Non-continent Urinary Diversion Research Articles

Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes.

The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.

Non-continent Urinary Diversion (Ileal Conduit) as Salvage Therapy in Patients With Refractory Lower Urinary Tract Dysfunctions due to Multiple Sclerosis: Results of a National Cohort From the French Association of Urology (AFU) Neurourology Committee and the French-speaking Neurourology Study Group (GENULF)

To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network. A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the Qualiveen short-form questionnaire (QSF) and patient global impression of improvement (PGI-I) were collected and analyzed. Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF confirmed by evaluation of PGI-I. This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.

Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

No data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. Robot-assisted radical cystectomy or open radical cystectomy (ORC). Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI, 28.8-34.2] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI, 27.7-34.8] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than noncontinent urinary diversion (mean HGS at 6 months, 27.4 [95% CI, 24.9-30.0] vs 29.5 [95% CI, 27.2-31.9] kg at baseline; P = .02), with no differences in other parameters. Baseline impairments in any parameter were not associated with 90-day complications or 1-year mortality. The results of this secondary analysis suggest that patients require 3 to 6 months to recover baseline levels after radical cystectomy irrespective of surgical approach. These data will be invaluable in patient counseling and preparation. Hand grip strength and ADL tended to recover to baseline earlier after RARC; however, there was no difference in the percentage of patients recovering when compared with ORC. Further study is needed to assess the clinical significance of these findings. ClinicalTrials.gov Identifier: NCT01157676.

Robot-assisted radical cystectomy: Where we are in 2023.

Open radical cystectomy (ORC) is associated with high rates of perioperative morbidity and mortality, owing to its extensive surgical nature and the high frequency of multiple co-morbidities among patients. As an alternative, robot-assisted radical cystectomy (RARC) has been increasingly adopted worldwide, being a reliable treatment option that utilizes minimally invasive surgery. Seventeen years have passed since the advent of the RARC, and comprehensive long-term follow-up data are now becoming available. The present review focuses on the current knowledge of RARC in 2023, and analyzes various aspects, including oncological outcomes, peri/post-operative complications, post-operative quality of life (QoL) change, and cost-effectiveness. Oncologically, RARC showed comparable oncological outcomes to ORC. With regard to complications, RARC was associated with lower estimated blood loss, lower intraoperative transfusion rates, shorter length of stay, lower risk of Clavien-Dindo grade III-V complications, and lower 90-day rehospitalization rates than ORC. In particular, RARC with intracorporeal urinary diversion (ICUD) performed by high-volume centers significantly reduced the risk of post-operative major complications. In terms of post-operative QoL, RARC with extracorporeal urinary diversion (ECUD) showed comparable results to ORC, while RARC with ICUD was superior in some respects. As the RARC implementation rate increases and the learning curve is overcome, more prospective studies and randomized controlled trials with large-scale patients are expected to be conducted in the future. Accordingly, sub-group analysis in various groups such as ECUD, ICUD, continent and non-continent urinary diversion, etc. is considered to be possible.

PD35-03 RISK OF URETEROILEAL ANASTOMOTIC STRICTURES WITH THE RETROSIGMOID ILEAL CONDUIT AFTER OPEN RADICAL CYSTECTOMY: MID-TERM FOLLOW-UP RESULTS OF A PROSPECTIVE TWO-CENTRE STUDY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-03 RISK OF URETEROILEAL ANASTOMOTIC STRICTURES WITH THE RETROSIGMOID ILEAL CONDUIT AFTER OPEN RADICAL CYSTECTOMY: MID-TERM FOLLOW-UP RESULTS OF A PROSPECTIVE TWO-CENTRE STUDY Gianluca Giannarini, Alessandro Crestani, Marta Rossanese, Giuseppe Alario, Giuseppe Mucciardi, Claudio Valotto, and Vincenzo Ficarra Gianluca GiannariniGianluca Giannarini More articles by this author , Alessandro CrestaniAlessandro Crestani More articles by this author , Marta RossaneseMarta Rossanese More articles by this author , Giuseppe AlarioGiuseppe Alario More articles by this author , Giuseppe MucciardiGiuseppe Mucciardi More articles by this author , Claudio ValottoClaudio Valotto More articles by this author , and Vincenzo FicarraVincenzo Ficarra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously compared the perioperative and short-term follow-up results of retrosigmoid ileal conduit without contralateral transposition of the left ureter versus traditional ileal conduit after radical cystectomy (RC) in a single-surgeon series, and observed a significantly reduced ureteroileal anastomotic stricture (UAS) rate with the former. In this study, we assessed perioperative outcomes, complications and, in particular, UAS rate at a longer follow-up in a larger, two-centre, two-surgeon cohort of patients receiving retrosigmoid ileal conduit after RC. METHODS: Between 03/2016 and 06/2020, 97 consecutive patients (median age 75 years) underwent open RC and retrosigmoid conduit using a 20-cm long ileal segment at two academic centres within a prospective study. Two expert high-volume surgeons performed all cases. Ureteric catheters were removed on postoperative day 7 and 8. All patients were followed with ultrasound examination of abdomen/pelvis at 3 months, CT of abdomen/pelvis at 6 and 12 months after surgery, and then CT yearly for 5 years or when clinically indicated. UAS was defined as any upper urinary tract dilatation requiring endourological or surgical management. Operating room time, estimated blood loss, and 90-day postoperative complications classified according to the Dindo-Clavien system were assessed. In particular, UAS rate and side was evaluated. RESULTS: Median operating room time was 245 (interquartile range [IQR] 215-290) min, median estimated blood loss was 350 (IQR 300-500) ml, and blood transfusions were given to 15 (15.5%) cases. No intraoperative complications were observed. Ninety-day postoperative complications were observed in 33 (34%) patients, being major (grade 3-5) in 19 (19.6%) cases. Two patients died of early postoperative complications. No single case of ureteroileal anastomotic leakage or any urinary fistula was observed. At a median follow-up of 25 (IQR 14-40) months, only one case (1%) of UAS was observed, involving the right ureter of an obstructed kidney and requiring an open ureteroileal reimplantation. CONCLUSIONS: We showed that retrosigmoid ileal conduit is a safe and valid option in patients undergoing non-continent urinary diversion after RC. Of note, UAS rate is very low with this technique, mainly due to the preservation of naïve location of, and blood supply to, the left ureter without transposition to the contralateral side. Further studies are warranted to confirm our very good results. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e589-e589 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gianluca Giannarini More articles by this author Alessandro Crestani More articles by this author Marta Rossanese More articles by this author Giuseppe Alario More articles by this author Giuseppe Mucciardi More articles by this author Claudio Valotto More articles by this author Vincenzo Ficarra More articles by this author Expand All Advertisement Loading ...

Patients living ≥25 years with a non‐continent urinary diversion: What can we learn?

AbstractHow is quality of life (QoL) experienced in patients living with a non‐continent urinary diversion (NCUD) for more than 25 years. The NCUD still is important in patients who suffer from congenital anomaly, urinary malignancy, end‐stage functional voiding or storage disorders. Various complications can occur having a NCUD and can influence psychological and social well‐being. In literature the importance of ostomy self‐care is described. Limited information is available about living ≥25 years with a NCUD. A mixed‐method (quantitative and qualitative) was used. Twenty‐one patients, who were using NCUD appliances were selected, from a cohort of 43. Data was collected using a validated questionnaire supplemented with some questions. Additionally, semi‐structured narrative‐based interviews were conducted. Informed consent was obtained. Questionnaire response was 71% (n = 15). One was invalid. Ratio female/male was equal. Mean age 62 (range 42–83) years. Mean time living with a NCUD 40 (range 25–56) years. Although results per question vary, a mean score of 63 for QoL was experienced. Eleven patients had a good QoL (mean 66). There were no differences between gender and for the age‐groups. Five patients were interviewed. Characteristics were comparable with the quantitative group. The results of the mixed method study strengthened each other and are consistent with the (limited) results described in literature. The QoL is generally experienced as good. The QoL is not so much influenced by the NCUD itself, but by the underlying disease and/or complications of the NCUD. During the first years information and guidance is important to secure good QoL. The guidance patients receive nowadays is generally experienced as very good in our group, however it remains important to discuss sexuality, involve partners, caregivers and the help of peers. Multi‐center studies and prospective follow‐up regarding QoL might give more insight in the QoL over the years.

Retrosigmoid ileal conduit without transposition of the left ureter after open radical cystectomy for bladder cancer.

To assess perioperative outcomes, complications, and rate of uretero-ileal anastomotic stricture (UAS) in patients undergoing retrosigmoid ileal conduit after radical cystectomy (RC). Clinical records of consecutive patients receiving retrosigmoid ileal conduit after open RC for bladder cancer between March 2016 and June 2020 at two academic centres were prospectively collected. Two expert surgeons performed all cases. Operating room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-day postoperative complications classified according to the Clavien-Dindo system, were assessed. In particular, rate of UAS, defined as upper urinary tract dilatation requiring endourological or surgical management, was evaluated. A total of 97 patients were analysed. The median (interquartile range [IQR]) OR time was 245 (215-290) min, median (IQR) EBL was 350 (300-500) mL, and blood transfusions were given to 15 (15.5%) cases. There were no intraoperative complications. There were 90-day postoperative complications in 33 patients (34%), being major (Grade III-V) in 19 (19.6%). Two patients died from early postoperative complications. At a median (IQR) follow-up of 25 (14-40) months, there was only one case (1%) of UAS, involving the right ureter and requiring an open uretero-ileal re-implantation. The retrosigmoid ileal conduit is a safe and valid option for non-continent urinary diversion after RC, ensuring a very low risk of UAS at an intermediate-term follow-up.

Orthotopic continent urinary diversion (the Budapest pouch) in 10 steps

After total or anterior pelvic exenteration, a urinary diversion must be performed. The Bricker conduit, a non-continent urinary diversion tailored from the ileum, sigmoid colon, or other bowel parts, is...

The significance of preoperative estimated glomerular filtration rate on survival outcomes in patients who underwent radical cystectomy and non-continent urinary diversion.

ABSTRACTPurpose To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD).Materials and Methods A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients’ characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups.Results The mean age was 64.5±8.7 (range: 32 - 83) years and the median follow-up was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2.Conclusions Overall mortality was higher and overall survival was lower in patients with preoperative eGFR <60mL/s. More patients had preoperative hydronephrosis with eGFR< 60mL/s.

Successful Treatment of Vesicovaginal Fistulas via an Abdominal Transvesical Approach: A Single-center 50-yr Experience

BackgroundA vesicovaginal fistula (VVF) is an abnormal communication between bladder and vagina, as a result of traumatic events to the female pelvis. A VVF is a rare event and challenging to cure. Successful treatment can be achieved through an abdominal approach, especially in complex or recurrent cases. This approach has been used in our institution as the procedure of choice for the past 50yr. ObjectiveTo analyze the results of the management of VVFs in our institution and to highlight the key points for success. Design, setting, and participantsA total of 138 patients with VVFs have been treated in our institution between 1969 and 2019. Up to now, this is the largest series reported so far on abdominal treatment of VVFs in the developed world. Interventionan abdominal transvesical approach has been performed as the procedure of choice. Outcome measurements and statistical analysisto evaluate the factors influencing the success rate of the abdominal approach at the first closure attempt. Statistical analysis was performed using STATA software. Results and limitationsIn total, 124 (90%) patients were submitted to transabdominal repair (89 extraperitoneal; 71.8%), 113 (91.1%) presented with a VVF not associated with another fistula, and 36 (29.0%) had undergone previous unsuccessful treatments elsewhere. Successful closure was obtained in 111/118 (94.1%) patients at the first attempt, excluding external noncontinent urinary diversions. Follow-up was possible in 95 (76.6%) patients; 91 (95.8%) patients were dry. Statistical analysis showed a significant association between fistula size and length, and VVF site in the bladder and extraperitoneal approach. Success rate decreased with the number of previous attempts and did not vary with VVF etiology. ConclusionsThe abdominal approach for the treatment of VVF has a high success rate. Standardization of the technique, identification of surgical key points, and centralization of care in centers with experience are critical. Patient summaryA vesicovaginal fistula (VVF) is a rare clinical condition, with a high impact on patients’ quality of life. We report a large series of VVFs treated in our institution in the past 50yr. Key factors for success include proper surgical technique and centralization of care in centers with high experience.

Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis.

The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.

Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies

BackgroundPelvic exenteration and its reconstructive techniques have been associated with high postoperative morbidity and a negative impact on patient quality of life. The aim of our study was to compare...

Dérivation urinaire non continente et modes mictionnels alternatifs chez les patients atteints de sclérose en plaques

To compare non-continent urinary diversion (NCUD) and other bladder managements in patients with multiple sclerosis (MS), in terms of satisfaction and burden of care. All patients with MS that were proposed a NCUD in our center for refractory lower urinary tract disorders between January 2005 and March 2018 were eligible. Patients were attributed to two distinct groups: "NCUD" and "Other bladder management". The primary endpoint was the satisfaction related to the bladder management quoted by a numerical rating scale (NRS) from 0 to 10. The secondary endpoints included, among other things, the evaluation of the burden of care associated with the bladder management. Twenty-three patients were included in the "NCUD" group and 11 in the "Other bladder management" group, with 4 patients pursuing with spontaneous voiding, 3 with intermittent catheterization, 2 that have undergone a sphincterotomy, 1 still performing self-intermittent catheterization and 1 with a supra-pubic catheter. The "NCUD" group had a significant higher NRS than the "Other bladder management" group (8.22±1.78 vs. 6.27±2.45; P=0.0056). The daily average duration of care was 16.42minutes in the "NCUD" group and 35.6minutes in the "Other bladder management" group (P=0.1111) CONCLUSION: This exploratory study, even if not conclusive, brings to light the preliminary results needed to elaborate a high level of evidence protocol regarding the satisfaction and the burden of care associated with NCUD in MS patients. 4.

947 - Long-term outcomes of non-continent cutaneous urinary diversion in patients with multiple sclerosis

947 - Long-term outcomes of non-continent cutaneous urinary diversion in patients with multiple sclerosis

Plasmacytoid Urothelial Carcinoma of the Bladder: Case Report and Review of the Literature

Introduction Plasmacytoid urothelial carcinoma (PUC) of the bladder is a rare histological variant, accounting for 1 to 3% of the invasive urothelial carcinomas, and it is typically aggressive. So far, it has not been well characterized, and the literature is based on reports and case series. Case Report A 70-year-old male patient presenting with 4 months of constitutional and urinary symptoms, with an ultrasound finding of bilateral hydronephrosis and diffuse thickening of the bladder walls. In the cystoscopy, trigone of infiltrated appearance, a biopsy wass performed, whose immunohistochemistry revealed a PUC. The abdominopelvic image showed an infiltrative lesion that compromised the muscle of the bladder and extended to the perivesical fat, without adequate plane of cleavage with the prostate and a single hypogastric adenopathy suspected of malignancy. It was classified as cT3b vs cT4aN1M0 (chest computed tomography [CT] negative for malignancy), and the patient was submitted to a radical cystoprostatectomy, extended pelvic lymphadenectomy and non-continent urinary diversion with ileal conduit. The pathology revealed a diffuse PUC with prostatic stromal involvement and 22 of 39 lymph nodes positive for malignancy. Finally, the patient presented a series of postoperative complications and died. Conclusion Plasmacytoid urothelial carcinoma of the bladder is a rare entity, characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis. Currently, an aggressive approach is recommended due to its high invasive potential.

Laparoscopic hand-assisted Miami Pouch after pelvic exenteration in 10 steps

BackgroundImprovements in surgical technique of pelvic exenteration have mainly occurred in the reconstructive phase of the procedure. Quality of life seems to be improved when performing continent rather than non-continent urinary diversion [1]. Unfortunately, Miami continent urinary pouch is a surgical technique not frequently used among surgeons. MethodsThis video illustrates the creation of a laparoscopic hand-assisted Miami Pouch in 10 consecutive steps. We present the case of a patient with an isolated central pelvic recurrence of cervical cancer who underwent a laparoscopic anterior pelvic exenteration, which is not included in the film. The surgery was performed by an experienced oncological surgeon in a French comprehensive cancer center. ResultsWe split the surgical technique in the 10 following steps:1.Trocar placement2.Right colon and ureteral mobilization3.Preparation of omental J-flap for pelvic filling and vaginal reconstruction4.Placement of circumferential retractor through a minilaparotomic incision5.Right colon and ileum transection followed by restoration of intestinal continuity6.Detubularization of the right colon7.Bilateral ureteral stent insertion and anastomosis to colonic mucosa8.Pouch closure and ileum tapering9.Exteriorization of ureteral stents and pouch fixation to abdominal wall10.Minilaparotomy closure and urostomy fixation ConclusionsMiami Pouch is a urinary reconstructive procedure that can improve quality of life after pelvic exenteration. As it has been previously reported, this film illustrates the feasibility of laparoscopic hand-assisted Miami Pouch after laparoscopic anterior pelvic exenteration [2,3]. A step-by-step comprehensive standardization of surgical techniques shortens learning curve of training surgeons [4]. [Display omitted]

Complications of non-continent cutaneous urinary diversion in adults with spinal cord injury: a retrospective study.

Retrospective cohort study. To report the long-term complications of non-continent cutaneous urinary diversion (NCCUD) in adult patients with spinal cord injury (SCI). Hospital in Paris, France. A retrospective single center study included all adult patients with SCI who underwent an ileal conduit between 1997 and 2014. Early complications were reported according to Clavien-Dindo classification. Long-term complications and reoperation rates were recorded, as well as stoma management and autonomy improvement related to urinary function. One hundred and two patients were included. The surgical indications included failure of intermittent catheterization (n = 43), urethral fistulae due to skin ulcers (n = 50), renal failure (n = 8), recurrent urinary tract infections (n = 9), lithiasis (n = 3), and bladder tumors (n = 2). There were 67 early postoperative complications for 44 patients (43%) leading to an additional surgery in 15 cases: 30 grade I-II, 30 grade III, 6 grade IV, and 1 grade V. A total of 37 late complications were reported for 36 patients (35%): 17 ureteral anastomosis stenosis, 3 stoma hernia, 3 pyocystis (3/15 patients), 7 pyelonephritis, 2 renal failures, 2 ureteral lithiasis, 1 uterine prolapse, 1 incisional hernia, and 1 tumor recurrence. Renal function remained unchanged (p = 0.53). Autonomy related to urinary function was improved in 88% of patients. The correct fitting of the stoma was possible for 81% of the patients. Despite a perioperative morbidity rate of 43% and a late complication rate of 35%, as a last resort procedure, NCCUD is an end-stage solution in patients with SCI to preserve renal function and achieve autonomy.

958 - Complications of non-continent cutaneous urinary diversion in adult spinal cord injured patients

958 - Complications of non-continent cutaneous urinary diversion in adult spinal cord injured patients

Long-term kidney transplant survival in patients with continent urinary diversion.

To report the long-term survival of transplanted kidneys in patients with a continent urinary diversion. Between January 1987 and July 2015, 16 patients with a median age of 37 years (range 21-63 years) underwent kidney transplantation on a continent urinary diversion. A total of 14 patients presented irreversible dysfunction of the lower urinary tract, and two patients had required radical cystectomy because of bladder cancer. All continent urinary diversions were carried out before the transplantation. There were nine Kock pouches, five Mainz pouches, one Mainz neobladder and one Hautmann neobladder. A total of 11 patients had a previous non-continent urinary diversion. Of the transplants, 14 came from brain-dead donors and two from related living donors. The median post-transplantation follow up was 171 months (range 30-298 months). Two patients died, while six patients lost their transplant and resumed hemodialysis. Nine patients (56.2%) were alive with a functional transplant at the end of follow up. The most common allograft complication was acute pyelonephritis, but no graft was lost as a result of urinary diversion complications. The kidney transplant survival rate was 73.3% after 10 years, and 66.6% after 15 years. Among patients who still had a functional transplant at the time of the study, creatinine clearance was >30 mL/min for seven patients and <30 mL/min for two patients. The present study is the longest series to date of renal transplantation on continent urinary diversions. The long-term outcome shows that the presence of a continent urinary diversion does not reduce transplant survival.

Neurogenic detrusor overactivity in patients with hereditary spastic paraplegias

Hereditary spastic paraplegia (HSP) represents a clinically and genetically heterogeneous group of neurodegenerative diseases, with a worldwide estimated prevalence of 1.3/100,000 [1] . The “pure” form of HSP is a characterized by a progressive spastic paraplegia, often associated with lower urinary tract symptoms (LUTS) (72.4% to 77.6%) [2] , [3] . However, urologic complications are rarely reported. The aim of this study was to characterize clinical and urodynamic aspects of LUTS following HSP, and to describe treatment and urological complications of LUTS in a large series of HSP patients. We performed a monocentric retrospective evaluation based on review of medical records of HSP patients admitted in the department of PRM from 1999 to 2016. Inclusion criteria were patients > 18 years. Presenting HSP. Clinical, urodynamic and radiologic data were recorded. Statistical analysis was performed using Microsoft Excel software. Thirty-three HSP patients were included. Mean age was 62 ± 14 years with 70% of men. The mean follow-up was 8.10 ± 5 years. Patients presented LUTS: urgency (85%), hesitancy (85%), nocturia (56%) and urinary incontinence (54%). The post-void residual volume (PVR) was over 100 mL in 70%. NDO was diagnosed according to urodynamic testing in 83% of patients, associated in 76% of them with a detrusor-sphinctger-dyssinergia (DSD). HSP patients were exposed to urologic–nephrologic complications: febrile urinary tract infections (25%), urolithiasis (21%), hydronephrosis (8%) and renal failure (17%). HSP patients have been mainly treated with anticholinergics (69%) and 10% were switched to intradetrusor botulinum toxin. Clean intermittent catheterization was performed by 30% of patients. Three patients underwent a non-continent surgical urinary diversion. A significant percentage of HSP patients presenting LUTS mainly resulting of the association of PVR, DO and DSD. However, for the first time, uro-nephrologic complications following LUTS related to HSP are underlined. Thus, HSP patients should be assessed, such as SCI patients, in order to improve management and HSP patients’ quality of life with a decrease of uro-nephrologic complications.