Ureteroileal Anastomosis Research Articles

Outcome of Radical Cystectomy With Urinary Diversion at Nicrh, Bangladesh

Introduction: Radical Cystectomy (RC) is an effective surgical procedure for muscle invasive bladder cancer ( MIBC). 5 years disease free survival after RCs are PT2 - 81%, PT3a – 68%, PT3b – 47%, PT4a – 44% respectively, Stein et al, 2001[1]. In this study early surgical & oncological outcome have been assessed. Patients & methods: A total of 24(N) patients underwent radical cystectomy with urinary diversion between December 2013 to June 2016. Age ranges from 41-69 years. Indications were T2HG for twenty cases and T1HG for four cases. Among the T1 tumours, one had early recurrence, one had numerous tumours and two had multiple tumours with concomitant CIS. Urinary diversion methods were: Orthotopic Ileal neobladder-1, Ileal conduit-20, Cuteneous Ureterostomy -3 (2 due to unhealthy mesentry with gut, 1 single kidney with poor general condition), For uretero-Ileal anaestomosis we used Bricker method in all cases. Result: Mean OR time was 3:45 hours, blood loss average 350 ml, hospital stay after operation 9 days, enlarged pelvic lymph nodes were found in two cases. In follow up we found,stomal stenosis of cutaneous ureterostomy in 1 out of 3 cases, Ileal conduit prolapse with para-stomal hernia in 1 out of 20 cases, stenosis at uretero-Ileal anastomosis in 1 pt. .Distant recurrence occurred in two cases, one in Lt. Supraclavicular LN and another in sacrum near SI joint. No local recurrence was found in any case. Conclusion: Our experience on RC and all the three types of UD are safe and effective for patient and encouraging for us. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.62-65

SC288 - Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion

To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD). We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy. 210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases. Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers.

Oral 13 - A Novel Technique in Uretero-Ileal Anastomosis: An Illustrated Description and Case Series

Oral 13 - A Novel Technique in Uretero-Ileal Anastomosis: An Illustrated Description and Case Series

Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion

Introduction and objectivesTo evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).Materials and methodsWe prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy.Results210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases.ConclusionsOur study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers.

Bladder cancer - complications related to urinary diversion

Even today, radical cystectomy with urinary diversion is one of the most complicated procedures in uro-oncology. Particularly in the long-term course, but also perioperatively, problems caused by urinary diversion play a significant role.Perioperatively, gastrointestinal problems such as an ileus, but also infections and early complications of the different anastomoses are most important. While ileus and perioperative infections can usually be treated conservatively, failure of the intestinal or ureteroileal anastomoses require regular surgical revisions.In the long-term follow-up, scarring can lead to chronic obstruction of urinary flow and, in the case of continental urinary diversions, to stone formation. These complications, as well as parastomal hernias in patients with poor conduits, may require further therapy. Functional bowel disorders may impair patients' quality of life significantly.Improved preoperative preparation and accompanying measures during the inpatient stay can significantly reduce non-surgical complications.Cystectomy with therapy-associated morbidity is a classical example of when surgery must be performed at specialised centers to reduce complications perioperatively as well as in follow-up.

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.

V12-05 ROBOTIC INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION: TIPS AND TRICKS

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-05 ROBOTIC INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION: TIPS AND TRICKS Akbar Ashrafi*, Rutveej Patel, Luis Medina, Andre de Castro Abreu, Andre Berger, Monish Aron, Inderbir Gill, and Mihir Desai Akbar Ashrafi*Akbar Ashrafi* More articles by this author , Rutveej PatelRutveej Patel More articles by this author , Luis MedinaLuis Medina More articles by this author , Andre de Castro AbreuAndre de Castro Abreu More articles by this author , Andre BergerAndre Berger More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, there has been a trend towards increasing use of completely intracorporeal ileal conduit urinary reconstruction after robotic-assisted cystectomy. METHODS: This video provides a step-by-step approach to robotic ileal conduit urinary diversion. The key steps of the procedure are as follows: 1) patient positioning and port placements; 2) identification of the ureters and bowel segment; 3) isolation of the bowel segment to be used for the conduit; 4) discarding a segment of bowel if required; 5) side-to-side bowel anastomosis; 6) Closure of the open end of the side-to-side anastomosis; 7) ureteroileal anastomosis over a ureteral stent 8) Fashioning of the stoma in the usual rose-bud manner. RESULTS: Some of the useful tips we recommend are to 1) use Cadiere forceps throughout the diversion to facilitate atraumatic handling of bowel and ureter; 2) use the 4th arm to hold up the distal end of the conduit to ensure adequate length and mobility; 3) elevate the tip of the laparoscopic stapler to ensure no bowel or mesentery has been entrapped before firing every time; 4) introduce the stapler from the lateral assistant port for all bowel work except the final load to close the open end of the side-to-side anastomosis; 5) use a suture to mark the bowel segments to be used for the anastomosis as soon as the bowel is divided; 6) consider discarding a small segment of bowel proximally to improve conduit mobility; 7) use ICG to assess ureteral vascularity before excising the distal ureter and completing the uretero-ileal anastomosis; 8) Use a double J stent through a miniport to simplify stent placement and minimize risk of stent extrusion. CONCLUSIONS: Completely intracorporeal robotic ileal conduit urinary reconstruction can be a challenging procedure. In this video, we provide a standardized step-by-step approach to this procedure with some tips and tricks to avoid common pitfalls and improve efficiency. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1111-e1111 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akbar Ashrafi* More articles by this author Rutveej Patel More articles by this author Luis Medina More articles by this author Andre de Castro Abreu More articles by this author Andre Berger More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

MP41-08 URETERAL SUBSTITUTION WITH INTESTINAL SEGMENTS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-08 URETERAL SUBSTITUTION WITH INTESTINAL SEGMENTS Boris Komyakov, Viktor Ochelenko*, and Husam Mhanna Boris KomyakovBoris Komyakov More articles by this author , Viktor Ochelenko*Viktor Ochelenko* More articles by this author , and Husam MhannaHusam Mhanna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral substitution with ileum and appendix remains a technique of choice in patients with extended ureteral strictures, but data about long-term results and complications of these interventions is still limited. The aim of this study is to examine the long-term efficacy and safety of these procedures on the basis of 170 ureteral substitutions with ileum and appendix. METHODS: From 2001 to 2019 170 patients underwent ureteral substitution with ileum – 144 (84.7%) and appendix - 26 (15.3%) at our clinic. 31 (19.3%) patients underwent laparoscopic reconstruction of ureter: 27 (15.9%) - with ileal segment and 4 (2.4%) – with appendix. There were 105 (61.7%) women and 65 (38.3%) men with a median age of 53.6 ± 9.3 years (range from 18 to 69 years). The main causes of ureteral strictures were: retroperitoneal fibrosis following radiation therapy, colorectal and gynecological cancer surgery. All patients underwent long-term follow-up including routine laboratory analysis and urinary tract imaging. Outpatient visits occurred at 3 and 6 months postoperatively and at least annually thereafter. RESULTS: The follow up period was from 3 months up to 18 years (mean 8.5±0.8 years). Postoperative complications developed in 16 (9.4%) cases. Short-term complications (less than 30 days postoperatively) occurred in 12 (7.1%) patients and included: intestinal obstruction -4 (2.4%), ileal graft mesentery thrombosis -2 (1.2%), bleeding -2 (1.2%), and acute pyelonephritis – 4 (2.4%). Late complication – stricture of uretero-ileal anastomosis developed in 4 patients (2.4%) in 3 months after operation. Thus, the complications which have required surgical treatment occurred at 12 (7.1%) patients. The results of all operations were successful. According to all patients the renal function was restored. There were no cases of metabolic acidosis. CONCLUSIONS: Ileal and appendicular ureteral reconstruction is a safe and efficacious procedures in patients with extended and multiple ureteral strictures. During long-term follow-up major complications are rare and renal function remains good. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e597-e598 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boris Komyakov More articles by this author Viktor Ochelenko* More articles by this author Husam Mhanna More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term evaluation of modified orthotopic Y-shaped ileal neobladder (Tanta pouch) with left retro-colic chimney.

In the present study, we evaluated the long-term results of modified Y-shaped orthotopic ileal neobladder (Tanta pouch) with trans-mesenteric left retro-colic chimney. A total of 70 patients with invasive bladder cancer underwent radical cystectomy and modified Y-shaped orthotopic ileal neobladder. (The left chimney elongated to pass to the left side through a window in the mesentery of the pelvic colon and the ureters were implanted directly end to side, in both chimneys after doing good spatulation. The mean follow-up period ranged between 7 and 10years (mean 7.8years). 18 patients died during the period of follow-up. 6months postoperatively, there was a spherical orientation of the pouch (The mean capacity was 542 ± 47cm3) and the maximum intra-pouch pressure was 24 ± 3.2cm H2O. Daytime continence was achieved in 93% of the patients and nighttime continence was achieved in 87%. Stress incontinence occurred in 15% and total incontinence in 2%. Renal function was stable in 93% of renal units. Stricture ureter was not recorded of any case. Of 14 renal units with preoperative dilated ureters, 5 units had improved postoperatively and the others had persistent reflux. 13 renal units (3 unilateral and 5 bilateral) with normal preoperative ureters had persistent postoperative reflux. Persistent reflux showed no influence on renal function. Modified Y-shaper pouch is suitable for short, dilated ureters. Longitudinal orientation of the pouch facilitates ileo-urethral anastomosis, especially with short mesentery. Long-term follow-up for direct uretero-ileal anastomosis did not show deterioration of the renal function.

Transitional cell carcinoma recurrence impacting intestinal diversion after radical cystectomy. Oncologic outcomes of a rare site of recurrence.

IntroductionTransitional cell carcinoma recurrence within an intestinal urinary diversion (TCCUD) after radical cystectomy (RC) is a rare condition with unknown origin, prognosis and treatment. The aim of this study was to describe treatment options and oncologic outcomes of this understudied site of recurrence in a multi-institutional case series.Material and methodsTCCUD relapse cases after RC were investigated in a retrospective, multi-institutional study. Surgical approach and adjuvant chemotherapy were discussed. Early and late complications were described according to the Clavien-Dindo classification. Kaplan-Meier method was used to assess progression-free and cancer-specific survival.ResultsA total of 19 patients were selected. The most common presentation was gross hematuria. The median interval between RC and TCCUD was 51.2 months. Fifteen patients (78.9%) underwent surgical excision, and two underwent concomitant radical nephroureterectomy. In 12 (63.1%) cases the site of TCCUD was the uretero-ileal anastomosis. Tumor invading the muscularis of the intestinal diversion was described in 10 (52.6%) cases. Surgical complications occurred in 7/15 (46.6%) patients, of these two with Clavien-Dindo Grade III. Four patients (21.0%) underwent adjuvant chemotherapy and two (10.5%) both chemotherapy and radiation therapy. During follow-up 15 patients (78.9%) presented with other sites of recurrence, with lymph nodes (21.0%) and liver (15.7%) being the most common localizations. Recurrence free and overall survival rates were 36.8% and 15.8%, and 56.5% and 24.2%, respectively at 12 and 18 months.ConclusionsMost patients with TCCUD have invasive disease and a substantial percentage experience upper tract cancer during their disease course. TCCUD is often the herald of advanced disease and systemic progression, with poor progression-free and overall survival rates.

Oncological Outcomes and Morbidity of Radical Cystectomy for Bladder Cancer: Experience of a Senegalese Centre

The purpose of this paperwork is to assess the oncological findings and the morbidity rate after complete cystectomy in our department. Patients and methods: We conducted a backward and descriptive study during a 80-month-period range from September 2011 to May 2018, in the Urology Department of Aristide Le Dantec Teaching Hospital standing as a referral structure in our country (Senegal). Results: Nineteen patients were included accounting for 13 men and 6 women corresponding to a sex ratio of 2. The mean age was at 58 years old (extremes range from 32 to 77 years old). Radical cystectomy consisted of an anterior pelvectomy and transileal cutaneous ureterostomy by Bricker approach in 6 women, a radical cystoprostatectomy with transileal cutaneous ureterostomy by Bricker approach in 12 men and a radical cystoprostatectomy followed by Studer orthotopic neobladder in 1 patient. Early post-operative morbidity consisted of one case of parietal suppuration (grade I), two cases of evisceration (grade IIIb), one case of digestive fistula (grade IIIb), and uroperitoneal peritonitis (grade IIIb) secondary to suture loosening of the uretero-ileal anastomosis (which occurred in the patient who had Studer neobladder). This patient died in resuscitation ward after surgical repair of the uretero-iliary anastomosis. Late complications were a case of acute pyelonephritis three months after cystectomy and a case of flanged occlusion. Two patients with urothelial carcinoma had received adjuvant chemotherapy using the M-VAC protocol. After an average follow-up of 15 months we recorded 13 deaths, three patients were lost of sight and three others respectively lived 4 years and 2 months, 5years and 8 months and 6years and 8 months after radical cystectomy. Mean overall survival was 15 months (4.2 to 25.8 months) with a median survival of 6 months. The only patient who had Studer neobladder died one week after cystectomy. The mean overall survival after previous pelvectomy was 17.2 months and that after cystoprostatectomy was 15.18 months. Conclusion: This work highlights the very poor prognosis of bladder cancers in our context linked to the advanced stage of tumours at the time of diagnosis, the rarity of endoscopic equipment essential for the diagnosis, treatment and monitoring of bladder cancers, the frequency of radiochemically resistant squamous cell carcinoma, the unavailability of chemotherapy in urothelial carcinoma to enable multimodal treatment, and the heaviness and complexity of radical cystectomy.

New Technique for Uretero-ileal Anastomosis for Patient With Bladder Cancer Who Are Suitable for Orthotopic Neobladder

New Technique for Uretero-ileal Anastomosis for Patient With Bladder Cancer Who Are Suitable for Orthotopic Neobladder

Internal double-J stent was associated with a lower incidence of ureteroileal anastomosis stricture than external ureteral catheter for patients undergoing radical cystectomy and orthotopic neobladder: A systematic review and meta-analysis.

Proper techniques used in procedures might play an important role in reducing ureteroileal anastomosis stricture (UIAS) for patients undergoing orthotopic neobladder. The present study was to evaluate the efficacy of internal double-J stent versus external ureteral catheter on UIAS for patients undergoing radical cystectomy and orthotopic neobladder. A comprehensive search of the literature referring to the topic was performed on 10th January 2019 in PubMed, EMBASE and Google Scholar, by using key words as radical cystectomy, orthotopic neobladder, stricture, stenosis. The Cochrane Collaboration's RevMan 5.3 software was employed for data analysis. The incidence of UIAS was evaluated as primary outcome. Five studies were included eventually. The incidence of UIAS was lower in the group of internal double-J stent than that in the group of external ureteral catheter (odds ratio [OR], 0.49; 95% CI, 0.25-0.97; p = 0.04) with a low heterogeneity (I2 = 0%). Besides, internal double-J stent group had a trend of a shorter length of stay than external ureteral catheter group. Based on the present meta-analysis, internal double-J stent placement was associated with a lower incidence of UIAS than external ureteral catheter for patients undergoing orthotopic neobladder. In addition, a trend of a shorter hospital stay was also detected, thus, internal double-J stent placement may be favored in the view of the enhanced recovery after surgery (ERAS).

Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer

BackgroundTo evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis.MethodsA total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up.ResultsSeventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m2 Bricker and 26.4 kg/m2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant (p = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m2, p = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group (p = 0.6) to develop stricture.ConclusionsThe stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.

Transnephrostomic Indocyanine Green-Guided Robotic Ureteral Reimplantation for Benign Ureteroileal Strictures After Robotic Cystectomy and Intracorporeal Neobladder: Step-By-Step Surgical Technique, Perioperative and Functional Outcomes.

Objectives: To describe our surgical technique of robotic ureteroileal reimplantation (RUIR) for ureteroileal anastomosis strictures with the use of near-infrared fluorescence imaging (NIFI) after transnephrostomic antegrade injection of indocyanine green in patients previously treated with robot-assisted radical cystectomy and intracorporeal orthotopic neobladder. Materials and Methods: From March 2015 to December 2017, 10 consecutive patients underwent RUIR in our tertiary referral center. All patients previously underwent percutaneous nephrostomy and at least one antegrade stenting and stricture dilatation attempt. Clinical data were prospectively collected into our institutional dataset. Both perioperative and functional outcomes were assessed. Results: Median time from robotic cystectomy to ureteroileal anastomosis strictures diagnosis was 5 months (interquartile range [IQR] 2-6). Median stricture length was 1.5 cm (IQR 1-2). Median operative time was 140 minutes (IQR 81-155), and median length of stay was 5 days (IQR 3-9). Two patients experienced Clavien grade 2 complications (urinary tract infection requiring antibiotics and blood transfusion, respectively). One patient underwent ileum resection and anastomosis due to bowel perforation (Clavien IIIb). At a median follow-up of 19 months (IQR 14-39), one patient developed a stricture recurrence. No patient developed worsening of renal function (newly onset chronic kidney disease stage 3b-4). Conclusions: Robotic reimplantation for ureteroileal anastomosis strictures is a safe and highly effective procedure, with a high success rate and excellent perioperative and functional outcomes. NIFI provides an easy guide to identify and progressively dissect the ureter.

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.

An improved ileal conduit surgery for bladder cancer with fewer complications

BackgroundRadical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer. Although this approach prolongs patient survival remarkably, there are postoperative complications associated with urinary diversion. This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma- and ureteroileal anastomosis-related complications, as compared with conventional ileal conduit urinary diversion.MethodsWe retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1, 2000 and June 30, 2016. Ileal conduit was created by the conventional or a modified technique. The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test. Multivariable logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma- and ureteroileal anastomosis-related complications in the two groups.Results145 and 100 patients underwent the modified and conventional ileal conduit surgery, respectively. The two groups were comparable with regard to clinicopathologic features. The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (0.7% vs. 17.0%, P < 0.001). No late stoma-related complications were seen in the modified ileal conduit group, but were seen in 13 (13.0%) patients in the conventional ileal conduit group. The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (4.8% vs. 15.0%, P = 0.001). In multivariable analyses, the modified ileal conduit group was significantly less likely to develop stoma- (odds ratio [OR] = 0.024, 95% confidence interval [CI] 0.003–0.235; P = 0.001) or ureteroileal anastomosis-related complications (OR = 0.141, 95% CI 0.042–0.476; P = 0.002) than the conventional ileal conduit group.ConclusionsOur modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis. Prospective randomized clinical trials are needed to confirm our results.

Сравнительный анализ результатов экстра- и интракорпорального формирования мочевого резервуара при эндовидеохирургической радикальной цистэктомии

The aim of the study is to compare the results and complications of muscle- invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation. Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden). In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases - Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis. Due to medical technologies development and endovideo-surgical equipment improving, it became possible to perform high-technological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.

Radical cystectomy and W-shaped ileal orthotopic neobladder reconstruction with serosa-lined tunneled ureteroileal anastomoses: A critical analysis of the short-term voiding patterns and urodynamic and functional outcomes.

Introduction:We present the short-term voiding patterns and functional and urodynamic outcomes of W-shaped ileal orthotopic neobladder (ONB) following radical cystectomy (RC).Materials and Methods:Forty-one patients who underwent RC and W-shaped ONB creation between July 2015 and January 2018 were enrolled. Data were analyzed in terms of voiding patterns, urodynamic findings, and functional outcomes at 6 months after surgery. Pouch-related quality of life (QoL) was assessed using European Organization for Research and Treatment of Cancer (EORTC) Generic (QLQ C30), Bladder Cancer-Specific Instruments (QLQ BM30), and IONB–Patient-Reported Outcome (IONB-PRO).Results:The mean length of follow-up was 19.4 months. At first follow-up, three patients had developed acidosis and rising serum creatinine, and one of them required temporary hemodialysis. One patient developed urethral-pouch anastomotic stricture, which required bladder neck incision. Balloon dilatation was performed for ureteroileal anastomotic stricture and mesh repair for incisional hernia was required in one patient each. Upper tract changes were observed in two patients. During the first and second follow-up, maximum flow rate, voided volume, and postvoid residual urine were 12 ± 4.7 mL/s, 212 ± 120 mL, and 72 + 81 mL and 14.7 ± 5.3 mL/s, 254 ± 168 mL, and 123.7 ± 42.5 mL, respectively. The mean pouch capacity and compliance were 436 ± 103.5 mL and 50.6 ± 17.8 mL/cm H2O. No patient required clean intermittent catheterization for bladder emptying. In EORTC QLQ-C30 questionnaire, the “Cognitive” domain had the highest and “global QoL” domain had the lowest level of functional scores. “Nausea and vomiting and abdominal bloating and flatulence” domain had the lowest level and “financial difficulties and urinary symptoms” had the highest level of symptomatology in EORTC QLQ questionnaire. The IONB-PRO questionnaire showed the highest level of functioning in “relation life” and the lowest level in “emotional life” domain.Conclusion:The Ghoneim pouch has a low complication rate with near-normal voiding patterns with an acceptable QoL impairment.