Urinary Reservoir Research Articles

A METHOD OF FORMING ANTIREFLUX URETEROCYSTOANASTOMOSIS AFTER BLADDER REPLACEMENT WITH A RESERVOIR FROM INTESTINE

Aim. Improvement of surgical treatment results of patients who underwent cystectomy and orthotopic bladder replacement with an intestinal reservoir by forming antireflux ureterocystoanastomosis. Materials and methods. With the help of this method we have performed 18 surgeries on patients aged 50-68. The period of treatment has been from 1 to 48 months. Indications for surgery: bladder cancer сT2NoMo. All reservoirs have been formed with the application of the intestine detubularization principles. The follow-up of the patients was conducted after 1, 3, 6, 12 months and further after six months. Anatomical and functional state of the urinary reservoir, the upper urinary tract (ultrasound, spiral computed tomography with contrast, mictional cystourethrography and dynamic radioisotope renography) was checked and controlled; laboratory tests were done. Results. Theobtainedpreliminarydataarenotinferiorineffectivenesstoothermethods. Concavitiesureterocystoanastomosis has full patency and all the functions of the antireflux mechanism. Conclusion. The developed method of ureteroneocystostomy has a reliable antireflux mechanism that allows using it in situations when it is necessary to perform the transplant of one or both ureters into the intestinal reservoir.

Artificial Urinary Sphincter Reservoir Related Complication Masquerading as Colonic Mass

Artificial Urinary Sphincter Reservoir Related Complication Masquerading as Colonic Mass

ENERGY HOMEOSTASIS OF THE ARTIFICIAL BLADDER IN EXPERIMENTAL CONDITIONS

Patients with malignant neoplasms of the bladder or severe anatomical and functional bladder abnormalities are the candidates for cystectomy and orthotopic urine diversion. The distal portion of the ileum is the most frequent anatomical organ, which is used for the formation of the urinary conduit. The formation of a urinary reservoir from the ileum that is unable to perform new functions, and mainly programmed to isolate enzymes, digest food and absorb nutrients, salts and minerals changes the energy exchange in the ileum wall under the influence of urine. The aim of the research is the examination of energy metabolism changes in the ileum wall during the formation of artificial bladder in experimental conditions conducted on mini-pigs. Experimental studies were performed on 21 female mini-pigs with an average age of 6 to 14 months. The duration of the experiment was 12 months. An imbalance of the ATP-ADP-AMP system was observed in the transplant tissue of the graft in different postoperative periods. Changes in the level of ATP are characteristics of the development of tissue ischemia. Results. The values of the adenosine nucleotides sum (the energy potential indicative of the respiration rate of mitochondria) and the phosphorylation index were lower at different times of observation in the transplant tissue. The energy charge value was lower to a lesser extent relative to the control. Conclusion. The revealed changes in the level of adenosine nucleotides confirm the severity of the disturbances of the energy homeostasis in the transplant tissue at all stages of the observation.

Postoperative rehabilitation after radical cystectomy with urinary reservoir plasty

Postoperative rehabilitation after radical cystectomy with urinary reservoir plasty

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

ABSTRACTStandard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome.This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula.In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Risky business: Adjusting the pressure of the artificial urinary sphincter reservoir

Risky business: Adjusting the pressure of the artificial urinary sphincter reservoir

Application of the allogenic mesenchymal stem cells in the therapy of the bladder tuberculosis.

Urogenital tuberculosis (TB) often leads to contraction of the bladder, a reduction of the urinary reservoir capacity, and, in the latest stage, to real microcystitis up to full obliteration. Bladder TB Stage 4 is unsuitable for conservative therapy, and cystectomy with subsequent enteroplasty is indicated. In this study, using a model of bladder TB in New Zealand rabbits, the therapeutic efficacy of the interstitial injection of autologous bone-derived mesenchymal stem cells (MSCs) combined with standard anti-TB treatment in the restoration of the bladder function was demonstrated. For analysis of the MSC distribution in tissues, the latter were labelled with superparamagnetic iron oxide nanoparticles. In vitro studies demonstrated the high intracellular incorporation of nanoparticles and the absence of cytotoxicity on MSC viability and proliferation. A single-dose administration of MSCs into the bladder mucosal layer significantly reduced the wall deformation and inflammation and hindered the development of fibrosis, which was proven by the subsequent histological assay. Confocal microscopy studies of the bladder cryosections confirmed the presence of superparamagnetic iron oxide nanoparticle-labelled MSCs in different bladder layers of the treated animals, thus indicating the role of stem cells in bladder regeneration.

Totally robotic-assisted laparoscopic radical cystectomy with intracorporeal orthotopic U-shaped ileal neobladder

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN). Methods A consecutive series of 4 patients (2 male, 2 female), who underwent RARC with TIOIN by a single surgeon, were included in the retrospective study, between March 2017 and June 2017. Their age ranged from 59 to 71 years, which the mean age was (65.7±4.9)years. Preoperative urinary CT scan, cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis. Among these, 2 patients underwent side-to-side bowel anastomosis using a linear stapler, while hand-sewn anastomosis was performed in the other 2 patients. The detubularized bowel segment was arranged in a U shape, and then the two medial borders were closed to create the posterior wall of the neobladder, which completed a partial U shape and anastomosed with the end of urethra. After placing the single J stents into the ureter, the uretero-neobladder was anastomosed.To close the urine reservoir, each border of the U-shaped segment was folded again and sutured to form a sealed pouch. Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min). The average operation time for urinary diversion was 214.2 min (ranging 163-251 min). The mean estimated blood loss was 304.5 ml(ranging 200-400 ml). The mean hospital stay was 20.5 d (ranging 13-32 day). The number of dissected lymph node ranged from 11 to 16 (mean 3.7±2.6). All the surgical margins were negative. The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days, respectively. The single-J stents were removed 1 months after operation, generally.No urine leakage was noticed after removing the drainage tube and catheter. The lymph leakage was observed in one case, which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory, except one patient complained about the nocturnal incontinence. After the regular pelvic exercise, the symptom improved two months after the operation. Hydronephrosis and intestinal leakage were not observed. Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon. Key words: Bladder cancer; Robot; Robot-assisted radical cystectomy; Intracorporeal orthotopic ileal neobladder

Efficacy and safety of solifenacin in the treatment of patients with bladder spasm after transurethral resection of prostate: a systematic review and meta-analysis

Objective To systematically review the efficacy and safety of solifenacin in the treatment of patients with bladder spasm after transurethral resection of prostate based on current evidence. Methods We searched Pubmed, EMbase, the Cochrane Library, CBM, CNKI, VIP and Wanfang Database from the establishment to October 2016 for the published literature on the treatment of patients with bladder spasm after transurethral resection of prostate with solifenacin.Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies.Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs involving 621 patients were included.The results of meta-analysis showed that: compared with the no-solifenacin group(n=311), the numbers of bladder spasm episodes[MD=-1.38, 95%CI(-1.97, -0.97)P<0.00001], duration of bladder spasm[MD=-0.26, 95%CI(-0.41, -0.11), P=0.0008], the time of bladder perfusion clearance[MD=-0.59, 95%CI(-0.88, -0.29), P<0.0001], indwelling catheter delivery[MD=-0.29, 95%CI(-0.48, -0.11), P=0.09]in solifenacin group(n=310) reduced significantly, and there was no statistical difference in the incidence of overall adverse events between the two groups[RR=0.71, 95%CI(0.17, 2.98), P=0.64]. Conclusion Current evidence indicates that solifenacin is more effective and safe in the treatment of patients with bladder spasm after transurethral resection of prostate.Due to the limited quantity and quality of the include studies, more high quality studies are needed to verify the above conclusion. Key words: Urinary reservoirs, continent; Transurethral resection of prostate; Meta-analysis; Solifenacin

PD64-04 QUALITY OF LIFE ASSOCIATED WITH BLADDER MANAGEMENT STRATEGY AFTER SPINAL CORD INJURY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2017PD64-04 QUALITY OF LIFE ASSOCIATED WITH BLADDER MANAGEMENT STRATEGY AFTER SPINAL CORD INJURY Shyam Sukumar, Sara Lenherr, Jeremy Myers, Darshan Patel, Ronak Gor, Amitabh Jha, Angela Presson, Chong Zhang, Jeffrey Rosenbluth, John Stoffel, Blayne Welk, and Sean Elliott Shyam SukumarShyam Sukumar More articles by this author , Sara LenherrSara Lenherr More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Darshan PatelDarshan Patel More articles by this author , Ronak GorRonak Gor More articles by this author , Amitabh JhaAmitabh Jha More articles by this author , Angela PressonAngela Presson More articles by this author , Chong ZhangChong Zhang More articles by this author , Jeffrey RosenbluthJeffrey Rosenbluth More articles by this author , John StoffelJohn Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2941AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about the relative quality of life (QoL) benefits of different bladder management strategies after spinal cord injury (SCI). We sought to describe bladder-related symptoms and QoL using a national sample of SCI patients. METHODS Data from a national prospective observational survey was used. Demographic and clinical information were obtained by interview. The Neurogenic Bladder Symptom Score (NBSS), a validated tool to measure urinary symptoms, was administered electronically. Patient demographics, NBSS total score and the NBSS QoL question (“If you had to live the rest of your life with the way your bladder (or urinary reservoir) currently works, how would you feel?”) were compared with bladder management method using chi-squared, Fisher′s exact, ANOVA and Kruskal-Wallis tests as appropriate. RESULTS Since January 2016, 780 participants completed the baseline interview. Median age was 46 (interquartile range, IQR: 35-56) with median 27 (IQR: 20-41) years since injury. 39% of participants were recruited in clinic and 55% online/remote. SCI level was: 49% paraplegia, 43% tetraplegia, and 8% unknown/other. Current bladder management was: 63% clean-intermittent catheterization (CIC), 23% indwelling suprapubic/urethral catheter or stoma, 9% spontaneous voiding, and 5% condom catheter. Those using CIC were significantly younger than those using other bladder management methods (p<0.001) and those using spontaneous voiding had the longest median time since injury (p<0.001). The total NBSS score was lowest for indwelling catheter/stoma (18.3 ± 10.5) as compared to condom catheter (22.9 ± 9.3), CIC (24.5 ± 9.9) and spontaneous voiding (28.1 ± 11.9) (p <0.001). Similarly, bladder QoL was ″pleased″ or ″mostly satisfied″ in 43% of people with an indwelling catheter/stoma, 35% for CIC, 27% for condom catheter, and 26% for spontaneously voiding (chi-square test with permutation, p=0.012; Figure 1). CONCLUSIONS In a large cohort of SCI patients, indwelling catheters or stoma drainage was associated with reduced bladder-related symptoms and consequences and best QoL among bladder management methods. This patient-centered outcome differs from the urologists preference for CIC based on medical benefits. Further exploration is needed to understand the patient-reported QoL and clinical outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1261 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shyam Sukumar More articles by this author Sara Lenherr More articles by this author Jeremy Myers More articles by this author Darshan Patel More articles by this author Ronak Gor More articles by this author Amitabh Jha More articles by this author Angela Presson More articles by this author Chong Zhang More articles by this author Jeffrey Rosenbluth More articles by this author John Stoffel More articles by this author Blayne Welk More articles by this author Sean Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fifteen years of experience radical cystectomy and intestinal urinary diversion

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy. Materials and method s. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve. Result s. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy. Conclusions . Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications.

Quality of Life in Elderly Bladder Cancer Patients Following a Cystectomy.

Bladder cancer is the ninth most common cancer worldwide. The most common treatment for invasive cancer is radical cystectomy and urinary diversion (ileal conduit, continent urinary reservoir, orthotopic neobladder). In elderly patients, the standards methods of urinary diversion have been the ileal conduit and ureterocutaneostomy. Quality of life is an important consideration for patients with urinary diversion. The purpose of the present study was to review the literature on quality of life in elderly patients with bladder cancer following a cystectomy and urinary diversion. A literature review was conducted using the electronic databases PubMed and Google scholar covering the period of time from 2006 to 2016. The following key words were entered: "quality of life", "bladder cancer", "elderly" "cystectomy" and a combination thereof. The exclusion criteria for the articles were languages other than English. It was found that various questionnaires were used. Some instruments measure QoL in general, whereas others are more specific with respect to the unique ways in which urinary diversion can impact patients' lives. Furthermore, some findings are contradictory, with certain results indicating that there is no statistically significant difference between quality of life parameters when comparing patients with a neobladder to those with an ileal conduit. In another study, patients who underwent orthotopic neobladder reconstruction reported significantly better physical functioning, role functioning, social functioning and QoL in general throughout the first postoperative months compared to patients who had ileal conduit formation. All types of treatment have a number of advantages and disadvantages, the details of which should be explained to elderly patients thoroughly. This calls for comprehensive counseling sessions during which the patient and health professional discuss all relevant considerations.

Thirty-day complications of radical cystectomy and factors that influence their development

Objective : to identify the most important factors influencing the development of complications after radical cystectomy (RCE). Materials and methods . The results of 182 RCEs performed in September 2014 and December 2016 were analyzed. The patients included 152 (83.5 %) men and 30 (16.5 %) women. The patients’ age ranged from 31 to 84 years (mean age 62.3 years). An orthotopic urinary reservoir was formed in 138 (75.8 %) patients. Postoperative complications were evaluated according to the Clavien–Dindo classification. The calculations were made with a computer program for SPSS Statistics 16. Results. No complications were recorded in 84 (46.2 %) patients within 30 days after RCE. The development of various postoperative adverse reactions was observed in 98 (53.8 %) patients. The most common complications were gastrointestinal (26.9 %) and infectious (25.8 %). Sixteen (8.8 %) patients developed grade I complications; grades II, III, IV, and V complications were seen in 53 (29.1 %), 21 (11.5 %), 5 (2.7 %), in 3 patients, respectively. Thirty-day mortality was 1.64 %. Univariate regression analysis has established that overweight (p = 0.031), T status (p = 0.021), preoperative hemoglobin levels (p = 0.001), intraoperative blood loss (p = 0.009), and intraoperative abdominal cavity infection (p <0.001) play a significant role in the development of complications following RCE. Multivariate regression analysis has revealed that the frequency of complications after RCE is influenced by body mass index (p = 0.008), preoperative anemia (p = 0.034), blood loss (p = 0.003), and intraoperative abdominal cavity infection (p <0.001). Conclusion. RCE is often accompanied by the development of different categories and severity of complications. Identification of risk factors for their complications will be able to elaborate effective ways for their prevention.

Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery

Prior studies suggest that obese patients are at increased risk for complications following continent catheterizable urinary (CCU) channel surgery. We hypothesized that postoperative weight gain increases the risk of channel angulation, difficulty catheterizing, and possible channel perforation requiring subfascial revision. The purpose of this study was to evaluate whether baseline obesity or becoming overweight/obese postoperatively was associated with a greater risk of subfascial revision. We reviewed retrospectively an institutional database of patients who underwent CCU channel surgery between the ages of ≥2 and <20 years from January 1990 to May 2013, excluding those with continent urinary reservoirs, continent vesicostomies, and those without body mass index (BMI) data. We collected data on patient/procedure characteristics, baseline/most recent BMI, and subfascial revision(s). We used Cox proportional hazard multivariable regression to assess the association of being overweight/obese at baseline (≥85% BMI) with time to first subfascial revision, and Fisher's exact test to compare rates of subfascial revision between those who became overweight/obese and those who did not. Of the patients, 328/501 (65.5%) had baseline and post-baseline BMI data available: 53.4% male, 90.6% white, median age 7.4 years; median follow-up 76.4 months. Of the 328 patients, 38 (11.6%) had subfascial revisions. Baseline BMI data were available for 378 patients, and, of these, 130 (34.4%) were overweight/obese at baseline. Overweight/obese patients were more likely to undergo umbilical Monti (10% vs. 8.1%), non-umbilical spiral Monti (33.8% vs. 13.7%), and spiral umbilical Monti channels (13.8% vs. 7.3%) versus normal/underweight patients (p<0.0001). From a multivariable Cox proportional hazard model controlling for age, BMI category, diagnosis, and ambulatory status, the hazard of subfascial revision for spiral umbilical Monti channels was 2.1× that of other channels (hazard ratio (HR) 2.1 [95% CI 1.2-3.8], p=0.01). Fifty-one out of 328 patients (15.6%) became overweight/obese postoperatively, with 7.8% having a subfascial revision vs. 12.3% of those whose weight category decreased or remained stable (p=0.3) (Table 1). Patients who were overweight/obese at baseline were more likely to have channels constructed that are at the highest risk of subfascial revision. Patients who became overweight/obese postoperatively were not at greater risk of subfascial revision. Limitations include potential bias because of differential follow-up and inaccuracy of BMI percentile as a measurement of obesity.

Predictors for morbidity of radical cystectomy and different types of urine derivation: 20-year experience of a surgery center

Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation. Objective: to search for risk factors for complications after RCE with different types of urine derivation. Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43). Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p &lt; 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up. In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho- and/or heterotopic urine derivations rather than to the former. Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeon’s insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation.

Botulinum Toxin Type A Injections for the Treatment of Continent Catheterizable Ileal-colic Urinary Diversion Muscularis Overactivity

Continent catheterizable diversions can exhibit long-term complications such as high pressures and involuntary unit contractions within the urinary reservoir, rendering them similar to neurogenic bladders. Given the similarity of these issues to neurogenic detrusor overactivity, the use of Botox injections is a logical treatment option to explore. A patient with a contracted Indiana pouch continent catheterizable diversion was treated with intra-pouch Botox injections after failing maximal doses of oral anticholinergic medications. This patient underwent four consecutive percutaneous Botox pouch injections every 11-12 months under general anesthesia. Flexible cystoscope via the catch stoma was attempted first on the first two surgeries, but the scope could not reach the majority of the pouch. Thus, percutaneous access was obtained under fluoroscopic guidance, and the injections were performed through a suprapubic tube access sheath. Two hundred to four hundred units of Botox (stained with methylene blue) were visually injected in 20-40 separate injection sites. Of note, the initial dose used was 200 units and was increased to 300 units then 400 units on subsequent treatments to improve results and durability. After each round of Botox injections, the patient noted resolution of her symptoms. Postinjection urodynamic studies showed normal filling with no evidence of muscularis overactivity, even at high volumes of 600 cc. Botox injections may be an excellent long-term treatment option for contracted continent catheterizable diversions, or at least used as a temporizing measure before surgical augmentation. Further studies are needed to verify the durability, complications, and long-term outcomes of this procedure.

Does Use of a Second Cuff Improve Artificial Urinary Sphincter Effectiveness? Evaluation Using a Comparative Cadaver Model

The artificial urinary sphincter is the gold standard long-term solution for male stress incontinence. Some urologists believe that including a second urethral cuff at the time of placement can improve efficacy but strong evidence is lacking. We compared the functionality of a single vs a tandem cuff in a cadaver model. Artificial urinary sphincter reservoir pressure was confirmed at 61 to 70 cm H2O. The bulbar urethra was dissected through a perineal approach in each of 4 cadavers. Distal and proximal bulbar urethral circumference was measured. The membranous urethra was transected. Cuffs sized based on circumference measurements were placed distal and proximal, and connected to the reservoir and pump. Retrograde leak point pressure was measured sequentially across the distal, proximal and tandem cuffs. We used the Friedman test to compare retrograde leak point pressure among the 3 cuff positions, the paired t-test to compare distal and proximal urethral circumferences and the Spearman correlation to compare urethral circumference to retrograde leak point pressure. Mean retrograde leak point pressure across the distal, proximal and tandem cuffs was 73.5, 77.75 and 79.25 cm H2O, respectively (p=0.44). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm, respectively (p=0.019). There was a strong positive correlation between urethral circumference and retrograde leak point pressure (rs=0.5). The tandem cuff did not improve retrograde leak point pressure. Proximal bulbar urethral circumference was greater than distal circumference and increasing urethral circumference correlated with increasing retrograde leak point pressure. Therefore, the perceived benefit of tandem cuffs may reflect more proximal placement of one of the cuffs.

Safe and effective catheterisation for patients in the community.

Approximately 450 000 people use long-term urinary catheters in the UK. Permanent catheters are used by 3% of the community population and occupy an estimated 4% of a district nurse's caseload in the UK. Catheterisation is defined as 'drainage or aspiration of the bladder or urinary reservoir' and can be intermittent or indwelling. Long-term indwelling catheterisation can be transurethral or suprapubic via the anterior abdominal wall. This article will discuss the safe and effective use of different forms of catheterisation for patients in the community setting.

Pregnancy and delivery after vesico ileocystoplasty –a case report

Neobladder is continent urinary reservoir made from a detubularized segment of bowel, with implantation of ureters and urethra. The most common indication for this operation is bladder replacement after cystectomy following bladder cancer in elderly or cervical cancer Stage IV patients. Nowadays indications are expanded to many benign diseases (interstitial cystitis (IC), neurogenic bladder, chronic pelvic pain) in reproductive age. Pregnancy in women with neobladder is a rare condition, hence published experience is limited. Most of the published cases were delivered by cesarean, due to the concern for possible complications. The authors report a case of a 36-year-old woman who underwent a vesico ileocystoplasty for IC, became pregnant six years after the operation, and delivered a healthy baby vaginally. Her obstetric and urologic outcomes were assessed, during, and after pregnancy. Careful antenatal monitoring by both an obstetrician and a urologist, awareness of potential complications, and their prompt treatment, can result in a successful pregnancy and vaginal delivery where neither fetus or mother nor neobladder are endangered.

Treatment of pouch stones after augmentation ileocystoplasty in children: is it always bothersome?

To report our experience with different approaches for management of pouch stones in children with ileal-based urinary reservoir. Charts of children who underwent ileal-based urinary reservoirs between 2000 and 2009 were retrospectively reviewed. Patients who were diagnosed with reservoir calculi were identified; medical records were reviewed for patients' demographics, diversion details, stone criteria, mode of treatment, perioperative complications, and recurrence rate. We identified 26 children with pouch stones after urinary diversion. There were 11 boys (42%) and 15 girls (58%). Mean age was 11 years (range, 4-16 years). Mean time for diagnosis was 42 months (24-120 months). Pouch stones were asymptomatic in 10 patients (38%). Fifteen cases were postbladder augmentation and 11 cases postcontinent cutaneous diversion. The mean stone size was 4 cm (range, 1-10 cm), and mean Hounsfield Unit was 585 (205-1090). Seventeen children (65%) had positive urine culture result, whereas 9 children were sterile. Seven children (27%) required open poucholithotomy, whereas 19 patients (73%) were managed endoscopically. Percutaneous approach was done in 5 children, whereas urethral access was used in 7 children. Mechanical extraction was performed in 12 cases, and stone disintegration was required in 7 cases. Eight children developed stone recurrence. Mean time for recurrence was 11 months (range, 3-19 months). Six children were after endoscopic disintegration, and all required redo endoscopic extraction. Stone analysis was available in 15 patients (struvite stones in 10 cases and calcium phosphate in 5 cases). Pouch stones are established long-term complication of urinary diversion. Open and endoscopic approaches are valid treatment strategies.