Urinary Diversion In Patients Research Articles

Perioperative outcomes and continence following robotic-assisted radical cystectomy with mainz pouch II urinary diversion in patients with bladder cancer

PurposeTo present the widely unknown perioperative outcomes and continence status of bladder cancer patients following robotic-assisted radical cystectomy (RARC) with Mainz pouch II urinary diversion (UD).Materials and methodsFrom November 2020 to December 2023, 37 bladder cancer patients who underwent RARC with Mainz pouch II UD were retrospectively assessed (ChiCTR2300070279). The results, which included patient demographics, perioperative data, continence, and complications (early ≤ 30 days and late ≤ 30 days) were reported using the RC-pentafecta criteria. RC-pentafecta criteria included ≥ 16 lymph nodes removed, negative soft tissue surgical margins, absence of major (Grade III–IV) complication at 90 days, absence of clinical recurrence at ≤ 12 months, and absence of long-term UD-related sequelae. A numeric rating scale assessed patient satisfaction with urinary continence 30 days after surgery. The validated Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire was used to evaluate bowel function. The Kaplan-Meier curve was used to evaluate overall survival (OS).ResultsOf the 37 patients evaluated over a median (range) follow-up period of 23.0 (12.0-36.5) months. The median (range) age was 65 (40–81) years. The median (range) time to urinary continence after surgery was 2.3 (1.5-6) months. Of the 37 patients, 31 (83.8%) were continent both during the day and at night, 34 (91.9%) were continent during the day, 32 (86.5%) were continent at night, 35 (94.6%) were satisfied with their urinary continence status, and 21 (56.8%) were very satisfied. The mean (range) voiding frequency was 6 (4–10) during the day and 3 (2-5.5) at night. The mean (range) PAC-SYM total score was 9.50 (4.00–15.00). In 12 (32.4%) of the patients, RC-pentafecta was achieved, and achieving RC-pentafecta was linked to better satisfaction scores (7.3 vs. 5.5, p = 0.034). There was no significant difference between RC-pentafecta and No RC-pentafecta groups in terms of OS (25.6 vs. 21.5 months, p = 0.16). 7 (19.4%) patients experienced late complications.ConclusionsMainz pouch II UD following RARC in bladder cancer patients results in a satisfactory continence rate. Achieving RC-pentafecta was correlated with better satisfaction scores. The intracorporeal approach to Mainz pouch II UD is beneficial for female patients due to its reduced invasiveness.Trial registrationChiCTR2300070279; Registration: 07/04/2023, Last updated version: 01/06/2023. Retrospectively registered.

Urinary microbiota signatures associated with different types of urinary diversion: a comparative study.

Radical cystectomy and urinary diversion (UD) are gold standards for non-metastatic muscle-invasive bladder cancer. Orthotopic neobladder (or Studer), ileal conduit (or Bricker) and cutaneous ureterostomy (CU) are mainstream UD types. Little is known about urinary microbiological changes after UD. In this study, urine samples were collected from healthy volunteers and patients with bladder cancer who had received aforementioned UD procedures. Microbiomes of samples were analyzed using 16S ribosomal RNA gene sequencing, and microbial diversities, distributions and functions were investigated and compared across groups. Highest urine microbial richness and diversity were observed in healthy controls, followed by Studer patients, especially those without hydronephrosis or residual urine, α-diversity indices of whom were remarkably higher than those of Bricker and CU groups. Studer UD type was the only independent factor favoring urine microbial diversity. The urine microflora structure of the Studer group was most similar to that of the healthy individuals while that of the CU group was least similar. Studer patients and healthy volunteers shared many similar urine microbial functions, while Bricker and CU groups exhibited opposite characteristics. Our study first presented urinary microbial landscapes of UD patients and demonstrated the microbiological advantage of orthotopic neobladder. Microbiota might be a potential tool for optimization of UD management.

Postoperative complications and determinant of selecting non intracorporeal urinary diversion in patients undergoing robot-assisted radical cystectomy: an initial experience.

Robot-assisted radical cystectomy (RARC) with urinary diversion has become a standard surgical procedure because of its three-dimensional high-definition surgical field of view, flexibility, and stability. However, because of the highly complex steps of surgery, postoperative complications cannot be ignored. This retrospective, single-center, observational cohort study investigated the postoperative complications following RARC at a non-high-volume center in Japan. From August 2019 to March 2023, 50 consecutive patients who underwent RARC for histologically proven muscle-invasive bladder cancer (MIBC) or high-risk non-MIBC with an indication for radical cystectomy according to the Japanese Urological Association Guideline 2019 were included. Factors correlated with the selection of extracorporeal urinary diversion (ECUD) or cutaneous ureterostomy rather than intracorporeal urinary diversion (ICUD) for urinary diversion were also investigated. In total, 33 (66%) and 31 (62%) patients experienced complications during the first 90 and 30 days after RARC, respectively. Among them, 19 (38%) and 18 (36%) patients developed Clavien-Dindo classification G2 complications, and 12 (24%) and 11 (22%) developed G3 or higher (major) complications during the first 90 and 30 days after RARC, respectively. The most common complications were gastrointestinal complications (26%) and urinary tract infections (22%). Nine patients (18%) underwent surgical intervention within 90 days of undergoing RARC. Higher infusion volume during the operations was significantly correlated with the occurrence of major complications within 90 days (P=0.025) and 30 days (P=0.0158) after RARC. Nineteen patients (38%) underwent non-ICUD. Twelve patients received ECUD as an ileal conduit or neobladder, and among them, three patients received ECUD due to intraabdominal adhesion for previous abdominal surgery or radiation, while four patients received ECUD ileal conduit due to comorbidities and advanced cases (palliative surgery) to shorten the surgery time. Surgical complications related to the initial experience with RARC at a non-high-volume center in Japan cannot be ignored. Although this complicated surgical procedure requires a learning curve to achieve a stable rate of much fewer major complications after RARC, careful assessment of patients' status before surgery and critical postoperative management may reduce complication rates more quickly, even at non-high-volume centers.

Comparison of Urinary Diversion in Patients With Prostatic Fistula to Those with Localized Radiation Injury After Radiotherapy for the Treatment of Prostate Cancer

ObjectivesTo compare characteristics and outcomes in patients who had radiotherapy (RT) for prostate cancer (PCa) and underwent urinary diversion (UD) due to prostatic fistula (Fistula) vs. localized radiation injury (Localized). MethodsThis study was a retrospective single-institution study. Exclusion criteria included: follow-up < 3 months, large pelvic tumor, and surgery for cancer control. The Fistula group included fistulization outside of the urinary tract (rectal, soft tissue, thigh, pubic symphysis, and extensive necrosis surrounding the prostate). The group Localized had a multitude of problems; however, all were confined to the urinary tract. Patient characteristics, perioperative variables, and outcomes were compared between groups. Results69 patients were included and had UD from 2009-2022. Median age and time from RT to UD were 73 (IQR-67.9,78.1) and 7.3 (IQR-3.2,12.5) years. There were 29 (42%) and 40 (58%) patients in the Fistula and Localized groups. The Fistula group had a higher rate of abdominal/perineal approach (62.1% vs. 12.5%,p<0.001), a lower rate of right colon pouch (17.2% vs. 40%,p=0.043), and a longer operative time (515.7 vs 414.2 mins,p=0.017). Clavien-Dindo complications ≥ 3 were higher in the Fistula group (44.8% vs. 20%,p=0.027), including a higher rate of re-operation for recurrent pelvic abscess (37.9% vs. 5%,p<0.001). Survival for the cohort was 85.5% and did not differ between groups. ConclusionsPatients with prostate fistula after RT for PCa undergoing UD had longer, more complex operations, and higher rates of complications, notably post-operative pelvic abscesses, compared to men with localized RT injury. Long-term survival was comparable in both groups.

Comparison of the Y-pouch orthotopic neobladder and the Studer technique after radical cystectomy: surgical and functional outcomes from a single-center series

BackgroundTo explore a method of constructing an orthotopic ileal neobladder (ONB) in the Y-pouch configuration. We describe the steps followed to create the Y-pouch ileal orthotopic neobladder (ONB) and compared the perioperative, functional, and urodynamics outcomes with the Studer neobladder technique.MethodsA retrospective cohort study of 90 bladder cancer patients, who received open radical cystectomy with the ONB performed at a hospital from June 2009 to May 2020. These patients were divided into two groups—the Y-pouch and the Studer neobladder groups. Perioperative, functional outcome, complication, renal function data outcomes, and pressure–volume study were used to evaluate the treatment outcomes after a radical cystectomy.ResultsNinety patients (54 Studer and 36 Y-pouch neobladder) were enrolled. The median patient age was 62.6 (± 11) years. The mean operative time for the Studer technique was 290 (242.5–350) min, and the Y-pouch technique was 300 (271.2–335) min) (p = 0.826). At 30 days postoperatively, the Clavien-Dindo classification of surgical complications revealed grade-2 urinary infections in two patients (5.6%) and six patients (11.1%) for the Y-pouch and Studer techniques, respectively. Intermediate complications (30–90 days) were reported in 4 (11.1%) and 18 patients (44.4%) in the Y-pouch and the Studer techniques, respectively (p = 0.062). In the urodynamics study (UDS), the Y-pouch group had a mean postvoid residual volume of 20 mL and Studer of 40 ml (p = 0.06). A mean capacity of 462 (380–600) mL compares to the Studer neobladder group with 495 (400–628) mL. The average mean compliance of the Studer group was 35.5 (28–52) ml/cm H2O and 33 (30–43) ml/cm H2O for Y pouch, and most patients had > 30 ml/cm H2O compliance (80/90 patients).ConclusionsThe Y-pouch neobladder technique in an RC with an orthotopic neobladder provides perioperative and functional outcomes compared to those of the Studer orthotopic neobladder resulting in similar intermediate-term. Therefore, the Y-pouch ileal neobladder is both feasible and safe to be used as a standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy and needs confirmation with long-term results.

MP65-10 VARIABILITY IN HEALTH CARE UTILIZATION AND PERIOPERATIVE OUTCOMES AMONG URINARY DIVERSION PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP65-10 VARIABILITY IN HEALTH CARE UTILIZATION AND PERIOPERATIVE OUTCOMES AMONG URINARY DIVERSION PATIENTS Anthony Fadel, Bridget L. Findlay, Katherine T. Anderson, Vidit Sharma, and Boyd R. Viers Anthony FadelAnthony Fadel More articles by this author , Bridget L. FindlayBridget L. Findlay More articles by this author , Katherine T. AndersonKatherine T. Anderson More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer urinary diversion (UD) outcomes remain the benchmark to which all other UD are compared. However, a sizable proportion are done for other invasive cancers or benign etiologies of the bladder. There is a paucity of literature comparing outcomes of UD for various indications, both benign and malignant. Herein, we aim to compare health care utilization and 30-day morbidity among benign and malignant UD etiologies. METHODS: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005-2020 on adult patients who underwent UD for various indications. ICD codes were used to assign patients to the following categories: Bladder Cancer (BC), GI/GYN Cancer (GC), Radiation (R), Fistula (F), Interstitial Cystitis/Benign Bladder (IB), and Neurogenic Bladder/Bowel (NGB). Patients that did not fall into these categories were excluded. Baseline characteristics and The Five Item Frailty Index (FFI) were compared across the 6 groups. Univariate and multivariate risk-adjusted regression models were developed to identify predictors of morbidity (30-day complications and mortality) and healthcare utilization (HU): prolonged length of stay (PLOS), 30-day readmissions (AR), and discharge to continued care (DCC). RESULTS: A total of 22,534 patients met inclusion criteria. The majority had primary bladder cancer (88%), were males (79%), with a median age of 69. GC had the highest complication rate (64%) and PLOS (44%), R had the highest readmission rate (24%), while NGB had the highest DCC (29%). GC and IB were the least frail (≈ 14% with FFI≥2) while NGB were the frailest (29%, p<.05). After adjusting for baseline characteristics (BC reference), there was a significant difference in PLOS, DCC, AR, and 30-day complication rates among different etiologies (p<.05, Figure 1). There was no significant difference in 30-day mortality. Compared to those with BC, those with NGB, F, R, and GC had significantly greater risk of serious complications and HU, whereas those with IB had a lower risk (p<.05). CONCLUSIONS: Postoperative HU and morbidity are greatly influenced by UD etiology. Care management in these vulnerable patient populations requires an individualized etiology-centered approach and cannot be benchmarked against those undergoing BC UD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e894 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Fadel More articles by this author Bridget L. Findlay More articles by this author Katherine T. Anderson More articles by this author Vidit Sharma More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

Effectiveness of Urinary Diversion in Patients with Cervical Cancer at Kariadi General Hospital

BACKGROUND: Obstructive uropathy and hydronephrosis are common complications of cervical cancer. In order to provide an alternative route due to ureteral obstruction, urinary diversion was performed. Urinary diversion procedures are a therapeutic option for obstructive uropathy but their effectiveness is remain unclear. There is limited data that support urinary diversion as a treatment of ureteral obstruction to improve overall survival and progression-free survival. AIM: To determine the effectiveness of urinary diversion in the treatment of obstructive uropathy in cervical cancer patients. METHOD: This study is a cross sectional involved cervical cancer patients with symptoms of obstructive uropathy. Data were obtained from medical records and limited to patients admitted from May, 2020 to May, 2021. Primary outcome was urea level, creatinine level, stage of hydronephrosis and overall survival rate of patients. RESULT: A total of 100 patients were included in the study. In both groups, the mean age of study subjects was 52-53 years with stage IIIB being the most widely reported. There was an improvement in post creatinine in the urinary diversion group. There was a significant difference in post creatinine levels between the non-urine diversion and urinary diversion groups (p=0.039).The 12-month survival rate, in the non-urinary diversion group had a value of 86% while the urinary diversion group had a value of 94%. CONCLUSION: This study shows that urinary diversion procedure is effective in increasing the renal function and increasing the 12-month survival of cervical cancer patients with obstructive uropathy.

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

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

Influences of Heider Balance on Knowledge, Attitude, Practice, and Quality of Life in Bladder Cancer Patients after Urinary Diversion.

To explore the influences of Heider balance on knowledge, attitude, practice (KAP), and quality of life in bladder cancer patients after urinary diversion. A set of bladder cancer patients after urinary diversion in our hospital from January 2016 to December 2020 were included in this study. Patients who received out-hospital intervention based on Heider balance were included in the observation group (85 cases). Meanwhile, patients who received routine out-hospital intervention were included in the control group (85 cases), and these patients matched with the observation group by gender, age, and education level. The scores of KAP, WHO quality of life-100 (WHOQOL-100) before discharge and at 6 months after discharge, and the rate of complications were compared in the two groups. At 6 months after discharge, the score of these items of KAP including basic knowledge of disease, procedure of pouch replacement, dealing with pouch leakage, skin care of stoma, purchase and storage of pouch, dealing with stoma complications, optimistic mentality for disease, optimistic mentality for stoma, trust in medical staff, willingness to correct bad habits, confidence in maintaining health behavior, maintaining in health dietary habit, maintaining in health behavior, learning from relevant books, learning from relevant videos, experienced in pouch replacement, and experienced in care of stoma of the observation group were significantly higher than those of the control group (t = 6.144, 9.366, 3.129, 3.809, 4.173, 5.923, 2.788, 8.871, 3.291, 10.797, 7.067, 7.805, 3.828, 9.454, 2.827, 4.059, and 8.662, respectively, all P < 0.05). The scores of 16 items of WHOQOL-100 such as energy and fatigue, sleep and rest, positive feelings, thinking, learning, memory and concentration, self-esteem, body image and appearance, negative feelings, mobility, activities of daily living, dependence on medical support, personal relationships, social support, health and social care: availability and quality, opportunities to get new information/skills, opportunities for recreation and leisure, and quality of life from viewpoint in the observation group were significantly higher than those in the control group (t = 2.666, 2.571, 2.961, 3.453, 4.279, 2.781, 3.775, 4.807, 5.850, 4.194, 3.324, 3.873, 5.118, 3.244, 2.956, and 4.218, respectively, all P < 0.05). The rate of complications of the observation group was significantly lower than that of the control group (x 2 = 5.829, P < 0.05). The Heider balance can help to reduce the rate of complications, improve knowledge, attitude, practice, and quality of life in urinary diversion patients. These merits make it an attractive approach in guidance of out-hospital intervention.

Palliative urinary diversion in patients with malignant ureteric obstruction due to gynaecological cancer

ObjectivesTo identify factors aiding the selection of patients with gynaecological cancer with malignant urinary obstruction who are least likely to benefit from palliative urinary diversion (UD), and to create a...

Cutaneous Ureterostomy or Ileal Conduit Urinary Diversion: Can We Spare the Bowel Following Radical Cystectomy in Patients with Solitary Functioning Kidney?

To compare the outcomes between cutaneous ureterostomy and ileal conduit urinary diversion in patients with solitary functioning kidney, undergoing radical cystectomy. This study was a retrospective analysis of the patients, with solitary functioning kidney, who underwent radical cystectomy with either cutaneous ureterostomy or ileal conduit from January 2014 to May 2019. Baseline characteristics, perioperative outcomes, and follow-up renal function were evaluated and compared. For renal function outcomes, we assessed the estimated glomerular filtration rate (eGFR) and included patients with a follow-up of at least 2years. A total of 43 patients were included in the study, 23 of them underwent cutaneous ureterostomy and 20 underwent ileal conduit urinary diversion. The two groups were similar with respect to their baseline demographic and clinical characteristics. Operative time (p < 0.001), time to drain removal (p = 0.016), postoperative length of hospital stay (p = 0.018), and bowel-related complications (p = 0.047) were significantly lower in patients who underwent cutaneous ureterostomy. The eGFR was comparable at baseline, and till 1year of follow-up. But, there was a greater decline in eGFR over 2years, in patients who received cutaneous ureterostomy (p = 0.039). The present study shows that cutaneous ureterostomy has better perioperative, and comparable short-term renal function outcomes over ileal conduit urinary diversion. However, over 2years of follow-up, there was an increased likelihood, and greater degree of decline in eGFR in patients who received cutaneous ureterostomy.

MP19-18 NOMOGRAM PREDICTING RENAL FUNCTION RECOVERY POST DIVERSION IN PATIENTS WITH OBSTRUCTIVE UROPATHY

You have accessJournal of UrologyCME1 May 2022MP19-18 NOMOGRAM PREDICTING RENAL FUNCTION RECOVERY POST DIVERSION IN PATIENTS WITH OBSTRUCTIVE UROPATHY Gopal Sharma, Sudheer K. Devana, Ravimohan S. Mavuduru, and Kalpesh M. Parmar Gopal SharmaGopal Sharma More articles by this author , Sudheer K. DevanaSudheer K. Devana More articles by this author , Ravimohan S. MavuduruRavimohan S. Mavuduru More articles by this author , and Kalpesh M. ParmarKalpesh M. Parmar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Identifying the predictors of recovery of renal function following urinary diversion in patients with obstructive uropathy (OU) can be of great prognostic and clinical significance to a urologist. We aimed to develop a nomogram predicting recovery of renal function in patients with OU following urinary diversion. METHODS: In this prospective observational study, we included patients of OU (aged 18-65 years) presenting with raised serum creatinine (>2.0 mg/dl) due to various etiologies. Renal function recovery was defined as creatinine ≤1.5 at 4 weeks after diversion. Univariate and multivariate regression analysis was used to identify predictors of renal function recovery. Nomogram was developed using variables identified in multivariate analysis. Nomogram was internally validated with boot strapping, goodness of fit, calibration plot and receiver operating curve (ROC) analysis. Decision curve analysis (DCA) was used to determine clinical utility of the nomogram. RESULTS: Of 110 patients included in the study, 40 patients (36.4%) had renal function recovery after diversion. On multivariate analysis, age, etiology, duration of symptoms, baseline hemoglobin level and pH were identified as independent predictors of renal function recovery. Nomogram was developed using above mentioned variables, internally validated and had an area under curve of 0.89 for predicting renal recovery. Nomogram was found to be clinically useful at threshold probability of 5% renal recovery. CONCLUSIONS: We developed and internally validated a nomogram which is highly accurate and simple to use in predicting renal function recovery after diversion in patients with OU. However, it needs external validation before widespread use. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e314 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gopal Sharma More articles by this author Sudheer K. Devana More articles by this author Ravimohan S. Mavuduru More articles by this author Kalpesh M. Parmar More articles by this author Expand All Advertisement PDF DownloadLoading ...

Early Warning Models to Predict the 90-Day Urinary Tract Infection Risk After Radical Cystectomy and Urinary Diversion for Patients With Bladder Cancer.

PurposeTo develop and validate a nomogram of the 90-day urinary tract infection (UTI) risk for patients with bladder cancer undergoing radical cystectomy (RC) and urinary diversion.Patients and MethodsThe predictive nomogram was based on a retrospective study on the consecutive patients who underwent RC and urinary diversion for bladder cancer between January 2014 and March 2021. The incidence and microbiology of UTI were reported. The univariate and multivariate logistic analyses were conducted to determine independent risk factors associated with UTI. The predictive accuracy and discriminatory ability of the established nomogram were evaluated by the concordance index (C-index) and decision curve analysis (DCA). The performance of the model was validated internally.ResultsA total of 220 patients were included and the incidence of UTI within 90 days was 27.3%. The most commonly identified pathogens were Enterococcus (42.0%), Escherichia coli (21.70%), and Candida (13.0%). Urinary diversion type, Charlson comorbidities index (CCI), stricture, and prognostic nutritional index (PNI) were included in the nomogram. The C-index of the nomogram for predicting UTI was 0.858 (95% CI: 0.593–0.953). In the validation cohort, the nomogram also showed high-predictive accuracy. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index indicated that PNI led to improvement in predictive ability.ConclusionThe proposed early warning model shows great accuracy in predicting the incidence of 90-day UTI after RC and urinary diversion in patients with bladder cancer.

Bowel obstruction incidence in urinary diversion patients: A meta-analysis study.

Bowel obstruction is a common complication that occurs in patient who underwent urinary diversion with an incidence of 0.7%-11%. Although previous studies have published risk factors, prevention and management of postoperative paralytic ileus, and data on urinary postdiversion bowel obstruction in the literature are still scarce and thus require further investigation of the diversion technique which allegedly has differences in pathogenesis, management, and results. To that end, this study conducted a systematic review study to compare two different diversion techniques, namely ileal conduit and continent diversion, especially orthotopic neobladder. This study is a systematic review by searching study in online databases such as PubMed, EBSCOhost, and ProQuest. Inclusion criteria included are full-text articles, English language, and articles of the past 10 years. After searching, we analyzed quantitatively using the RevMan application for meta-analysis. From 3403 studies, we got 12 studies that were included in the analysis. In a study conducted from the study of van Hemelrijck et al. stated that intestinal obstruction has an incidence of 50.73-1000, the third-highest when compared with advanced complications such as death (145.07/1000 population) and urinary tract infections (127.03/1000 population). It was found that odds ratio was 0.64 (0.45-0.91). The ileal conduit and orthotopic neobladder methods have no significant difference in the incidence of intestinal obstruction.

Enhanced Recovery After Surgery in the Urinary Diversion Population: Are Protocols Applied Differently in the Benign Indication Population?

ObjectiveTo retrospectively evaluate enhanced recovery after surgery (ERAS) protocol administration, hospital length of stay, 30-day readmission, and complication rates among cystectomy and/or urinary diversion patients with benign or malignant indication. Materials and methodsData was extracted retrospectively for cystectomy and/or urinary diversion performed at our institution from June 2016 to May 2019. Descriptive statistics, Chi squared, Wilcoxon rank-sum, binary logistic regression, and linear regression functions in R 4.0.4 (R Foundation), R Package “Tidverse” V1.3.0.9, and RStudio V1.44.1106 (RStudio, PBC) were used to analyze data. Results102 patients met selection criteria with 36 and 66 patients in the benign and malignant indication cohorts, respectively. Significant differences between cohorts included BMI, age, opioid exposure, and spinal anomalies. The malignant cohort had higher ERAS completion rates for preoperative and intraoperative protocols (41% and 53% vs 14% and 19%). The mean ERAS item administration for benign and malignant indication patients differed significantly (2.9 vs 4.2, P < 0.01). Logistic regression demonstrated benign indication was significantly associated with ERAS failure (OR 4.25, 95% CI 1.18 – 21.03, P = 0.043). Higher ERAS item administration sum was associated with shorter hospitalizations and lower complication rates (P = < 0.01, P = 0.019). No association was observed for 30-day readmission. ConclusionThe benign urinary diversion/cystectomy population more frequently possesses characteristics adverse to ERAS protocol completion and in our study received fewer ERAS protocol items. This was associated with longer hospitalizations and higher postoperative complication rates. Population-specific ERAS protocols targeted at increasing ERAS completion could reduce morbidity.

Impact of radiation therapy on perineal urethrostomy for penile cancer

ObjectiveA lack of demonstrated clinical benefit precludes radiotherapy (RT) from being recommended for pN1/pN2 penile cancer (PeCa) lesions; but it may be recommended in case of extranodal (pN3) disease or for positive resection margins. Perineal urethrostomy (PU) is a technique of urinary diversion in patients with PeCa requiring total or subtotal penectomy as primary therapy. Prior studies suggest PU failure rates of up to 30%, without specific mention of the potential role of RT. When RT is delivered for PeCa it is usually to the pre-pubic fat, groin and lateral pelvis, and not to the region of the PU. Here we describe the role of perioperative RT in a large, multi-institutional registry of PU for PeCa. MethodsIn our cohort, 299 patients from seven international, high-volume centers in Belgium, Brazil, China, Netherlands, United Kingdom and the United States underwent PU as urinary diversion for PeCa between 2000 and 2020. Demographic and clinicopathologic characteristics were reviewed. ResultsMedian patient age was 67 years and median follow-up was 19 months. Seven patients (2.3%) received pre-operative RT; six of them with chemotherapy. 37 received RT post-operatively, 21 (57%) with chemotherapy. Stenosis of the PU occurred in 35 (12%) of the total population. The majority of these patients (74%) required surgical revision at a median of 6.1 months post-operatively. RT delivery was neither significantly related to PU stenosis (p = 0.16) or to subsequent revision (p = 0.75). ConclusionReceipt of RT was not significantly associated with increased stenosis risk in PeCa patients who underwent PU.

The Comparison on Complications from Suprapubic vs. Transurethral Urinary Diversion After Hypospadias Repair: Meta-Analysis

Background: Urinary diversion post hypospadias repair plays an important role in the prevention of complications. This study objective was to analyze the comparison among suprapubic versus transurethral urinary diversion in preventing the complications after hypospadias repair. We aimed to compare the complications from suprapubic urinary diversion and transurethral urinary diversion in patients after hypospadias repair. Methods: A systematic search was conducted in PUBMED and Google Scholar databases to identify relevant randomized controlled trials (RCTs). The subjects were studies that involved post-operative hypospadias patients. Compared outcomes were the incidence of urethrocutaneous fistula, meatal stenosis, and repair disruption. The approach to systematic study began with the use of PRISMA protocol based on inclusion and exclusion criteria. Meta-analysis was performed based on pooled analysis. Visualizations of each study were described with forest plots. Results: There were two RCTs that met the criteria for quantitative analysis. Forest plot analysis showed the use of suprapubic diversion might significantly lower the risk of urethrocutaneous fistula (OR 0.22, 95% CI 0.05 - 0.89, p = 0.03). Meatal stenosis and repair disruption between the two studies did not differ significantly. Conclusion: There was a significantly lower incidence of urethrocutaneous fistula in postoperative hypospadias patients who performed suprapubic urine diversion compared to those who received transurethral urine diversion. The difference in the incidence of meatal stenosis and repair disruption was insignificant between the two groups of urine diversion.

Definitive surgical therapy for refractory radiation cystitis: Evaluating effectiveness, tolerability, and extent of surgical approach

Introduction and ObjectiveThe management of severe symptoms secondary to radiation changes to the bladder can be difficult. Many patients often endure costly procedures, hospitalizations, transfusions, and physician visits for intractable symptoms. Our aim was to evaluate the short-term efficacy and feasibility of urinary diversion in patients with severe, debilitating symptoms related to radiation cystitis by focusing on perioperative data examining surgical feasibility and assess for any improvement in the number of procedures, transfusions, hospitalizations, and office visits required. MethodsWith IRB approval, we queried our institutional database for patients with a diagnosis code of radiation cystitis who underwent urinary diversion with or without bladder removal from 2011 to 2018. We reviewed institutional and regional record to assess pre, peri and postoperative outcomes, including rates of surgical procedures, hospitalizations, transfusions and clinic visits, in the year before and after treatment. Non-parametric statistics and linear regression were used. ResultsOf the 286 patients with radiation cystitis, 45 patients underwent definitive urinary diversion – 31 with concomitant cystectomy and 14 with diversion alone. Analysis of perioperative variables such as estimated blood loss, surgical time, post-operative hospital stay or complication rates were similar to our experience with cystectomy in non-radiated patients. With a mean follow up of 14.6 months, we found that the number of procedures, hospitalizations and transfusions objectively improved following radical surgery. Office visits, however, did not seem to be impacted by performing urinary diversion. There were no significant differences in post-operative benefits between patients that received a concomitant cystectomy and those that only underwent diversion. ConclusionPatients suffering from severe refractory symptomatic radiation cystitis may be best treated with a radical surgical approach. Definitive urinary diversion with or without cystectomy can lower burden of disease by reducing the need for additional procedures, hospitalizations, and blood transfusions on short term follow-up.

Outcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience

PurposePerineal urethrostomy (PU) is often the definitive form of urinary diversion in patients with locally-advanced or anatomically unfavorable penile cancer (PC) requiring total penectomy. Here, we report post-operative PU-related complications and PU stenosis rates after total penectomy with PU in a large multicenter cohort of PC patients. MethodsWe retrospectively reviewed the medical records of 299 patients who underwent PU as a means of urinary diversion for primary PC across seven international centers from 2000 to 2020. The Clavien-Dindo grading system was used to record 30-day post-operative complications. Cumulative incidence of stenosis was evaluated using the Kaplan-Meier method. ResultsMedian patient age was 67 years (interquartile range (IQR) 58–74), and median follow-up was 19 months (IQR 7.2–57). A total of 58 patients (19%) developed a 30-day post-operative complication, of which 45 (79%) were deemed minor (CD Grade I and II). Wound infection (11%; CD grade I–III) and dehiscence (4.0%; CD grade I–III) were the more common complications. The overall incidence of stenosis was 12% (35/299 patients), of which 26 (74%) needed surgical revision (probability of stenosis revision at one year of 9.3%, median time until the revision: 6.1 months (IQR 3.0–13)). Only two stenoses were seen after two years of follow-up. ConclusionWe present the most extensive series of PU in the management of PC to date. Wound infections of the primary surgical site were the most common complication. Stenosis occurred mostly within one and a half years after treatment.

Abstract No. 166 Institution-wide experience with in-house modified occluding nephroureteral stents

To describe our institution-wide experience with in-house modified occluding percutaneous nephroureteral stents Current reversible therapies for temporary urinary diversion include percutaneous nephrostomies (PCN) and percutaneous internal/external nephroureteral (PCNU) stents. These methods offer external drainage of urine, thereby decreasing the flow down the ureter and into the bladder. However, some patients may require better urinary diversion than PCNs and PCNU stents can offer. At our institution, a mechanically modified occluding percutaneous nephroureteral (MOPNU) stent has been used. The modification for MOPNU stent is accomplished by using a heating element to soften and seal a standard PCNU catheter which has been cut across its mid-portion between its two loops. The modified catheter is then inserted via a peel-away sheath. In a retrospective review of subjects receiving a MOPNU stent between October 2006 and December 2019 at our institution, a total of 85 subjects were identified, including 29 females and 56 males. The mean age was 64.7(SD = 14.9), ranging from 27.3 to 92.7. The most common indications for MOPNU stent placement were urinary diversion for urinary tract fistulas, ileal conduit complications, iatrogenic urinary injury and persistent hematuria. Of these patients, 69 (81%) had a history of cancer and 4 (5%) had history of inflammatory bowel disease. The primary endpoint was durable treatment at 6 weeks defined as complications free complete urinary diversion. The secondary endpoints were durable treatment at 3, 6 months and 1 year. There were 52 (61.2%) subjects with a durable treatment at 6 weeks, 31 (36.5%) at 3 months, 17 (20.0%) at 6 months, and 12(14.1%) at 1 year. No clear predictors of failure or success were identified. Sixty-three patients were converted from PCN to MOPNU stent, while twenty-two patients had MOPNU stents placed in a primary fashion. MOPNU placement had a 100% success rate. During the entire duration of treatment 10 subjects (11.9%) had tube blockage, 8 (9.5%) had urine leak, 8 (9.5%) had decreased tube output, 13 (15.5%) had a hematuria, 20 (23.8%) had tube dislodgement, 28 (33.7%) were diagnosed with a UTI, 13 (15.5%) needed revision for unknown reason. Having a tool for reversible urinary diversion is invaluable to treat certain medical conditions. MOPNU stents can provide temporary, safe, reversible urinary diversion in patients requiring better urinary diversion than PCNs and PCNUs can offer.