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Barone B, Napolitano L, Reccia P, Calace FP, De Luca L, Olivetta M, Stizzo M, Rubinacci A, Della Rosa G, Lecce A, Romano L, Sciorio C, Spirito L, Mattiello G, Vastarella MG, Papi S, Calogero A, Varlese F, Tataru OS, Ferro M, Del Biondo D, Napodano G, Vastarella V, Lucarelli G, Balsamo R, Fusco F, Crocetto F, Amicuzi U. Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review. J Pers Med 2024; 14:392. [PMID: 38673019 PMCID: PMC11051023 DOI: 10.3390/jpm14040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.
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Affiliation(s)
- Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Pasquale Reccia
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Francesco Paolo Calace
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Luigi De Luca
- Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy;
| | - Michelangelo Olivetta
- Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d’Aragona, 84085 Mercato San Severino, Italy;
| | - Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Andrea Rubinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Giampiero Della Rosa
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Arturo Lecce
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Lorenzo Romano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | | | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Gennaro Mattiello
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Maria Giovanna Vastarella
- Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Salvatore Papi
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Octavian Sabin Tataru
- Department of Simulation Applied in Medicine, The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Vincenzo Vastarella
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
- Division of Cardiology, Cardiovascular Department, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Raffaele Balsamo
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Ferdinando Fusco
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Ugo Amicuzi
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
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Che X, Huang H, Wang W, Zhong L, Yu S, Huang Y, Xi Z. Parastomal Hernia Following Ileal Conduit: Incidence, Risk Factors, and Health-Related Quality of Life. J Wound Ostomy Continence Nurs 2024; 51:126-131. [PMID: 38527321 PMCID: PMC11008435 DOI: 10.1097/won.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to measure the incidence of parastomal hernia (PH) after radical cystectomy and ileal conduit. Secondary aims were the identification of risk factors for PH and to compare the health-related quality of life (QOL) between patients with and without PH. DESIGN Retrospective review of medical records combined with cross-sectional administration of the QOL instrument and telephone follow-up. SUBJECTS AND SETTING The study sample comprised 219 patients who underwent radical cystectomy and ileal conduit for urothelial cancer between February 2014 and December 2018. The study setting was Peking University First Hospital (Beijing, China). METHODS Demographic and pertinent clinical data, including development of PH, were gathered via the retrospective review of medical records. Participants were also asked to complete the traditional Chinese language version of the City of Hope Quality of Life-Ostomy Questionnaire (C-COH). Multiple linear regression analysis was used to identify the effect of PH on C-COH scores. Logistic regression analysis was used to identify risk factors for PH development. RESULTS At a median follow-up of 34 months (IQR = 21-48), 43 of 219 (19.63%) patients had developed a PH. A body mass index (BMI) indicating overweight (OR = 3.548; 95% CI, 1.562-8.061; P = .002), a prior history of hernia (OR = 5.147; 95% CI, 1.195-22.159; P = .028), and chronic high abdominal pressure postdischarge (CHAP-pd) (OR = 3.197; 95% CI, 1.445-7.075; P = .004) were predictors of PH after operation. There was no significant difference between C-COH scores of patients with or without PH. No significant differences were found when participants with PH were compared to those without PH on 4 factors of the C-COH: physical scores (β= .347, P = .110), psychological scores (β= .316, P = .070), spiritual scores (β=-.125, P = .714), and social scores (β= .054, P = .833). CONCLUSION Parastomal hernia is prevalent in patients undergoing radical cystectomy and ileal conduit urinary diversion. Overweight, hernia history, and CHAP-pd were predictors of PH development. No significant differences in QOL were found when patients with PH were compared to those without PH.
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Affiliation(s)
- Xinyan Che
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Haiwen Huang
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Wei Wang
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Lijun Zhong
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Shuhui Yu
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Yanbo Huang
- Correspondence: Yanbo Huang () or Zhijun Xi (), Department of Urology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - Zhijun Xi
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
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Lutz MA, Le QC, Müller M, Müller SC, Rosenbaum CM, Vetterlein MW, Kluth LA. [Urinary diversion with or without simple cystectomy as a salvage option for benign diseases of the lower urinary tract]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:34-42. [PMID: 38157068 DOI: 10.1007/s00120-023-02246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Benign diseases of the lower urinary tract can occur as a result of oncological or neurological diseases or their respective therapies (e.g., surgery or radiation treatment) and can significantly reduce the quality of life for affected patients. Urinary diversion serves as a salvage option when all other therapeutic regimens have been carried out and proven unsuccessful. When selecting the suitable urinary diversion, a comprehensive clinical assessment of the patients is required in order to ensure long-term success. In some cases, a cutaneous, catheterizable pouch offers the last and only option for a long-term and definitive treatment of a patient's condition. Overall, a decreasing trend in the establishment of a continent urinary diversion is observed in Germany. Current data on benign indications for urinary diversion are limited. Therefore, further data collection and research are needed.
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Affiliation(s)
- Malin A Lutz
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Quynh Chi Le
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Matthias Müller
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Stefan C Müller
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | | | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
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Ranti D, Pfail J, Garcia M, Razdan S, Bieber C, Rosenzweig S, Waingankar N, Hosseini A, Radros J, Mehrazin R, Lavallée E, Wiklund PN, Sfakianos JP. Neobladder creation in patients with chronic kidney disease: A viable diversion strategy. Urol Oncol 2022; 40:168.e21-168.e27. [PMID: 35039217 DOI: 10.1016/j.urolonc.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 11/26/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Renal function impairment is often cited as a contraindication to continent diversion strategies. There is little evidence exploring renal function changes between continent and incontinent surgery in patients with preoperative chronic kidney disease (CKD), in particular CKD3B. METHODS This was a retrospective review of two high-volume centers performing robotic assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) or ileal conduit (IC) between 2014 to 2020. Patients were stratified based on CKD estimated glomerular filtration (eGFR) stage, which was estimated via the CKD-EPI equation. Postoperative renal function was compared for up to 60 months postoperative. Surgical, post-surgical, complications, and readmission data were gathered and compared between all patients RESULTS: 522 cystectomy patients, 430 with IC and 125 with ONB, were included. eGFR decline was statistically significant in a matched cohort of IC and ONB patients only at 3 months. There were no statistically significant differences between readmission rates, time to readmission, or complications. 34.6% of stage 3B patients had hydronephrosis on imaging prior to surgery, compared to 11.4%, 22.1% and 21.8% of CKD stage 1, 2, and 3A patients. CKD stage 3B had statistically and clinically improved eGFR through 24 months. CONCLUSION ONB surgery may be a viable diversion strategy in patients previously thought to be contraindicated due to low renal function.
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Affiliation(s)
- Daniel Ranti
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - John Pfail
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mariely Garcia
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirin Razdan
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christine Bieber
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shoshana Rosenzweig
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikhil Waingankar
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Abolfazl Hosseini
- Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Jari Radros
- Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Reza Mehrazin
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Etienne Lavallée
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter N Wiklund
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Dept of Molecular Medicine and Surgery section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - John P Sfakianos
- Department of Urologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:49-56. [PMID: 34838493 DOI: 10.1016/j.acuroe.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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Alonso Mediavilla E, Campos-Juanatey F, Azcárraga Aranegui G, Varea Malo R, Ballestero Diego R, Domínguez Esteban M, Ramos Barseló E, Zubillaga Guerrero S, Calleja Hermosa P, Gutiérrez Baños JL. Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. Actas Urol Esp 2021; 46:S0210-4806(21)00119-4. [PMID: 34332809 DOI: 10.1016/j.acuro.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. RESULTS The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
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Affiliation(s)
- E Alonso Mediavilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - F Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España.
| | | | - R Varea Malo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - E Ramos Barseló
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España
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7
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The robotic approach improves the outcomes of ERAS protocol after radical cystectomy: A prospective case-control analysis. Urol Oncol 2021; 39:833.e1-833.e8. [PMID: 34092478 DOI: 10.1016/j.urolonc.2021.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Minimally-invasive approach is one of the mainstays of Enhanced Recovery After Surgery (ERAS) pathways. Robot-assisted radical cystectomy (RARC) introduction has reduced the surgical burden on patient's recovery. Accordingly, ERAS protocol benefits may be more striking in RARC patients. We evaluated the impact of surgical approach on perioperative outcomes, Fast Track (FT) recovery steps and Trifecta success rates in patients undergoing RC followed by FT protocol. MATERIALS AND METHODS We considered 147 patients who underwent RC, with open (Open radical cystectomy [ORC]; 47.6%) or robotic (RARC; 52.4%) approach at 2 tertiary centers. Urinary diversions were ileal conduit or orthotopic neobladder. All patients underwent FT protocol. We analyzed perioperative surgical and functional outcomes and Trifecta success rates (namely, defecation <5 days, in-hospital stay <10 days and no major complications). Uni and multivariable logistic regression explored the predictors for Trifecta success and the impact of surgical approach on recovery steps. RESULTS Patients undergoing RARC had higher FT adherence (95% vs. 61%) compared to ORCs (P < 0.01). Trifecta success rates were higher for RARC (79.2% vs 28.6%; P < 0.001). At multivariable analyses, RARC was an independent predictor for Trifecta success (OR 9.1), early mobilization (OR 5.9) and FT adherence (OR 3.33; all P < 0.001). Surgical technique was not associated with major complications or readmission within 90 days (all P > 0.05). CONCLUSION RARC has more favorable perioperative outcomes compared to ORC, with higher Trifecta success rates. Accordingly, robotic approach should be ideally included in every center where ERAS protocol is applied to RC for maximizing patient's recovery.
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8
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Incontinent Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Kobayashi K, Goel A, Coelho MP, Medina Perez M, Klumpp M, Tewari SO, Appleton-Figueira T, Pinter DJ, Shapiro O, Jawed M. Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management. Radiographics 2020; 41:249-267. [PMID: 33306453 DOI: 10.1148/rg.2021200067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since their introduction into clinical practice in the 1950s, ileal conduits have been the most common type of urinary diversion used after radical cystectomy worldwide. Although ileal conduits are technically simpler to construct than other forms of urinary diversion, a variety of complications can occur in the early and late postoperative periods. Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit. Interventional radiologists can play a pivotal role in diagnosis and management of these complications by performing image-guided minimally invasive procedures. In this article, the authors review the surgical anatomy of an ileal conduit and the underlying pathophysiology of and diagnostic workup for complications related to ileal conduits. The authors also discuss and illustrate current approaches to interventional radiologic management of these complications, with emphasis on a collaborative approach with urologists or endourologists to best preserve patients' renal function and maintain their quality of life. ©RSNA, 2020.
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Affiliation(s)
- Katsuhiro Kobayashi
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Atin Goel
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Marlon P Coelho
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mariangeles Medina Perez
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Matthew Klumpp
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Sanjit O Tewari
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Tomas Appleton-Figueira
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - David J Pinter
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Oleg Shapiro
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mohammed Jawed
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
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10
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Ercolino A, Droghetti M, Schiavina R, Bianchi L, Chessa F, Mineo Bianchi F, Barbaresi U, Angiolini A, Casablanca C, Mottaran A, Molinaroli E, Pultrone C, Dababneh H, Bertaccini A, Brunocilla E. Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal. Minerva Urol Nephrol 2020; 73:763-772. [PMID: 33200895 DOI: 10.23736/s2724-6051.20.03843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC. METHODS We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: in-hospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups. RESULTS Seventy-five patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days P=0.006), HS (12 vs. 14 days P=0.008) and lower readmission rate (8% vs. 19% P=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% P=0.006). Trifecta achievement rate was higher for FT group (31% vs. 8% P<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups. CONCLUSIONS FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.
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Affiliation(s)
- Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Umberto Barbaresi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Angiolini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristian Pultrone
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hussam Dababneh
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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11
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Hagemans J, Voogt E, Rothbarth J, Nieuwenhuijzen G, Kirkels W, Boormans J, Koldewijn E, Richardson R, Verhoef C, Rutten H, Burger J. Outcomes of urinary diversion after surgery for locally advanced or locally recurrent rectal cancer with complete cystectomy; ileal and colon conduit. Eur J Surg Oncol 2020; 46:1160-1166. [DOI: 10.1016/j.ejso.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022] Open
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12
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Shen H, Liao K, Wu W, Yu H, Wu H. Urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma as a treatment for severe metabolic disorders post-radical cystectomy: A case report. Exp Ther Med 2019; 18:4881-4887. [PMID: 31798711 PMCID: PMC6880452 DOI: 10.3892/etm.2019.8111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/02/2019] [Indexed: 11/06/2022] Open
Abstract
A total of six male patients, who had undergone radical cystectomy and sigma-rectum pouch surgery due to bladder cancer (2-5 years previously), developed hyperchloremic metabolic acidosis, hypokalemia and renal dysfunction. The patients underwent urinary undiversion surgery (the pouch was isolated from the intestinal tract, abdominal ostomy was performed, and the sigmoid colon and rectum were reconnected) and blood gas and electrolyte analysis and renal function were compared pre- and post-surgery. Blood hydrocarbonate levels significantly improved 3 months post-surgery compared with the preoperative levels (17.90±4.12 vs. 7.57±4.25; P=0.026). At 6 months post-surgery, blood pH (7.36±0.04 vs. 7.16±0.08; P=0.028) and potassium levels (3.95±0.38 vs. 3.12±0.21; P=0.032) were found to have improved significantly compared with the pre-surgery levels, and remained normal. Serum creatinine levels decreased significantly from the preoperative levels at 6 months post-surgery (213.00±44.85 vs. 304.67±55.58; P=0.028). Serum chlorine (99.17±2.75 vs. 110.90±4.38; P=0.038) significantly improved until 3 years post-surgery. The results of this case report indicated that urinary undiversion from a sigma-rectum pouch to a cutaneous urinary stoma that separates the pouch and intestine may be a beneficial treatment for post-sigma-rectum pouch surgery acidosis and electrolyte disturbances.
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Affiliation(s)
- Hua Shen
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, P.R. China
| | - Kai Liao
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, P.R. China
| | - Weili Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, P.R. China
| | - Hongbo Yu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, P.R. China
| | - Hongfei Wu
- Department of Urology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, P.R. China
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13
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Abstract
This article focuses on the care and management of patients living with a urostomy. Improved surgical techniques and shortened hospital stays result in more patients receiving home care in the immediate postoperative period after surgical creation of a urostomy. It is important that home care clinicians have the knowledge and skills to manage the care of patients with a urostomy from hospital discharge to self-care. This article reviews the anatomy and physiology of the urinary tract, the formation of a stoma, and indications for the creation of a urostomy. Stent management, peristomal skin care, stomal complications as well as pouching options and accessories are discussed. Knowledge of care of patients with a urostomy can reduce the risk of complications and hospital readmissions, and assist patients to adjust to life with a urostomy.
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14
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Small AC, Benson CR, Brandes SB. Case of Delayed Ileal Conduit Necrosis Related to Infiltrative Diffuse Large B-cell Lymphoma. Urology 2018; 123:12-15. [PMID: 30266378 DOI: 10.1016/j.urology.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Alexander C Small
- Department of Urology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Cooper R Benson
- Department of Urology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Steven B Brandes
- Department of Urology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY.
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