Pelvic Drainage Research Articles

Clinical Pathway After Robotic Nephroureterectomy: Omission of Pelvic Drain With Next-day Catheter Removal and Discharge

To determine the feasibility of applying a postoperative clinical pathway after robotic nephroureterectomy (RNU) targeting safe omission of a pelvic drain and removal of the bladder catheter on the day after surgery with hospital discharge on postoperative day 1 (POD#1). We reviewed a prospectively collected database of all RNUs performed by a single surgeon (R.A.) since institution of our clinical pathway in 2008 that includes pelvic drain omission, bladder catheter removal the morning after surgery, and discharge on POD#1. Patient demographics, and perioperative and postoperative outcomes were evaluated. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined. RNU was performed in 29 patients with mean age and body mass index of 69 years (50-90 years) and 30 kg/m(2) (19-41 kg/m(2)), respectively. No patient required a pelvic drain, and 2 were discharged with a catheter. All but 2 patients (93%) were discharged on POD#1. Overall, successful pathway application was achieved in 26 of 29 patients (90%) including no drain, catheter removal on the morning after surgery, and discharge on POD#1. No patient developed urine leak or other complications related to early catheter removal. Our clinical pathway after RNU allows safe omission of a pelvic drain with early discontinuation of the bladder catheter and discharge on the POD#1 in most patients. To our knowledge, similar pathways have not been previously achieved with nephroureterectomy by any approach, but should be considered by surgeons treating urothelial carcinoma of the upper urinary tract.

Editorial Comment

This manuscript presents an aggressive clinical pathway in a large number of patients who underwent robotic nephroureterectomy. The pathway involves no placement of a pelvic drain, Foley catheter removal on postoperative day 1 (POD#1), and discharge home on POD#1. The authors were able to achieve POD#1 discharge in 93% of patients and all 3 criteria of no drain, early catheter removal, and POD#1 discharge in 90% of patients. The authors attribute using a robotic approach to perform the distal ureteral resection and bladder closure as the major contributor to the success of this pathway.

Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery

Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique. Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method. AL was noted in 35 (7.6%) of 460 patients with rectal cancer. Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (BMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level BMI related (p=0.007) and advanced TNM stage related (p<0.001). AL after anterior resection for rectal carcinoma is related to advanced age, low tumor site, male sex, high preoperative BMI, low pH value of pelvic drainage on POD 3 and a significant reduction of TSGF on POD 5. In addition to their high risk of immediate postoperative morbidity and mortality, AL, worse physical status, severe obesity and advanced TNM stage have similarly negative impact on survival.

To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta‐analysis

Anastomotic leakage is the one of the most serious complications in rectal cancer surgery and is associated with high mortality, morbidity and an increased incidence of local recurrence. Although many studies have compared drained and undrained colorectal anastomoses, to date the role of pelvic drainage in extraperitoneal colorectal anastomosis remains undefined. We carried out a systematic review of the literature, performing an unrestricted search in MEDLINE and Embase up to 30 October 2012. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We performed a meta-analysis of the data currently available on the incidence of extraperitoneal anastomotic leakage, according to the presence or absence of pelvic drainage. Overall, eight studies - three randomized clinical trials (RCTs) and five non-RCTs, comprising a total of 2277 patients - were included in the meta-analysis. Pelvic drainage was demonstrated to reduce both the leak rate and the rate of reintervention in patients who underwent anterior rectal resection with extraperitoneal colorectal anastomosis (OR=0.51, 95% CI: 0.36-0.73; and OR=0.29, 95% CI: 0.18-0.46, respectively) compared with patients without drainage. Overall mortality and infection rates were also evaluated, but a nonsignificant correlation was found with the presence of drainage. The meta-analysis shows that the presence of a pelvic drain reduces the incidence of extraperitoneal colorectal anastomotic leakage and the rate of reintervention after anterior rectal resection.

Extended Low Hartmann Operation with Total Mesorectal Excision - Optimal Surgical Treatment in Stage IV Mid and Upper Rectal Cancer

Background: The main surgeries that can be performed in upper and mid rectal cancer are low anterior rectal resection (LAR), lateral colostomy (LC), and extended Hartmann operation with mesorectal excision (EHO). Compared to lateral colostomy, EHO is a curative surgery; it also takes a shorter time to perform and has a lower mortality compared with LAR. Objective: The aim of this study was to analyze the postoperative surgical complications in patients who underwent LAR, LC, or EHO. Methods: The study is a prospective analysis based on a Surveillance protocol for patients with liver metastases of colorectal origin used in First Surgical Oncology Unit, Regional Institute of Oncology IaAŸi, Romania. The postoperative complications occurring within 60 days postoperatively were analyzed. Results: In the interval June 2012 – May 2014, 87 patients were diagnosed with upper and mid-rectal cancer and liver metastases; LAR was performed in 18 patients, LC in 19 patients and in 50 patients EHO with pelvic drainage abdominally exteriorized or perineally (37 and 13 patients, respectively). The postoperative complications related to surgical wound, stoma, pelvic abscess, postoperative bleeding, prolonged postoperative ileus, anastomotic leakage, reinterventions, readmissions, and mortality were analyzed. A higher rate of pelvic abscesses was found in EHO patients (24%, n=12), of which 9 patients (18%) required reinterventions for drainnage of pelvic fluid collection; all these patients had pelvic drainage exteriorized abdominally. No presacral abscesses were recorded in patients with pelvic drainage exteriorized perineally. Conclusions: Extended Hartmann Operation (EHO) remains a safe technique, that shares some indications with LAR and LC; however, it is associated with a higher percentage of pelvic abscesses and reinterventions that can be avoided by postoperative perineal drainage of the presacral space

Evaluation of the outcomes of laparoscopic hysterectomy for normal and enlarged uterus (&gt;280 g)

The aim of this study was to evaluate intraoperative and postoperative outcomes of laparoscopic hysterectomy (LH) with routine intraoperative cystoscopy (CYS) for enlarged uterus (>280g). The patients, who underwent LH procedure in the Department of Obstetrics and Gynecology in Düzce University Faculty of Medicine between July 2012 and July 2013, were included in this study. Perioperative outcomes were compared between patients with and without enlarged uterus. Uterus weight of the operated patients ranges between 38 and 700g. Mean uterus weight was 196.40±142.32g. Although we found longer operation time (148.75±32.37 vs. 128.28±27.58) and higher delta hemoglobin (2.98±3.09 vs. 1.61±1.29) in patients with enlarged uterus undergoing LH, these findings were not statistically significant (p=0.077 and 0.058). No significant difference was found between the two groups in terms of need for insertion of pelvic drainage (p=0.664), duration of bladder catheterization (p=0.673), time of first postoperative flatus (p=0.509) and the duration of hospitalization (p=0.844). None of the patients had postoperative fever. The two groups were not significantly different in terms of postoperative body temperature (p=0.736). In normal uterus group, 1 patient developed ureterovaginal fistula and 1 patient required re-operation. No major complication was observed in large uterus group. In our study, we compared the outcomes of LH in patients with large uterus measuring up to 700g. and patients with normal uterus, and we achieved successful results by making minor changes in the operation technique and performing diagnostic CYS at the end of the operation.

Acidic Pelvic Drainage as a Predictive Factor For Anastomotic Leakage after Surgery for Patients with Rectal Cancer

To demonstrate the value of sequential determinations of pelvic drainage in the identification of increased risk of anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Between January 2004 and December 2011, data for the daily postoperative pH of pelvic drainage fluid in 753 consecutive patients with rectal cancer who initially underwent anterior resection with a double stapling technique were reviewed. All patients experienced a total mesorectal excision. Patients with anastomotic leakage (Group AL, n=57) were compared to patients without leakage (Group nAL, n=696). Patients with perioperatively abdominopelvic implants that were likely to affect pH value (determined at 25 °) other than leakage were excluded. Mean postoperative values were compared. Anastomotic leakage was noted in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of anastomotic leakage was made between the 6th and 12th postoperative day (POD; mean 8th POD). There was no significance of the daily average values of pH on POD1 and 2 in group AL while a significantly sharp declining mean pH value reached its diagnostic point of AL (p<0.001) on POD3. A cut-off value of 6.978 on the 3rd POD maximized the sensitivity (98.7.0%) and specificity (94.7%) in assessing the risk of leakage. According to these results, an early and persistent declining of pH value of pelvic drainage fluid after rectal surgery with anastomosis, is a marker of AL. A cut-off value of 6.798 on POD3 maximizes sensitivity and specificity.

Application of modified loop ileostomy in laparoscopic low and super-low radical resection of the rectal cancer with preservation of anus

Objective To investigate the value of modified loop ileostomy in laparoscopic low and superlow radical resection of the rectal cancer with reservation of anus.Methods The clinical data of 108 patients who received laparoscopic low and super-low radical resection of rectal cancer with preservation of anus at the Subei Hospital of Jiangsu Province from January 2010 to June 2012 were retrospectively analyzed.Fifty-three patients who received preventive ileostomy were in the ileostomy group,and 55 patients who did not receive preventive ileostomy were in the non-ileostomy group.The operation,incidence of complication and follow-up of the 2 groups were analyzed.All data were analyzed using the t test,chi-square text or Fisher exact test.Results The operation time and blood loss were (185 ± 14)minutes and (31 ± 26)ml in the ileostomy group,and (154 ± 12)minutes and (28 ± 19)ml in the non-ileostomy group,with no significant difference between the 2 groups (t =2.34,1.82,P ＞ 0.05).The time to first flatus,time to liquid diet intake,time to pelvic drainage tube removal,duration of hospital stay,hospital costs were (1.1 ± 0.3) days,(1.1 ± 0.2) days,(5.2 ± 1.0) days,(7.2 ± 1.4) days,(3.0 ± 0.2) ×104 yuan in the ileostomy group,and (4.2 ± 0.6) days,(4.3 ± 0.6) days,(8.4 ± 3.9) days,(12.9 ±4.4)days,(3.8 ±0.7) × 104 yuan in the non-ileostomy group,with significant differences between the 2 groups (t =7.25,28.12,15.34,34.01,7.83,P ＜ 0.05).The incidences of postoperative complications and anastomotic fistula were 5.7％ (3/53) and 0 in the ileostomy group,and 21.8％ (12/55) and 12.7％ (7/55) in the non-ileostomy group,with significant differences between the 2 groups (P ＜ 0.05).Conclusion Modified loop ileostomy in laparoscopic low and super-low radical resection of rectal cancer can effectively reduce the incidence of anastomotic fistula,and helps the recovery of patients. Key words: Rectal neoplasms; Laparoscopy; Ileostomy

Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences: A prospective study about 93 patients.

69 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the literature at the most 10 publications are found. However the interest of urological surgeons is growing fast. We want to evaluate the rate of SLN SPECT-CT detection, the rate of SLN involvement, and the incidence of the SLN biopsy on the surgical and oncological management of patients. Methods: 93 patients with prostate cancer were included (gleason 6-9). All patients were elected for a radical laparoscopic prostatectomy. Nanocis* was intratumorally injected, guided by transrectal ultrosonography. 2 injections 0.6 ml in each lobe of the prostate were performed. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after. Results: A lymphatic pelvic drainage was seen in 95,6 % (89/93) by SPECT-CT (external or internal iliac arteries areas). For 27 patients lymphatic drainage was on the right side, for 24 patients it was on the left side, for the 37 remaining patients migration was bilateral. The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe (Clerad, France), the SLN detection rate was 97.7% (87/89); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed (including external iliac to common iliac arteries areas) in all 93 cases. An SLN involvement was found in 6 cases (5/87= 5.75%); in these 6 cases and in the 81 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 9 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.

Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary?

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The occurence of lymphoceles in patients after radical prostatectomy is well known (2-10%). It appears that patients undergoing open extraperitoneal radical prostatectomy develop more lymphoceles than patients undergoing robot-assisted radical prostatectomy with transperitoneal access. The present study investigates in a prospective randomized manner whether the time of drainage (1 vs 7 days) makes a difference or whether drainage is even necessary. The study data, collected in the same institution, are compared with the incidence of lymphocele in patients treated by robot-assisted radical prostatectomy. To investigate whether routine drainage is advisable after open extended pelvic lymph node dissection (ePLND) and retropubic radical prostatectomy (RRP) by measuring the incidence of lymphoceles and comparing these results with those of a series of robot-assisted radical prostatectomy (RARP) and ePLND. A total of 331 consecutive patients underwent ePLND and RRP or RARP. The first 132 patients underwent open ePLND and RRP and received two pelvic drains; these patients were prospectively randomized into two groups: group 1 (n = 66), in which the drains were shortened on postoperative (PO) days 3 and 5 and removed on PO day 7, and group 2 (n = 66), in which the drains were removed on PO day 1. The next 199 patients were assigned to two consecutive groups not receiving drainage: group 3 (n = 73) undergoing open ePLND and RRP, followed by group 4 (n = 126) treated by transperitoneal robot-assisted ePLND and RARP. All patients had ultrasonographic controls 5 and 10 days and 3 and 12 months after surgery. Lymphoceles were detected in 6.6% of all patients, 3.3% of whom were asymptomatic and 3.3% of whom were symptomatic. Symptomatic lymphoceles were detected in 0% of group 1, 8% of group 2, 7% of group 3 and 1% of group 4, with groups 2 and 3 differing significantly from group 4 (P < 0.05). In total, 5% of all patients undergoing open RRP (groups 1-3) had symptomatic lymphoceles vs 1% of patients undergoing RARP (group 4) (P = 0.06). Nodal-positive patients had significantly more symptomatic lymphoceles than nodal-negative patients (10% vs 2%) (P < 0.02). Symptomatic lymphoceles occur less frequently after open RRP and pelvic drainage over 7 days than after open RRP and pelvic drainage over 1 day or without drainage. Patients undergoing RARP without drainage had significantly fewer lymphoceles than patients receiving open RRP without drainage.

Is placement of pelvic drain indispensable after radical cystectomy, extended lymph node dissection, and orthotopic neobladder substitution?

To evaluate the necessity of leaving a pelvic drain after open radical cystectomy. Materials and methods: Between January 2007 and January 2010, 58 patients with muscle-invasive bladder carcinoma were included. All patients underwent radical cystectomy, extended lymph node dissection, and orthotopic bladder (Studer pouch) substitution. Patients were randomized to have a pelvic drain catheter (Group 1, n = 22) or not (Group 2, n = 36). Ureteral catheters were removed at postoperative days 7 and 8. The pelvic drain catheters in Group 1 were removed when daily production was

潰瘍性大腸炎手術における骨盤内ドレーン早期抜去についての検討

潰瘍性大腸炎手術における骨盤内ドレーン早期抜去についての検討

A clinical analysis on modified laparoscopically assisted vaginal hysterectomy

Objective To explore the clinical efficacy and safety of modified laparoscopically assisted vaginal hysterectomy (LAVH).Methods 60 patients who had been hospitalized from January 2011 to April 2012 were randomly divided into study group and control group,30 for each group.The study group received modified LAVH while the control group underwent ordinary LAVH.The intra-operative and post-operative conditions were compared between the two groups.Results There were significant differences in mean surgical duration,intra-operative blood loss,time to postoperative anal exsufflation,and volume of postoperative pelvic drainage between the study group and the control group (P＜ 0.05).Size of the uterus and lengh of hospital stay did not differ significantly (P ＞ 0.05).Conclusions Modified laparoscopically assisted vaginal hysterectomy has shorter surgcial duration,less intra-operative bleeding,and more efficacious.It can replace the ordinary procedure in clinical practice. Key words: Modified procedure; Laparoscopy; Vaginal hysterectomy

The Position and Suction Power of the Pelvic Drain: A key point after Surgical Repair for Urinary Tract Injury Complicating Gynaecological Surgery

Cavernosal abscesses are rarely reported with the majority of reported cases having an identifiable underlying causative factor. We present the case of a 50-year-old male with poorly controlled diabetes mellitus and large abscesses of the bilateral cavernosal bodies. He was successfully treated with surgical debridement and healing of the wound by secondary intention. Authors: Bradley, […]

Changes in perioperative management of radical prostatectomy using clinical pathways according to a standardized care plan: A multi‐institutional study

To improve the perioperative care for radical prostatectomy patients at a multi-institutional level and practice. A prospective multi-institutional study involving 50 hospitals was carried out in cooperation with the Japanese Society of Endourology. As the first step, a consensus meeting was held to establish a standardized perioperative care plan. Second, the clinical pathways were individually developed and revised according to the standardized care plan in each of the participating hospitals. Patterns of perioperative care, including preoperative hospital stay, resuming meals and ambulation, removal of pelvic drain and urethral catheter, antimicrobial administration, and postoperative hospital stay, were compared before (2007) and after developing/revising pathways (2009). Furthermore, actual practice and complications before and after implementing the pathways were investigated. Except for resuming ambulation, all perioperative pathways were significantly shortened with the adoption of the newly defined clinical pathway (P < 0.001). Furthermore, all settings except for postoperative hospital stay significantly decreased in terms of variance (P < 0.002). In 2009, the overall complication rate significantly decreased (P < 0.001), and all of the outcomes except urethral catheter removal were also significantly shortened (P ≤ 0.008) and decreased in variance after implementation of the new pathways (P ≤ 0.006). In multivariate analyses, implementation of the refined clinical pathways was an important factor to improve perioperative care. When standardized goals in perioperative care are recommended to hospitals and care plans are developed/revised in individual hospitals, both settings and practice are significantly improved. It is to be investigated whether a similar intervention could be useful to achieve a standardization of surgical pathway for other diseases.

Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): A new method for sentinel lymph node detection in endometrial cancer

ObjectiveThe objective of this prospective study was to determine the feasibility, safety and performance of a new method for sentinel lymph node (SLN) detection in endometrial cancer (EC) using transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR). MethodsFrom 2006 to 2011, 74 patients with high-risk EC were included in the study. Twenty-four hours before surgery 148MBq of 99mTc-nanocolloid (8mL) was injected into two spots in the anterior and posterior myometrium using an ultrasound-guided transvaginal puncture. SLN was localized preoperatively by lymphoscintigraphy and intraoperatively with gamma probe. After SLN biopsy the patients underwent a complete laparoscopic pelvic and paraaortic lymphadenectomy. ResultsThe TUMIR method was successfully achieved in 67/74 patients (90.5%). SLN was identified in 55 women (74.3%). No adverse effects were observed. Pelvic drainage was observed in 87.2% of women and paraaortic SLN was identified in 45.4%, with 12.8% of the patients draining only in this area. The mean number of SLN retrieved was 2.8 per patient (range 1 to 9). Metastatic disease was found in 13 (23.6%) patients. Metastatic involvement of the paraaortic lymph nodes was observed in 4 (30.7%) cases. All were identified by TUMIR. The sensitivity and negative predictive value of SLN detected by TUMIR to detect metastasis were 92.3% (95% CI 22.9–100) and 97.7% (95% CI 82.0–100), respectively. ConclusionsTUMIR is a safe, feasible method to detect SLN in patients with EC, has a good detection rate and provides representative information of the lymphatic drainage of EC.

Utility of closed suction pelvic drains at time of large bowel resection for ovarian cancer

ObjectiveTo test the hypothesis that the use of closed suction pelvic drains placed at time of large bowel resection (LBR) for ovarian cancer (OC) decreases morbidity following anastomotic leak (AL). MethodsConsecutive cases of LBR for OC between 01/01/1994 and 06/20/2011 were retrospectively identified. Drains were routinely used until bowel movement. AL was defined as: 1) feculent fluid from drains/wound/vagina, 2) radiographic evidence of AL, or 3) AL found at reoperation. Descriptive statistics, Wilcoxon rank-sum, Pearson's chi-square and Fisher's exact test were used. Results43 cases met inclusion criteria. AL was characterized by method of diagnosis as follows: change in drain output only (DO, n=8); change in drain output associated with ambiguous clinical signs/symptoms (D-SSX, n=11); or clinical signs/symptoms only (SSX, n=24). The sensitivity of drains in diagnosing AL was 50%. Time to diagnosis was earlier in DO/D-SSX (median 7 vs. 11days, P=0.003), however, no significant differences were observed in rates of reoperation, length of stay, time to chemotherapy (TTC), and 30- and 90-day mortality between DO/D-SSX and SSX. Comparing cases where no drains were placed (n=5) vs. those with drain (n=38), we observed no differences in outcomes. TTC though statistically significant (47 vs. 59days, P=0.023) was not clinically significant. ConclusionsThough a change in drain output correlated with earlier diagnosis, this did not appear to impact overall outcomes. We did not find strong evidence supporting routine prolonged drainage after LBR for OC. Additionally, absence of change in drain output does not rule out presence of AL.

Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences, about 74 patients.

e15109 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the international literature at the most 10 publications are found. However the interest of urological surgeons and oncologists is growing fast. Goals of our study were: on the first hand to evaluate the rate of SLN SPECT-CT detection and the rate of SLN involvement, on the other hand to evaluate the incidence of the SLN biopsy results on the surgical and oncological management. Methods: 74 patients with prostate cancer were included. All patients had a Gleason score between 6 and 8. All patients were elected for a radical laparoscopic prostatectomy. Nanocis-Tc 99m was intratumorally injected, guided by transrectal ultrosonography. 2 injections of 0.6 ml in each lobe of the prostate were performed, depending on the size of the prostate. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after SPECT-CT lymphoscintigraphy. Results: A lymphatic pelvic drainage was seen in 94,6 % (70/74) by SPECT-CT. Lymphatic drainage was on the right side (23), on the left side (15), or bilateral (32). The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe, the SLN detection rate was 97% (68/70); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed in all 74 cases. An SLN involvement was found in 5 cases (5/68= 7.35%); in these 5 cases and in the 63 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 8 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.

Pelvic collection drainage by Heald anal stent

Pelvic collection drainage by Heald anal stent

V1892 EARLY RESULTS WITH A TOTALLY EXTRAPERITONEAL ILEAL CONDUIT

You have accessJournal of UrologyOncology, Bladder Oncology1 Apr 2012V1892 EARLY RESULTS WITH A TOTALLY EXTRAPERITONEAL ILEAL CONDUIT Rolf Gillitzer, Mehran Farasaty-Ghazwiny, Johannes Fritsch, Jörg Schede, and Christian Hampel Rolf GillitzerRolf Gillitzer Darmstadt, Germany More articles by this author , Mehran Farasaty-GhazwinyMehran Farasaty-Ghazwiny Darmstadt, Germany More articles by this author , Johannes FritschJohannes Fritsch Darmstadt, Germany More articles by this author , Jörg SchedeJörg Schede Darmstadt, Germany More articles by this author , and Christian HampelChristian Hampel Mainz, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Incontinent urinary diversion continues to be the most widely used diversion type. Even with improved perioperative clinical care pathways, urinary diversion remains a morbid procedure. In order to improve perioperative reconvalescence and minimize bowel complications formation of a totally extraperitoneal ileal conduit is presented. METHODS 10 patients (8 male, 2 female) received radical cystectomy with extended pelvic lymphadenectomy and totally extraperitoneal ileal conduit for muscle invasive bladder cancer. Perioperative data was prospectively collected. RESULTS Mean patient age was 71 years (58 – 80) and the mean age-related Charlson comorbidity index 5.8 (3 – 8). Mean body mass index was 26.2 (18.9 – 32.7). 4/10 patients had previous abdominal surgery including one appendectomy case. No intraoperative complications occurred. Mean pathologist lymph node count was 18.3 (8 – 24). The gastric tube was clamped on the first postoperative day in every patient and removed the following day. 1/10 patients required gastric tube reinsertion. Mean time to bowel movement was 3.7 days (1 – 6). Pelvic drains were removed after a mean of 8.1 days (5 – 12). An asymptomatic postoperative lymphocele was diagnosed in 2/10 patients, but none required drainage. 5/10 patients had postoperative complications Clavien grade ≤ 2. One patient died postoperatively of myocardial infarction. Mean follow-up was 5.1 months (1 – 13). One patient was readmitted to the hospital within 90 days due to apoplectic insult. One patient had ureteric reimplantation of the left ureter eight months after cystectomy. CONCLUSIONS Tailoring of a totally extraperitoneal ileal conduit is feasible and can expedite postoperative recovery after cystectomy without being associated with a worrisome complication rate. However, pelvic drain indwelling time after extended lymphadenectomy can be prolonged. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e763 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rolf Gillitzer Darmstadt, Germany More articles by this author Mehran Farasaty-Ghazwiny Darmstadt, Germany More articles by this author Johannes Fritsch Darmstadt, Germany More articles by this author Jörg Schede Darmstadt, Germany More articles by this author Christian Hampel Mainz, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...