with erectile function recovery were higher in the seminal vesicle-sparing groups at all time points in all analyses, respectively, with pronounced earlier recovery in patients with bilateral seminal vesicle sparing. Importantly, patients with seminal vesicle sparing were significantly less in need of erectile aids to achieve erection and intercourse. Over the whole period, daytime urinary-continence was significantly better in the seminal vesicle sparing groups (OR 2.64 to 5.21). In a highly selected group of patients, seminal vesicle sparing radical cystectomy is oncologically safe and results in excellent functional outcomes that are reached at an earlier time point after surgery and remain superior over a longer period of time.

Rectal Tumor With Perineal Invasion and Peritoneal Carcinomatosis: Pelvic Exenteration Followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy - A Case Report

Background: Pelvic exenteration is an established treatment option for locally advanced rectal cancer. However, only a few studies evaluate the important role of such procedure, due to its morbidity and exclusion criteria. This study will indicate the rare and successful association of cytoreductive surgery (CRS), total pelvic exenteration, abdominoperineal amputation, ileal urinary reservoir, peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC), in a patient with preoperative diagnosis of rectal tumor with perineal invasion and peritoneal carcinomatosis in the pelvis, in a brazilian surgery service.

Intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports: a pilot study.

IntroductionRadical cystectomy is one of the most complex operations in urology, in which orthotopic ileal neobladder construction is an important part. With the development of laparoscopic instruments and surgical techniques, laparoscopic radical cystectomy has been shown to be feasible and safe and has obvious benefits. However, intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is rarely reported.AimTo share our experience in intracorporeal laparoscopic U-shaped ileal neobladder construction with three ports in patients with bladder cancer and explore the feasibility, safety and benefits of this procedure.Material and methodsFrom January 2018 to December 2019, 32 patients with bladder cancer underwent laparoscopic intracorporeal radical cystectomy and orthotopic neobladder. In this article, complete intracorporeal U-shaped ileal neobladder construction with three ports will be presented.ResultsThe median estimated intraoperative blood loss was 130 ml. The median total operative time was 270 min, and ileal reservoir construction and anastomosis required 93 min. The median time to recovery of intestinal function following the operation was 3 days. At a median follow-up of 13 months, 8 patients had hydronephrosis.ConclusionsIntracorporeal laparoscopic U-shaped ileal neobladder construction with three ports is feasible and safe. This procedure is less invasive and is highly beneficial for patients with difficulty with anastomosis of the ileum and urethra due to high mesenteric tension.

The Utility of Adding a Liquid-Nutrient Meal to Aid Interpretation of Small-Bowel Transit Scintigraphy

Small-bowel transit scintigraphy (SBTS) evaluates the accumulation of a radiolabeled meal in the terminal ileal reservoir (TIR) 6 h after ingestion. The location of the TIR may be difficult to determine because anatomic information is limited; for equivocal studies, the patient is asked to return the next day to help determine the TIR location by potential transit into the colon. The purpose of this study was to evaluate whether administration of an additional liquid-nutrient meal (LNM) at 6 h can promote movement of the radiolabeled meal to aid in the interpretation of SBTS and eliminate the need for the patient to return. <b>Methods:</b> This retrospective study reviewed 117 SBTS studies from February 2017 to September 2019. Patients were fed a standardized mixed radiolabeled solid–liquid meal for gastric emptying with SBTS according to Society of Nuclear Medicine and Molecular Imaging practice guidelines. An additional LNM was given at 6 h, and post-LNM images were obtained at least 20 min after the LNM. Two board-certified nuclear medicine physicians independently evaluated all images as equivocal or diagnostic at 6 h. <b>Results:</b> Of the 117 patients (71.8% female; median age, 42.0 y) undergoing SBTS, 37 were equivocal cases at 6 h before the LNM (31.6%; 95% CI, 23.3%–40.9%), compared with 12 equivocal cases after the LNM (10.3%; 95% CI, 5.4%–17.2%). Of the equivocal cases, 25 (69.4%; 95% CI, 51.9%–83.7%) had a definitive result after the LNM, whereas 11 (30.6%; 95% CI, 16.4%–48.1%) remained equivocal and 1 showed rapid transit. Among the 23 patients with gastroparesis, only 13 (57%) responded to the LNM, and none of the 3 patients with irritable bowel syndrome responded. <b>Conclusion:</b> The number of equivocal SBTS cases decreased after administration of an LNM at 6 h, converting to a definitive result. This suggests that with use of an LNM, most patients can complete SBTS in 1 d without the need for repeat imaging at 24 h. Administering an LNM appears to be less effective for patients with gastric disorders. However, the clinical significance remains to be explored, and it is unclear whether such patients have both a gastric and a small-bowel disorder, hence reducing any motility-promoting effect of the LNM.

Long-term Outcomes of Cystectomy and Crossfolded Ileal Reservoir Combined with an Afferent Tubular Segment for Heterotopic Continent Urinary Diversion: A Longitudinal Single-centre Study

BackgroundThe crossfolded ileal reservoir combined with an afferent tubular isoperistaltic segment for heterotopic continent urinary diversion has been performed on a regular basis for over 20 years. Yet data on long-term-outcomes remain sparse. ObjectiveTo report long-term functional and oncological outcomes, gastrointestinal and metabolic disturbances, urinary tract infections (UTIs), and quality of life. Design, setting, and participantsLong-term functional and oncological outcomes of a consecutive series of 118 patients undergoing cystectomy and construction of a continent cutaneous crossfolded ileal reservoir from 2000 to 2018 were evaluated. InterventionPatients underwent cystectomy and construction of a continent cutaneous crossfolded ileal reservoir according to the Studer technique for bladder reconstruction. Outcome measurements and statistical analysisPre- and postoperative data until last follow-up appointment were entered prospectively in the departmental database. Self-reported questionnaires regarding quality of life, patient satisfaction, and difficulty in catheterisation were sent to patients preoperatively; after 3, 6, 12, and 24 mo; and at last follow-up, and were then manually entered in the departmental database. Results and limitationsThe median follow-up was 7.8 (interquartile range 3–12.7) yr. Patient satisfaction was high in 77.4% and moderate in 16.9%. Serum creatinine and estimated glomerular filtration rate remained stable during follow-up. Of all patients, 81% (96/118) had at least one UTI during follow-up. Recurrent UTIs occurred in 67% (79/118) of patients. Urolithiasis was found in 12% (14/118), with 6% (7/118) having a single and 6% a recurrent event. Of all stone formers, 79% (11/14) had recurrent UTIs. In oncological patients, 12.5% (10/79) developed a local recurrence. Cancer-specific survival and overall survival were 90% and 88%, and 68% and 56% after 1 and 10 yr, respectively. A limitations is the retrospective analysis from prospectively assessed data. ConclusionsA high satisfaction level, stability of kidney function, and low rates of urolithiasis in patients with a heterotopic continent ileal reservoir can be achieved, provided that close attention is paid to intra- and postoperative details. Regular lifelong follow-up is essential for timely detection and treatment of complications. Oncological outcome is not affected by the urinary diversion. Patient summaryIn patients with a continent cutaneous ileal reservoir, good quality of life and a high satisfaction rate are possible provided that patients adhere to regular lifelong follow-up.

Impact of fecal microbiota transplantation on chronic recurrent pouchitis in ulcerative colitis with ileo-anal anastomosis: study protocol for a prospective, multicenter, double-blind, randomized, controlled trial

BackgroundAlmost 15% of patients with ulcerative colitis (UC) will require a proctocolectomy with ileal pouch–anal anastomosis (IPAA) as a result of fulminant colitis, dysplasia, cancer, or medical refractory diseases. Around 50% will experience pouchitis, an idiopathic inflammatory condition involving the ileal reservoir, responsible for digestive symptoms, deterioration in quality of life, and disability. Though the majority of initial cases of pouchitis are easily managed with a short course of antibiotics, in about 10% of cases, inflammation of the pouch becomes chronic with very few treatments available.Previous studies have suggested that manipulating the composition of intestinal flora through antibiotics, probiotics, and prebiotics achieved significant results for treating acute episodes of UC-associated pouchitis. However, there is currently no established effective treatment for chronic antibiotic-dependent pouchitis. Fecal microbiota transplantation (FMT) is a novel therapy involving the transfer of normal intestinal flora from a healthy donor to a patient with a medical condition potentially caused by the disrupted homeostasis of intestinal microbiota or dysbiosis.MethodsOur project aims to compare the delay of relapse of chronic recurrent pouchitis after FMT versus sham transplantation. Forty-two patients with active recurrent pouchitis after having undergone an IPAA for UC will be enrolled at 12 French centers. The patients who respond to antibiotherapy will be randomized at a ratio of 1:1 to receive either FMT or sham transplantation.DiscussionOn April 30, 2014, the World Health Organization published an alarming report on antibiotic resistance. Finding an alternative medical treatment to antibiotics in order to prevent relapses of pouchitis is therefore becoming increasingly important given the risk posed by multiresistant bacteria. Moreover, if the results of this study are conclusive, FMT, which is less expensive than biologics, could become a routine treatment in the future.Trial registrationClinicalTrials.gov, NCT03524352. Registered on 14 May 2018.

Functional Results, Complications Associated with the Serosa-lined Tunnel, and Quality of Life with a Cross-folded Ileal Reservoir Combined with an Afferent Tubular Isoperistaltic Segment for Heterotopic Continent Urinary Diversion: An Observational Long-term Cohort Analysis

BackgroundIn patients who do not qualify for an orthotopic urinary diversion, for example, the urethra cannot be spared or is functionally impaired, a heterotopic continent cutaneous cross-folded ileal reservoir offers a good alternative. ObjectiveTo describe the indication, surgical technique, and postoperative management, and to report the reservoir-related outcomes and complications associated with the serosa-lined tunnel. Design, setting, and participantsPerioperative outcomes of 118 consecutive patients after cystectomy and a heterotopic ileal reservoir adapted from the Studer bladder substitute technique, operated between 2000 and 2018, were evaluated. The catheterisable serosa-lined tunnel was constructed from the appendix (Mitrofanoff, n = 63), an ileal segment (Yang-Monti, n = 48), or a fallopian tube (n = 7). Outcome measurements and statistical analysisPre- and postoperative data until last follow-up appointment were entered prospectively in the departmental database. The chi-square test was used to compare proportions. Results and limitationsMedian follow-up was 94 (interquartile range 36–152) mo. No peri- or postoperative mortality was observed within 90 d of surgery. Patient satisfaction was high in 77.5% and moderate in 16.9%. Overall, complications associated with the serosa-lined tunnel occurred in 52% (61/118) of patients. Stenosis of the continent outlet developed in 38% (45/118) of patients: 33/45 (75%) were simply dilated/incised at the outpatient clinic, of those 24% (8/33) required additional endoscopic dilatation. Of patients with stenosis of the continent outlet, 27% (12/45) needed open revision surgery. During follow-up, 8% (nine/118) of patients required revision of the serosa-lined tunnel due to incontinence. Twelve months postoperatively, 95% (92/97) patients were continent. A limitation is the retrospective analysis from prospectively assessed data. This could limit the generalisability of these findings, as selection bias cannot be excluded. ConclusionsThe heterotopic continent cutaneous cross-folded ileal reservoir achieves good functional results. Complications associated with the serosa-lined tunnel occur in about half of the patients but generally are easy to manage. As a result, patient satisfaction is high. Patient summaryIn patients who do not qualify for an orthotopic bladder substitute, a heterotopic continent cutaneous cross-folded ileal reservoir offers a viable alternative with good postoperative functional results and high patient satisfaction.

Inflammatory, infectious, and ischemic disorders of the pelvic pouch

Pouchitis refers to a spectrum of inflammatory disorders affecting the ileal reservoir following restorative proctocolectomy and can be classified as idiopathic or secondary if a specific identifiable entity is identified. Pouchitis is a principal complication of the ileal pouch-anal anastomosis (IPAA) procedure and understanding the evaluation, diagnosis, and treatment of pouchitis is essential for the physician managing IPAA patients. Diagnosis and treatment of pouchitis is typically aided with multidisciplinary coordinated care leveraging specialized medical, pathological, and pharmacological expertise. While most mild and acute episodes of idiopathic pouchitis are easily treated, the gravity of the disease is clear – pouchitis significantly impairs the quality of life for IPAA patients and is a common cause of pouch failure.

Ileal Continent Reservoir: A Feasible Option for Bladder Augmentation and Urinary Diversion

To present the results of technique of continent urinary diversion, described by Macedo, that allows the configuration of a tunnel with a flap of the ileal tube at the same segment created for the reservoir. From January 2006 to November 2016, 29 patients were underwent a urinary diversion by Macedo's technique. Patients' demographics, hospitalization time, surgical time, follow up, continence rate, reservoir capacity, and postoperative complications were evaluated. Sixty-nine percent were male and the median age was 16.9 years. The main etiology was meningomyelocele (69.1%). The mean surgical time was 4.2 hours (standard deviation [SD] 0.9 range 2.9-6.3). The median length of hospital stay was 10 days (interquartile range: 11.3 range 5-51). The mean follow up was 3.3 years (SD 2.2 range 0.3-9.8). Procedure in the bladder neck was performed in 12 patients (41.3%). A continence rate of the catheterizable conduit was 82.8%.The reservoir capacity increased from 134.4 to 364.4 ml (P <.0001). The continence rate improved significantly (20 vs 74%, P <.0001). There was no change in glomerular filtration rates in the long term (143.1 vs 147, P = .45). Morbidity rate was 58% (25 complications in 17 patients), 72% occurred within the first 60 days and 60% were classified as Clavien-Dindo I or II. Except for publications from the original author, this is the first series described. The outcomes are similar, adding important data with respect to this technique. They show that the ileal reservoir is feasible, reproducible, and with good results.