Ureteroileal Stricture Research Articles

Comparative effectiveness of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy for bladder cancer.

To assess the comparative effectiveness of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) vs open radical cystectomy(ORC) for bladder cancer (BC). We conducted a real-life monocentric study including all consecutive patients who underwent RARC with ICUD or ORC for BC at our institution from 2014 to 2023. Uni- and multivariable logistic and Cox regression analyses were used to compare perioperative, oncological and stricture outcomes between both groups by calculating odds (ORs) and hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs), respectively. Overall, 316 patients underwent either RARC with ICUD (n = 228 [72.2%]) or ORC (n = 88 [27.8%]). The perioperative benefits of RARC vs ORC included decreased risks of major blood loss (OR 0.10, 95% CI 0.04-0.23; P < 0.001), perioperative transfusion (OR 0.30, 95% CI 0.16-0.57; P < 0.001), 90-day major complications (OR 0.56, 95% CI 0.29-0.99; P = 0.04), and prolonged initial length of hospital stay (OR 0.20, 95% CI 0.09-0.35; P < 0.001), as well as more days alive and out of the hospital within 90 days of surgery (OR 2.56, 95% CI 1.46-4.6; P < 0.01). In addition, the use of RARC vs ORC was associated with a higher lymph node (LN) count (OR 3.35, 95% CI 1.83-6.30; P < 0.001), while there was no significant difference in recurrence-free (HR 0.72, 95% CI 0.49-1.07; P = 0.1), cancer-specific (HR 0.69, 95% CI 0.43-1.10; P = 0.1), overall (HR 0.76, 95% CI 0.47-1.20; P = 0.3) and uretero-ileal stricture-free (HR 1.18, 95% CI 0.62-2.25; P = 0.6) survival between both groups after a median (interquartile range) follow-up of 42.3 (16.4-73.8) months. Our real-world study supports the effectiveness of RARC with ICUD vs ORC for BC. We generally observed better perioperative outcomes, as well as similar oncological-except for higher LN count-and uretero-ileal stricture outcomes after RARC with ICUD vs ORC.

Comparative study between the use of double J ureteric stents vs bander ureteric stents during robotic-assisted radical cystectomy with intra corporeal ileal conduit urinary diversion.

Robotic-assisted radical cystectomy (RARC) is fast becoming the standard of care with comparable oncological outcomes to open surgery for patients with muscle-invasive bladder cancer. Ileal conduit is by far the most popular means of urinary diversion following a cystectomy. Use of stents is common practice to reduce uretero-enteric anastomosis-related complications. In the current study, practice was changed from the use of Double J (DJ) stents to bander stent intraoperatively. The potential advantages of using bander stent are avoiding second surgery for stent removal and easier change under local anaesthetic in the interventional radiology department. To compare the incidence of blocked, slipped stents and rate of ureteroileal anastomotic stricture after RARC with intracorporeal ileal conduit between practices of using DJ stents and bander stents. Retrospective analysis of all the patients undergoing Robotic radical cystectomy and intracorporeal ileal conduit between June 2014 and August 2023 was done. Initially, all intracorporeal anastomosis were covered with DJ stents. The practice was changed to cover the anastomosis with bander stent in November 2020. Number of patients needing re-surgery for blocked, slipped stents and ureteroileal anastomotic stricture were analyzed and compared using Chi-square analysis and Fisher's exact test (P < 0.05). A total of 168 patients underwent RARC with intracorporeal ileal conduit between June 2014 and August 2023 of which 128 patents were diverted with DJ stents and 40 with bander stent. The mean age and the patient demographics between the two groups were comparable. Of the 128 patients who were diverted with DJ stents, 6 (4.7%) had blocked stents, 3 (2.3%) had slipped stents, and 3 (2.3%) developed ureteroileal stricture needing readmission and urgent invasive intervention to exchange the stent or nephrostomy tube, whereas only 1 (2.5%) of the 40 patients with bander stent had blocked stent which was changed under local anaesthetic in the interventional radiology suite with no slipped stents reported and 2 (5%) had ureteroileal stricture who needed nephrostomies. Intraoperative ureteric stenting using bander stent has the potential to reduce the incidence of stent-related complications, such as blockage, slippage, and ureteroileal anastomotic stricture, following RARC with intracorporeal ileal conduit urinary diversion. Additionally, managing bander stent-related complications is less invasive with lower rate of readmission postoperatively compared to managing DJ stent-related ones.

V09-08 LAPAROSCOPIC BILATERAL URETERO-ILEAL RE-IMPLANTATION AFTER OPEN RADICAL CYSTECTOMY: STEP BY STEP

You have accessJournal of UrologyCME1 Apr 2023V09-08 LAPAROSCOPIC BILATERAL URETERO-ILEAL RE-IMPLANTATION AFTER OPEN RADICAL CYSTECTOMY: STEP BY STEP Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, Carlos Oliveira, Mário Cerqueira-Alves, João Pimentel Torres, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Mário Cerqueira-AlvesMário Cerqueira-Alves More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) with urinary diversion (UD) is the gold-standard treatment for muscle-invasive bladder cancer. Ureteroenteric (UE) anastomotic stricture is a known complication, with sequelae such as kidney injury (KI) and urinary tract infection (UTI), requiring intervention. UE strictures present multifactorial etiology, yet, periureteral fibrosis and scarring secondary to ischemia or urine leakage at the anastomotic site are thought to be the main reasons. Classical open revision was the gold-standard for these strictures; however, minimally invasive approaches are arising. METHODS: An open RC (ORC) with Bricker UE anastomosis in ileal conduit (IC) complicated with bilateral stricture after 2 months (M). Patient presented recurrent UTI and KI, so, bilateral percutaneous nephrostomies (PN) were placed. Endoscopic balloon dilation was attempted, but impossible on the left. Thus, we performed a laparoscopic (lap) 5-port bilateral UE re-implantation due to uretero-ileal stenosis, 6.5M after ORC. RESULTS: Extensive peritoneal adhesions and fibrotic peri-ureteral tissue were found. Identification of anatomical landmarks, careful dissection and structures release was done. After IC release, we dissected the right ureter (the least fibrotic and with previous mono J stent) until the uretero-ileal junction. The left ureter revealead marked fibrosis and devascularization. After maximum fibrosis excision and ureteral spatulation, we performed an UE Bricker re-implantation over 7Ch mono J stents, using 4-0 Vicryl in 8 simple interrupted sutures, bilaterally. On the right, we used the previous site on the IC for re-implantation. On the left, due to fibrosis, we chose a different location. Operative time was 2 hours. Stents were removed after 4 weeks (right) and 2M (left). Patient had some UTI, but remains stents-free 9M after. CONCLUSIONS: Laparoscopy allows direct visualization of known UE anastomosis issues that contribute to strictures: ureteral skeletonization with blood supply compromise leading to ischemia; not tension-free and water-tight anastomosis, facilitating urine leak; tension and angled pathway of left ureter under the sigmoid mesocolon. In re-implantation surgery, correcting these problems is challenging, but essential for success. Careful dissection, using traction and counter-traction, anatomical planes and structures correct identification and preservation is mandatory. After maximum possible excision of fibrosis, suture with mucosa apposition rather than strangulation is required for a quality UE anastomosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author Carlos Oliveira More articles by this author Mário Cerqueira-Alves More articles by this author João Pimentel Torres More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes of Uretero-ileal Anastomosis in Bladder Cancer Cystectomies: Bricker vs. Wallace 1.

BackgroundThe two commonly used methods for uretero-ileal anastomosis (UIA) during radical cystectomy for muscle-invasive bladder cancer (MIBC) are the Bricker and Wallace 1 techniques. Published data on the incidence of strictures at anastomotic sites is limited. This study compares both anastomotic techniques in terms of uretero-ileal stricture (UIS) rates and the factors that govern it in the patient group.Material and methodsRecords of all patients presenting with bladder cancer who underwent radical cystectomy at the department of uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) Lahore, Pakistan, from January 1, 2009, to December 31, 2018, were reviewed retrospectively, and all adult patients aged >18 years out of them were selected for the study.ResultsWith a total of 116 patients, the mean age was 54.37 ± 11.16 and a male majority (83.6%). Urinary diversion using ileal conduit was performed in 70 (60.3%) patients and the rest of them i.e. 46 (39.7%) had neobladder formation. Amongst them, uretero-ileal anastomosis was constructed via Bricker and Wallace 1 in 73 (62.9%) patients and 43 (37.1%) patients respectively. Pelvic radiotherapy was received by 13 (11.2%) patients. Anastomotic stricture developed in 19 (16.4%) cases. A relatively similar proportion of stricture rate was found in Bricker and Wallace 1 technique (10% vs 13%). Body mass index (BMI) was found to be significantly higher in patients who developed UIS. Incidence of stricture formation was more on the left than right side i.e. 12 (63.2%) vs five (26.3%) while two (10.5%) patients developed bilateral strictures.ConclusionNo significant difference in stricture formation was noted between Bricker and Wallace 1 technique. High BMI and anastomotic leaks were the contributory factors for this complication during our experience.

Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches.

The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis(36.5%) and spinal cord injury(25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.

Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center

IntroductionUreteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. Material and methodsDescriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student’s t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. ResultsThe study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). ConclusionSurgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Evaluation of Galdakao-modified Valdivia Position in Combined Simultaneous Access to Upper and Lower Urinary Tract Pathologies

Abstract Background Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced. Aim of the Work To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units. Patients and Methods The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019. Results The study has included 60 patients comprising males and females. Conclusion We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate.

We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.

MP58-16 RADICAL CYSTECTOMY WITH JUNIOR RESIDENTS: LONGER DAYS, EQUIVALENT OUTCOMES

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-16 RADICAL CYSTECTOMY WITH JUNIOR RESIDENTS: LONGER DAYS, EQUIVALENT OUTCOMES Joshua Linscott, Randie White, Stephen Ryan, Moritz Hansen, Jesse Sammon, and Matthew Hayn Joshua LinscottJoshua Linscott More articles by this author , Randie WhiteRandie White More articles by this author , Stephen RyanStephen Ryan More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Jesse SammonJesse Sammon More articles by this author , and Matthew HaynMatthew Hayn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is known to be a highly morbid, complex, and technically challenging operation. At academic centers, the assistant is traditionally a chief or senior resident. Our institution has one urology resident per year and annually performs a total of 40-50 open or robotic radical cystectomies. This leads to junior residents (PGY2, PGY3) frequently participating as the primary assistant. Here we explore the impact of resident experience level on operative, hospital, and post-operative outcomes in RC. METHODS: A single institution, prospectively maintained database identified 159 consecutive patients who underwent open or robotic RC from 2015-2019. Resident involvement was recorded in 154 cases. Operative time, estimated blood loss (EBL), intraoperative transfusion, length of stay (LOS), in hospital complication, complications in 90d, readmission at 90d, and urinary diversion complications (eg uretero-ileal stricture) were compared between junior (PGY2 & PGY3) and senior (PGY4 & PGY5) residents. Patient demographics including age, sex, BMI, neoadjuvant chemotherapy, and ASA score were examined. Statistical analysis was performed with SPSS. RESULTS: Over a 5-year period, junior residents assisted in 53 of 154 cases (34%) where a resident was involved. The number of cases done by PGY2, PGY3, PGY4, & PGY5 residents was 6, 47, 44, and 57, respectively. The percentage of open versus robotic cases was similar. There were no differences in examined patient demographics between groups. Cases with junior residents took 29.1 min (CI 3.4-54.8, p=0.027) longer than when a senior resident was present. No other significant differences between the two groups were seen when comparing EBL, intraoperative transfusion, surgical margin status, LOS, in hospital complication, 90d complication, 90d readmission, or urinary diversion complication (Table 1). CONCLUSIONS: RC remains a challenging urologic operation demanding technical excellence. Our data suggests participation by junior residents increases the length of operation by ∼10% (29.1 min) but does not negatively impact patient outcomes. We propose this is explained by increased time required for teaching and oversight from the attending surgeon, which allows junior residents to participate in a complex surgery without increasing the risk to the patient. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e994-e994 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Linscott More articles by this author Randie White More articles by this author Stephen Ryan More articles by this author Moritz Hansen More articles by this author Jesse Sammon More articles by this author Matthew Hayn More articles by this author Expand All Advertisement Loading ...

Estenosis de la anastomosis ureteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel

IntroductionUreteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. Material and methodsDescriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. ResultsThe study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). ConclusionSurgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy

BackgroundThe aim of this study is to describe a modified technique in ileal orthotopic bladder substitution with a new ureteroileal anastomosis.Case presentationAfter a classic open radical cystectomy with bilateral pelvic lymphadenectomy was performed extraperitoneally, a 56-cm ileal segment was used to construct the spheroidal shape bladder substitution. The 8-cm long proximal and distal ends of the ileal segment were used as afferent limbs. Two-centimeter ileal segments of afferent limbs were detubularized and transversally tubularized. The elongated ileal tube was anastomosed with the ureter in an end-to-end fashion. The pathway of the ureteroileal anastomosis was placed between the abdominal cutaneous fat and the anterior rectus muscular sheath. Perioperative data and long-term functional outcomes were assessed. Between December 2011 and December 2015, seven male patients underwent this procedure with a median 46 (30–77) months follow-up in our hospital. There was no difference between preoperative and postoperative estimated glomerular filtration rates (Z = − 1.693, P = 0.09). One of 14 sides had ureteroileal anastomotic stenosis; two of 14 sides in one patient had ureteroileal anastomotic stenosis caused by invasion of pelvic recurrence 15 months postoperatively. Reflux was completely prevented by placing pressure on the corresponding point on the abdominal surface when voiding urine in all patients.ConclusionsWe describe a feasible technique modification in detail, which provides some advantages for effective anti-reflux by mechanical finger pressing and abdominal contraction, a low incidence of stricture, and ease for a secondary operation in the long-term follow-up period.

ANTIREFLUX URETEROILEAL ANASTOMOSIS FOR ORTHOTOPIC ILEAL NEOBLADDER USING WALLACE TECHNIQUE IN A SINGLE TROUGH

Background: The creation of antireflux mechanism for ureteroileal anastomosis in a low- pressure pouch is controversial and benefits should be weighted by possible morbidity. Different techniques were used as antireflux to preserve the upper urinary tract. Aim of the Work: to evaluate a modification of the subserous extramural tunnel for non-refluxing uretero-ileal anastomosis in orthotopic diversion using Wallace technique in a single trough after 2-year-duration follow up in terms of uretero-ileal anastmosis stricture, reflux and urinary tract infections. Patients and Methods: In all, 100 patients underwent orthotopic urinary diversion after radical cystectomy. Inclusion criteria included age from 30 to 65 years old, negative positive urethral margin, serum creatinine less than 2 mg/dl and tumor stage T2-T3. Exclusion criteria were stricture urethra, single kidney and poor performance status. Patients were followed up by serum creatinine, pouchogram, renal ultrasound and intravenous pyelogram if serum creatinine below 1.5 mg/dl. Results: In all, 2 patients missed follow up and 98 patients were evaluable over 24 months. Mean serum creatinine raised from 1.16 preoperative to 1.20 after 2 years. Reflux has been detected in 3 patients while stricture has affected 3 patients. 9 patients had symptomatic urinary tract infections or being infected with organism other than E.coli that necessitated admission and parenteral antibiotics; three of which were advised to do clean intermittent catheterization. Conclusion: Combining serous-lined extramural tunnel and Wallace techniques is an effective technique and has a comparable result to the other antirefluxing techniques in terms of ureteroileal stricture, reflux and acute pyelonephritis.

Morbidité, résultat fonctionnel, et qualité de vie des néovessies après cystectomie pour cancer : comparaison de la voie ouverte vs robotique

Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming. To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol). From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC. We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P<0.001) but length of stay was 5 days shorter (median 12 vs 17 days; P<0,05). Patients in RARC group had less blood transfusion (0 vs 23.6%; P<0.05), but a higher rate of uretero-ileal anastomosis stenosis and eventration at long term (respectively 25.5 vs 3.6% et 23 vs 2%; P<0.05). No statistical differences were found concerning quality of life items and functional results between the groups. RARC with totally IC ONB reconstruction lead to less perioperative morbidity with a reduced rate of blood transfusion and a reduced hospital length of stay. At long term, RARC could provide higher rates of uretero-ileal stenosis and eventration. RARC and ORC do not have any differences in terms of functional outcomes and Qol at long term after ONB reconstruction. 3.

Comparison of perioperative outcomes and complications of robot assisted radical cystectomy with extracorporeal vs intracorporeal urinary diversion

ObjectivesTo compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer. Material and methodsRetrospective revision of 43 patients who underwent RARC for bladder cancer between 2015 and 2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy. ResultsForty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44–83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360min (240–540) and length of hospital stay was 12 days (7–73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, p=0.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, p=0.044). ConclusionsRARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.

Comparación de los resultados perioperatorios de la cistectomía radical asistida por robot con derivación urinaria extracorpórea vs. intracorpórea

ObjectivesTo compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer. Material and methodsRetrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy. ResultsForty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P=.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P=.044). ConclusionsRARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.

Re: Endo-Urological Techniques for Benign Uretero-Ileal Strictures Have Poor Efficacy and Affect Renal Function.

Re: Endo-Urological Techniques for Benign Uretero-Ileal Strictures Have Poor Efficacy and Affect Renal Function.

1095 - Rational renographic approach for the evaluation of uretero-ileal stenosis

1095 - Rational renographic approach for the evaluation of uretero-ileal stenosis

52] Treatment of uretero-ileal stenosis after dilatation catheter cystectomy: Monocentric study

ObjectiveTo evaluate the treatment of uretero-ileal stenoses after dilatation catheter bladder tumour cystectomy in the Department of Urology, Ehu Oran, Algeria, as the dilatation catheter has been proposed as an alternative to open surgery in the treatment of uretero-ileal stenosis due to its low morbidity.

Impact of Thermo-Expandable Memokath Ureteral Stent on Renal Function in the Management of Ureteroileal Anastomotic Stricture

Purpose: The study aimed to assess the impact of the Memokath 051 stent (MK) on glomerular filtration rate (GFR) and split renal function in the management of ureteroileal anastomotic strictures. Materials and Methods: We treated 6 patients in the ages of 66–77 years, 2 of whom had bilateral strictures, with a total of 8 ureteroileal strictures using the MK stent. Five patients had chronic kidney disease (CKD) prior to MK insertion. Mean time between conduit surgery and MK insertion was 28.4 months. Serum creatinine, GFR, and MAG-3 renography were determined before stent insertion and postoperatively at 3 months. Results: Postoperative complications at 3-month follow-up included migration in 2 patients, occlusion in 2 patients, and urinary tract infection in 4 patients. The mean stent indwelling time was 353.4 ± 169.3 days. Mean preoperative creatinine, GFR, right, and left split renal function were 158.3 ± 76.3 μmol/L, 43.6 ± 32.9 mL/min/1.73 m², 52.8 ± 22.2%, and 47.1 ± 22.2%, respectively. Mean postoperative values were 168.1 ± 84 μmol/L (p = 0.84), 40.8 ± 28.4 mL/min/1.73 m² (p = 0.56), 51.1 ± 18.3% (p = 1), and 48.8 ± 18.3% (p = 1), respectively. Conclusion: MK stent is a safe and efficient minimally invasive long-term treatment option to preserve GFR in patients who develop CKD through ureteroileal anastomotic stricture. In spite of MK stent insertion and alleviation of obstruction, it was presumably inserted too late to improve renal function.

MP49-11 DOES RADIATION EXPOSURE PORTEND WORSE POSTOPERATIVE OUTCOMES AFTER CYSTECTOMY WITH URINARY DIVERSION FOR BENIGN INDICATIONS?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2018MP49-11 DOES RADIATION EXPOSURE PORTEND WORSE POSTOPERATIVE OUTCOMES AFTER CYSTECTOMY WITH URINARY DIVERSION FOR BENIGN INDICATIONS? Paurush Babbar, Andrew Sun, Ann Kim, Daniel Hettel, Shree Agrawal, Alice Crane, Daniel Sun, Ryan Berglund, Hadley Wood, and Kenneth Angermeier Paurush BabbarPaurush Babbar More articles by this author , Andrew SunAndrew Sun More articles by this author , Ann KimAnn Kim More articles by this author , Daniel HettelDaniel Hettel More articles by this author , Shree AgrawalShree Agrawal More articles by this author , Alice CraneAlice Crane More articles by this author , Daniel SunDaniel Sun More articles by this author , Ryan BerglundRyan Berglund More articles by this author , Hadley WoodHadley Wood More articles by this author , and Kenneth AngermeierKenneth Angermeier More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1602AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative radiation exposure is traditionally thought to correlate with increased postoperative complications after cystectomy with urinary diversion (CxUD) for benign indications. We assessed postoperative outcomes among patients who received CxUD, stratified by radiation exposure. METHODS A retrospective review of patients undergoing CxUD over a 10 year period encompassed demographics, operative parameters, 30 and 90 day readmission and complications. CxUD for malignant indications and in patients below 18 years of age were excluded. Chi-square and t-test analyses assessed demographics and indications. Complications were measured by univariate and multivariate logistic regression models. RESULTS Among 103 patients, 39 (38%) had radiation exposure prior to CxUD. Mean age for patients with radiation exposure undergoing cystectomy and urinary diversion was significantly higher (69.8 vs 59.7 years, p=0.001). In patients receiving preoperative radiation, 23.1% (9/39) had congestive heart failure (p=0.005). Other preexisting conditions such as diabetes, previous myocardial infarction, renal disease and liver disease were not associated with radiation exposure. Operative time (p=0.861), estimated blood loss (p=0.756) and length of stay (p=0.776) were not associated with radiation exposure. There was a significant correlation between radiation exposure and having a preoperative diagnosis of genitourinary fistulae (p=0.001), neurogenic bladder (p<0.0001) and urethral stricture (p=0.002). Radiation exposure did not correlate to readmission at 30 days (p=0.256) or at 90 days (p=0.576). Ureteroileal strictures requiring interventional radiology procedures were observed in 6 patients (5.8%) and stomal stenosis was seen in 2 patients (1.9%). Neither variable was correlated with radiation exposure (p=0.27 and p=0.265, respectively). CONCLUSIONS In spite of patients being older with more comorbidities at baseline, patients with preoperative radiation exposure undergoing CxUD for benign indications did not have increased readmission at 30 or 90 days or increased complications postoperatively. Additionally, operative parameters such as surgery time, estimated blood loss and length of stay were similar between radiation and naïve patient groups. These findings suggest radiation exposure prior to CxUD may not portend as negative consequences as once thought. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e670 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Paurush Babbar More articles by this author Andrew Sun More articles by this author Ann Kim More articles by this author Daniel Hettel More articles by this author Shree Agrawal More articles by this author Alice Crane More articles by this author Daniel Sun More articles by this author Ryan Berglund More articles by this author Hadley Wood More articles by this author Kenneth Angermeier More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...