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Yang H, Jiang P, Zhang Z, Zhou Y, Li P, Zeng Q, Zhang X, Sun Y. Laparoscopic Ureteric Reconstruction After Partial Ureterectomy for Locally Advanced and Recurrent Pelvic Malignancies (with Video). Ann Surg Oncol 2024:10.1245/s10434-024-15947-w. [PMID: 39078599 DOI: 10.1245/s10434-024-15947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The urinary tract is one of the most frequently involved organs in advanced non-urologic pelvic malignances. Extensive resection of ureteric organs is mandatory during a curative surgery. Urinary reconstruction after partial ureterectomy, the most challenging situation, is associated with a higher incidence of complication than cystectomy, especially when performed with laparoscopy. Furthermore, to date, no generally accepted strategy for urinary reconstruction after extensive tumor resection with partial ureterectomy has been established. METHODS The study identified and scrutinized intraoperative videos and clinical records of patients with locally advanced or recurrent pelvic malignancies who underwent segmental ureterectomy during en bloc resection of advanced tumors between February 2020 and February 2024. RESULTS The study enrolled nine patients, including four cases managed by ureteroureteral anastomosis, two cases managed by ureteroneocystomy, two cases managed by Boari flap reconstruction, and one case managed by ileal interposition. In all nine cases, R0 margins were obtained, and no case needed conversion to laparotomy. No clinical evidence of postoperative urinary leakage was identified. The median follow-up period was 14 months (range, 5-19 months). In three of the nine cases, recurrence was identified, at the 3rd, 18th, and 19th month follow-up evaluations, respectively. One patient died of systemic metastasis. CONCLUSIONS Laparoscopic ureteric reconstruction is feasible for patients who undergo segmental ureterectomy during extensive surgery for locally advanced or recurrent pelvic malignancies. A low anastomotic leakage rate and favorable postoperative renal function could be achieved in this study when anastomosis was performed laparoscopically.
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Affiliation(s)
- Hongjie Yang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Peishi Jiang
- Nankai University, Tianjin, People's Republic of China
| | - Zhichun Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Yuanda Zhou
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Peng Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Qingsheng Zeng
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China
- Nankai University, Tianjin, People's Republic of China
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China
| | - Yi Sun
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, People's Republic of China.
- Nankai University, Tianjin, People's Republic of China.
- Tianjin Institute of Coloproctology, Tianjin, People's Republic of China.
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Christiaans CHH, Polm PD, van Steenbergen TRF, Wyndaele MIA, de Kort LMO. Why are continent catheterizable channels continent? A stomal pressure profilometry feasibility study. Neurourol Urodyn 2024. [PMID: 38989648 DOI: 10.1002/nau.25546] [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: 01/18/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION A continent catheterizable channel (CCC) may be a solution for patients with impaired bladder emptying and difficult transurethral access. Leakage of the CCC is a common complication. To prevent leakage, the pressure in the CCC has to be higher than the reservoir (bladder/pouch) pressure in at least one location. It has not been clearly defined through which mechanism(s) the CCC achieves continence. In this feasibility study, we measured the CCC pressure profile in adult patients with various types of CCC's with and without stomal leakage. METHODS Adult patients with a CCC on a (augmented) bladder or pouch who underwent a urodynamic investigation between January and March 2023 were included. Next to the standard urodynamic investigation, a continuous stomal pressure measurement (CSP) and stomal pressure profilometry with empty bladder (SPP-1) and with filled bladder (SPP-2) of the CCC were performed. RESULTS A total of 17 patients were included. It was technically possible to perform SPP-1 and SPP-2 in all patients, and to measure the CSP in 16/17 patients. The median maximum stomal pressures in SPP-1 and SPP-2 were 112 (interquartile range [IQR], 76-140) cmH2O and 120 (IQR, 92-140) cmH2O, respectively. Nine patients had stomal leakage during the urodynamic investigation. In five patients, the detrusor leak point pressure (dLPP) was low (<20 cmH2O). A pressure peak at the beginning of SPP-2 was absent in all patients with stomal leakage at low dLPP. CONCLUSION SPP and CSP measurement in CCCs are feasible. We found differences in SPP-2 between patients with and without leakage at low dLPP, indicative of a role of the intravesical tunnel in continence or high dLPP. The results of this study may improve our understanding of the physiology and dynamics of CCCs as well as the management of CCC-related complications.
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Affiliation(s)
| | - Pepijn D Polm
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands
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Kochkin A, Kalfountzos C, Gallyamov E, Biktimirov R, Sanzharov A, Sergeev V, Popov S, Dal Moro F, Tokas T, Gözen AS. Laparoscopic intracorporeal ileal ureter replacement: multi-institutional data from 102 patients. MINIM INVASIV THER 2024; 33:140-146. [PMID: 38265869 DOI: 10.1080/13645706.2024.2302889] [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] [Received: 07/12/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To present long-term results of our laparoscopic intracorporeal ileal ureter replacement (LIUR) cohort, including more complex cases of laparoscopic ileocalycostomy. MATERIAL AND METHODS We collected records of patients undergoing LIUR. Follow-up included a chemical profile and urine cultures. Imaging consisted of renal ultrasonography, excretory urography, cystography, and computer tomographic or magnetic resonance urography. RESULTS One hundred and two patients were included. Stricture location was left (46.1%), right (39.2%), or bilateral (14.7%). No open conversion was performed. Seventy-four patients (72.5%) underwent a total ureteral unit removal. The mean operative time was 289.4 (120 - 680) minutes. The estimated blood loss was 185.2 (10-400) mL. Three patients had intraoperative complications, and fifteen had early postoperative complications. The mean postoperative hospital stay was 12.2 (7-35) days. The mean follow-up duration period was 37.7 (12-162) months. Most patients' follow-up was uneventful (88%), and seven patients presented with Grade 2 late complications. CONCLUSIONS Intracorporeal laparoscopic ileal ureteral replacement in cases of extensive ureteral lesions offers optimal long-term outcomes and a low complication rate. Ileocalycostomy constitutes a viable option in the small group of patients with long proximal ureteral strictures and intrarenal pelvis.
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Affiliation(s)
- Alexey Kochkin
- Department of Urology, Urological Center of Russian Railways Hospital, Privolzhskiy Research Medical University, Nizhny Novgorod, Russia
| | - Christos Kalfountzos
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Viopolis, Larissa, Greece
| | - Eduard Gallyamov
- Department of Common Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Rafael Biktimirov
- Department of Urology, Federal Clinical Center of High Medical Technology of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Andrey Sanzharov
- Department of Urology, Federal Scientific and Clinical Center for Specialized Methods of Medical Care and Medical Technologies of Federal Medical Biological Agency, Moscow, Russia
| | - Vladimir Sergeev
- Department of Urology, Russian State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sergey Popov
- Department of Urology, I.I. Mechkikov North - Western State Medical University, St. Petersburg, Russia
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
- Department of Urology, Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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El Khoury MAJ, Chartier-Kastler E, Parra J, Vaessen C, Roupret M, Seisen T, Lenfant L. Continent cutaneous diversion: Unveiling the interplay of neuro-urology and oncological challenges. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102665. [PMID: 38849033 DOI: 10.1016/j.fjurol.2024.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES The objective of our study is to demonstrate the practical application of continent cutaneous urinary diversion (CCUD) in oncological patients, with a focus on various aspects of the procedure: surgical challenges, functional outcomes, and quality of life. MATERIALS AND METHODS We studied the perioperative and follow-up data of patients who underwent cystectomy for cancer associated with CCUD (Mitrofanoff, Monti or Casale). We retrospectively analyzed complications within 30days and beyond 30days post-surgery. We evaluated oncological outcomes. Patients' quality of life was assessed using the Bladder Cancer Index (BCI) questionnaire. Results are given on an intention-to-treat basis. RESULTS A total of 24 patients were included in the study (July 2001 and May 2022), with a median follow-up of 62.5months. We report three deaths due to neoplasic recurrence. Forty-six percent had an early postoperative complication, two of whom required revision surgery. Overall, the medium-term complication rate was 70% and the reoperation rate was 62%. There were 8 stomal cutaneous stenoses (33%) and 3 uretero-ileal stenoses (12.5%). Overall satisfaction was rated at 9.2/10 on average, and body image was unaltered or slightly altered in 62.5% of patients. Of the patients who responded to the BCI, 75% had complete continence. DISCUSSION The experience gained with continent stomas in neuro-urology has allowed, in carefully selected cases, to offer patients an alternative that can improve their quality of life in a context already burdened by the shadow of cancer. CCUD can be proposed as an alternative to Bricker diversion in cases of urethral invasion or a high risk of neobladder incontinence, in selected patients. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Michael-Abdo-Jefferson El Khoury
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France; Université libre de Bruxelles, Faculté de Médecine, Bruxelles, Belgium.
| | - Emmanuel Chartier-Kastler
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France; Sorbonne Université, Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France
| | - Jérome Parra
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France
| | | | - Morgan Roupret
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France; Sorbonne Université, Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France
| | - Thomas Seisen
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France; Sorbonne Université, Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France
| | - Louis Lenfant
- Hôpital Universitaire Pitié-Salpétrière, AP-HP, Paris, France
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Polm PD, Christiaans CHH, Dik P, Wyndaele MIA, de Kort LMO. Continent catheterizable urinary channels: Lessons for lifelong urological care from a comparative analysis of very long-term complications and revision-free survival of three different types. Neurourol Urodyn 2024; 43:1083-1089. [PMID: 38078684 DOI: 10.1002/nau.25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Continent catheterizable channels (CCC) provide an alternative route to the bladder in both pediatric and adult patients. This study compared very long-term complications and revision-free survival of three different CCC techniques: appendicovesicostomy (AVS), ileum (Monti), and tubularized bladder flap (TBF). MATERIALS AND METHODS A retrospective cohort study was performed. Data from adult patients with CCC under surveillance at our academic tertiary referral urological center in 2020 and 2021 were collected. Both patients who acquired the CCC as a child and as an adult were included. The primary outcome was revision-free survival of the three CCC types. The secondary outcome was the prevalence of complications requiring surgical revision. Revisions were categorized as major (open subfascial or complete revisions) and minor (open suprafascial or endoscopic). RESULTS We included 173 CCCs (AVS 90, Monti 51, TBF 32). Median follow-up was 12.4 years (4.8-18). Mean revision-free survival was 162 ± 13 months, with no significant difference between the three types. Ninety-two individual CCCs (53%) required surgical revision and a total of 157 surgical revisions were performed. Seventy CCCs (40%) required major surgical revision: AVS (27/90%-30%), Monti (31/51%-61%), TBF (12/32%-38%). CONCLUSION Complications of CCCs are common; in this study with very long-term follow-up, more than half of CCCs required surgical revision. Revisions were more common in Monti channels compared with AVS and TBF. The mean revision-free survival of >13 years illustrates the sustained long-term durability of CCCs which is important in the lifelong urological care of this population with high life expectancy.
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Affiliation(s)
- Pepijn D Polm
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Pieter Dik
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands
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Polm PD, Wyndaele MIA, Dik P, de Kort LMO. Tubularized Bladder Flap as a Continent Catheterizable Channel in Adults. Urology 2024; 187:140-146. [PMID: 38471636 DOI: 10.1016/j.urology.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To describe a modified, less invasive, surgical technique to create a continent catheterizable channel (CCC) in adults: the tubularized bladder flap (TBF). MATERIALS AND METHODS We retrospectively reviewed records of patients in whom a TBF CCC was constructed at adult age between 2019 and 2023. We reported on demographics, operative outcomes, and 30-day and post-30-day complications. RESULTS A total of 11 patients (10 female) were described. The median operative time was 96 (range 90-115) minutes in patients with only TBF creation. Estimated blood loss was <100 cc in all patients. Within 30 days postoperatively, 6/11 (55%) patients developed a complication, all grade 1 Clavien Dindo. No bowel complications occurred (paralytic ileus, mechanical obstruction, or leakage/perforation). Median follow-up was 25 (range 6-56) months. In 2/11 (18%) patients surgical revision for stenosis was done; 3/11 (27%) patients underwent surgical revision for stomal leakage. CONCLUSION TBF as a means to create a CCC avoids intraperitoneal surgery, and bowel closure (appendicovesicostomy) or anastomosis (retubularized ileum). Postoperative bowel complications were not seen in any of our patients. Surgical revision rates for a TBF CCC appear to be comparable to other CCCs. Therefore, TBF could be considered in patients with sufficient bladder capacity as TBF is less invasive than other CCC techniques and avoids potential bowel complications.
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Affiliation(s)
- Pepijn D Polm
- UMC Utrecht, Department of Urology, Utrecht, The Netherlands.
| | | | - Pieter Dik
- UMC Utrecht, Department of Urology, Utrecht, The Netherlands.
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Chen S, Wu Y, Zhang P, Li Z, Li X, Li Z, Yang K, Li X. Laparoscopic continent cutaneous urinary diversion using a modified Yang-Monti technique in an adult: A case report including 5-year follow-up. Curr Urol 2024; 18:71-74. [PMID: 38505162 PMCID: PMC10946638 DOI: 10.1097/cu9.0000000000000230] [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: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 03/21/2024] Open
Abstract
Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable. The Yang-Monti channel is an alternative to the tunneled appendix for urinary diversion. We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously. No tumor recurrence was observed; however, the patient experienced severe catheter-related bladder irritation after the procedure. The patient was readmitted to the authors' hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang-Monti channel. The operation lasted 232 minutes, with an estimated blood loss of 10 mL. The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube. After this, clean intermittent catheterization was performed every 3 hours for 4 weeks. Five years after the procedure, the modified Yang-Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed. The patient was satisfied with his postoperative quality of life.
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Affiliation(s)
- Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yuye Wu
- Department of Urology, Fujian Second People’s Hospital, Fuzhou, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhenyu Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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Ruiz J, Imizcoz FL, Weller S, Szklarz MT, Tessi C, Rosiere N, Zabala LD, Blain O, Gomez Y, Gallino E, Burek CM, Sager C, Corbetta JP. Urological outcome with the use of salvage continent vesicostomy in pediatric reconstructive surgery. A single tertiary center experience. J Pediatr Urol 2023; 19:752.e1-752.e6. [PMID: 37704529 DOI: 10.1016/j.jpurol.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To report our experience and results in terms of complications, reoperation rate and urinary continence with the Salvage Continent Vesicostomy (SCV) technique in pediatric patients with history or need of enterocystoplasty and absent appendix. METHODS Retrospective review of all patients with a history of a continent catheterizable channel surgery performed in our institution between June 2016 and January 2022. Only patients with a SCV surgery with a minimum 6-month post operative follow up were included in this cohort and divided in group 1 (history of previous bladder augmentation) and group 2 (simultaneous bladder augmentation and SCV). Primary outcome of the study was to assess both continence and postoperative complication rates. Early complications were assessed using the Clavien-Dindo classification (I-V). Late complications were focused on the need of further subfascial revision. RESULTS 84 patients with a history of a continent stoma creation surgery were identified. In 20 of them (12 males) a SCV was performed. The mean age at surgery was 10.38 (range 4.87-15.6) years and the median postoperative follow-up time was 32 (range 6-64) months. Eleven patients were included in Group 1, while 9 patients in Group 2. Early complications occurred in 4 patients (20%), two of them required a re-intervention (Clavien-Dindo IIIb). Stoma subfascial revision was further required in 2 patient (10%). Continence rate at last follow up was 95%. CONCLUSIONS In our early experience, the salvage continent vesicostomy has proven to be a simple continent stoma technique with acceptable both continence and complication rates that can be used in selected patients with a history or need of bladder augmentation and absent appendix.
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Affiliation(s)
- Javier Ruiz
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina.
| | - Felicitas Lopez Imizcoz
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Santiago Weller
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - María Tatiana Szklarz
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Catalina Tessi
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Nicolas Rosiere
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Luciana Diaz Zabala
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Otilia Blain
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Yesica Gomez
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Esteban Gallino
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Carol Maria Burek
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Cristian Sager
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Urology Department ¨Prof. Dr. Juan P. Garrahan¨ Pediatric Hospital, Combate de Los Pozos 1881, C1245, Buenos Aires, Argentina
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Bokova E, Svetanoff WJ, Lopez JJ, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050846. [PMID: 37238394 DOI: 10.3390/children10050846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Chawla A, Patil MC, Reddy SJ, Pillai S, N SSB. Global Differences in Management of Neurogenic Bladder: Indian Perspective. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Boehm D, Rosenfeld J, Ji E, Lee Z. A Review of Bowel-based Urinary Diversions for the Colorectal Surgeon. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [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] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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Wu T, Haleem H, Yin M. Case report: A case of neoadjuvant immunotherapy in combination with the Yang–Monti technique for the treatment of ureteral carcinoma after radical cystectomy and left radical nephroureterectomy. Front Oncol 2022; 12:889028. [PMID: 35965513 PMCID: PMC9366000 DOI: 10.3389/fonc.2022.889028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Recurrence of urothelial carcinoma in a patient with solitary kidney is always a clinical challenge. In the immune checkpoint inhibitor era, neoadjuvant immunotherapy in combination with the Yang–Monti technique might be a good option for the patient with a high-risk tumor when kidney-sparing surgery for renal function preservation is desired. We report the case of a 74-year-old man with solitary kidney who was diagnosed with recurrence of urothelial carcinoma in the right ureter. He was initially deemed unfit for segmental resection of the ureter. Neoadjuvant immunotherapy with tislelizumab was performed in this patient with a partial response to urothelial carcinoma. He underwent segmental resection of the ureter with negative margins, and the ureteral defect was bridged by modified ileal replacement, which is the Yang–Monti technique. This patient has remained disease-free with adequate kidney function for longer than 18 months.
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15
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Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med 2022; 12:968. [PMID: 35743752 PMCID: PMC9225534 DOI: 10.3390/jpm12060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 12/14/2022] Open
Abstract
Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management. The kidneys and the ureters, representing the upper urinary tract system, can be at risk related to dyssynergy between the urethral sphincters and high pressures that lead to potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD). Recent guidelines for diagnosis, evaluation, treatment and follow up of the neurogenic bladder will be reviewed and options provided for risk stratification and management. Mechanical, pharmacological, neurolysis and surgical management will be discussed.
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Affiliation(s)
| | | | - Katherine Amin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Raveen Syan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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16
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Grosman J, Aigrain Y, Goulet O, Lacaille F, Capito C, Chardot C. Preservation of native sigmoid colon for secondary continent cystostomy after multivisceral transplantation for chronic intestinal pseudo-obstruction. Pediatr Transplant 2022; 26:e14180. [PMID: 34747091 DOI: 10.1111/petr.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
Chronic intestinal pseudo-obstruction (CIPO) is characterized by severe digestive +/- urinary dysmotility. If the conservative management fails, multivisceral transplantation (MVT) may be needed. However, urinary dysmotility remains after MVT and requires to continue urinary catheterizations and/or drainage. We report on a boy with severe CIPO complicated by (1) chronic intestinal obstruction requiring total parenteral nutrition, decompression gastrostomy, and ileostomy; (2) recurrent line infections; (3) hepatic fibrosis; and (4) distension of the bladder and upper urinary tract, and recurrent urinary infections, leading to non-continent cystostomy for urinary drainage. He underwent MVT at the age of 5 years. The transplant included the liver, stomach, duodenum and pancreas, small bowel, and right colon. The distal native sigmoid colon was preserved. Fifteen months later, he underwent a pull through of the transplanted right colon (Duhamel's procedure), together with a tube continent cystostomy (Monti's procedure) using the native sigmoid. Postoperative course was uneventful, and the remaining ileostomy was closed 3 months later. Five years post-transplant, he is alive and well. He is fed by mouth with complementary gastrostomy feeding at night. He has 3-6 stools per day, with occasional soiling. The cystostomy is used for intermittent urinary catheterization 4 times/day and continuous drainage at night. He is dry, with rare afebrile urinary infections, normal renal function, and un-dilated upper urinary tract. Conclusion: in severe CIPO with urinary involvement, preservation of the distal native sigmoid colon during MVT allows secondary creation of a continent tube cystostomy, which is useful to manage persistent urinary disease.
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Affiliation(s)
- Julien Grosman
- Service de chirurgie pédiatrique viscérale, hôpital Necker - Enfants malades, Paris, France
| | - Yves Aigrain
- Service de chirurgie pédiatrique viscérale, hôpital Necker - Enfants malades, Paris, France.,Université de Paris, Paris, France
| | - Olivier Goulet
- Université de Paris, Paris, France.,Service d'hépato-gastroentérologie et nutrition pédiatrique, hôpital Necker - Enfants malades, Paris, France
| | - Florence Lacaille
- Service d'hépato-gastroentérologie et nutrition pédiatrique, hôpital Necker - Enfants malades, Paris, France
| | - Carmen Capito
- Service de chirurgie pédiatrique viscérale, hôpital Necker - Enfants malades, Paris, France
| | - Christophe Chardot
- Service de chirurgie pédiatrique viscérale, hôpital Necker - Enfants malades, Paris, France.,Université de Paris, Paris, France
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17
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Pattou M, Baboudjian M, Pinar U, Parra J, Rouprêt M, Karsenty G, Phe V. Continent cutaneous urinary diversion with an ileal pouch with the Mitrofanoff principle versus a Miami pouch in patients undergoing cystectomy for bladder cancer: results of a comparative study. World J Urol 2022; 40:1159-1165. [DOI: 10.1007/s00345-022-03954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
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Ismail N, Daugherty M, Strine AC, DeFoor WR, Minevich E, Reddy PP, VanderBrink BA. Diagnosis, management and recurrence rates of Mitrofanoff polyps. J Pediatr Urol 2021; 17:855.e1-855.e4. [PMID: 34635438 DOI: 10.1016/j.jpurol.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intraluminal polyps are a known complication following creation of a urinary continent catheterizable channel (Mitrofanoff). These polyps can lead to difficult catheterizations in addition to symptomatic bleeding. However, there is limited data available regarding management and outcomes of these polyps. We aim to describe clinical presentation and management of a large series of polyps occurring in a Mitrofanoff channel. METHODS We performed a retrospective review of all patients that were treated for polyps in a Mitrofanoff at our institution. Information was collected regarding presenting symptoms, management and recurrence rates of the polyps. RESULTS A total of 24 patients were identified that fulfilled inclusion criteria. The majority of these polyps developed in channels composed of appendix (87%), while only 3 patients (13%) had polyps develop in an ileal composed channel. Thirteen (54%) of these polyps were incidentally diagnosed while 11 patients presented with a variety of symptoms such as difficulty in catheterization, bleeding with catheterization or both difficulty catheterizing and bleeding. For management of the polyps, a cystoscopy was performed and snaring the polyp with stone basket was performed in 37%, energy was applied to base to remove polyps in 33%, 16% were fulgurated and only 13% were left in situ. All procedures were performed under general anesthesia and all of the pathology was benign showing chronic inflammatory tissue. Eight polyps (33%) recurred after initial treatment. DISCUSSION We did not observe an asymptomatic channel polyp convert to a symptomatic during our follow up period. Our experience has led us to not intervene on all asymptomatic Mitrofanoff polyps encountered during cystoscopy under assumption they will inevitably become symptomatic. Although we admit our follow up period may not be long enough to make this a universal declaration of best practice when any Mitrofanoff polyp is diagnosed. Endoscopic treatment was effective minimally invasive method to address the symptomatic polyp rather than excision and construction of new channel. CONCLUSIONS This is the largest series to date of polyps developing in urinary continent catheterizable channels. The majority of these polyps were encountered incidentally however symptomatic polyps presented with difficulty with catheterizations. Symptomatic polyps can be managed endoscopically but recurrence of the polyp can occur.
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Affiliation(s)
- Nabeel Ismail
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - Michael Daugherty
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - Andrew C Strine
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - W Robert DeFoor
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - Eugene Minevich
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - Pramod P Reddy
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
| | - Brian A VanderBrink
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 5037, Cincinnati, OH, 45229, USA.
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The feasibility and efficacy of catheterizable stoma's in adults. Curr Opin Urol 2021; 31:550-555. [PMID: 34519676 DOI: 10.1097/mou.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW A continent vesicostomy represents a useful alternative for adult patients with impaired bladder emptying who are unable to perform clean intermittent (self-) catheterization through the urethra. In a pediatric setting, there exists a vast experience in these procedures. But experience with continent catheterizable vesicostomies is less abundant in adult patients. We want to give an overview and discuss recent literature about catheterizable conduits in the adult population. RECENT FINDINGS Adult patients who undergo continent vesicostomy comprise a diverse cohort. Because of this very heterogeneous population, it can be difficult to make an objective analysis and draw conclusions on both the success rate and complication rate of these diversions. We will discuss short- and long-term surgical outcomes and changes in quality of life after the procedure in these patients. SUMMARY A continent vesicostomy is a valuable and durable reconstructive technique for adult patients with impaired bladder emptying. Surgery can be challenging and a better knowledge of complications can help with patient counseling. In the future we hope that minimally invasive surgery will decrease the morbidity of such surgery and hopefully also improve functional outcomes and diminish the complication rate.
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Galvez C, Lopategui DM, Horodyski L, Castellan M. Totally robotic intracorporeal Monti-Yang continent ileovesicostomy in patient with previous robotic surgery-Technique description. J Pediatr Urol 2021; 17:579-580. [PMID: 34074607 DOI: 10.1016/j.jpurol.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022]
Abstract
We present a video case report of a pediatric patient with previous robotic abdominal surgery who underwent robotic assisted Monti-Yang continent ileovesicostomy. This 10-year-old female had a history of spina bifida, with previous myelomeningocele repair and ventriculoperitoneal shunt as an infant and robotic-assisted Malone procedure and artificial urethral sphincter placed 4 years ago. After undergoing bilateral hip surgery, she presented with difficult urethral catheterization due to reduced leg mobility. A Monti-Yang ileovesicostomy procedure was planned. A 5 mm laparoscopic port placed through the umbilicus followed by four additional DaVinci XI working ports. Twenty centimeters proximal the ileocecal valve, a 3 cm segment of ileum was dissected, then transected, detubularized, and retubularized around a 10 Fr catheter. This conduit was reimplanted to the anterior bladder wall. The other edge was fixed to the umbilicus. A 10 Fr Foley catheter was left clamped in the conduit, and a urethral Foley was left to gravity. Total operative time was 3 h 56 min. The patient did well post-operatively. She was discharged home on POD 6. Starting three weeks after surgery, the patient began catheterizing through the umbilical stoma. At 3 month follow-up, the patient catheterizes through her stoma every 3 h without leakage between catheterizations.
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Affiliation(s)
- Cinthia Galvez
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, 33136, FL, USA; Department of Urology, Miami University Medical School, Miami, 33136, FL, USA
| | - Diana M Lopategui
- Department of Urology, Mount Sinai Medical Center of Florida, Miami Beach, 33140, FL, USA
| | - Laura Horodyski
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, 33136, FL, USA; Department of Urology, Miami University Medical School, Miami, 33136, FL, USA
| | - Miguel Castellan
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, 33136, FL, USA; Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, 33155, FL, USA; Department of Urology, Miami University Medical School, Miami, 33136, FL, USA.
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21
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Daugherty M, Strine A, Frischer J, DeFoor WR, Minevich E, Sheldon C, Reddy P, VanderBrink B. Outcomes according to channel type for continent catheterizable channels in patients undergoing simultaneous urinary and fecal reconstruction. J Pediatr Surg 2021; 56:1335-1341. [PMID: 33256970 DOI: 10.1016/j.jpedsurg.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION When creating a continent catheterizable channel (CCC) the choice of bowel segment used as the conduit should be tempered with the morbidity associated with it. The split-appendix technique allows the creation of both a urinary and fecal CCC without the need for a bowel anastomosis. However, there is concern that by splitting the appendix there is compromise to its blood supply and may affect outcomes. We aim to compare what affect the bowel segment used for urinary and fecal CCCs has on perioperative and long-term outcomes in patients undergoing simultaneous urinary and fecal reconstruction. METHODS A retrospective review was performed analyzing all patients that underwent simultaneous continent catheterizable urinary and fecal CCC between the years 2010-2016. Patient demographics, channel characteristics, perioperative complications and clinical success rate were analyzed. RESULTS A total of 106 patients were identified that had simultaneous fecal and urinary CCC created at time of reconstruction. For urinary CCC, there were 64 patients (60.4%) that underwent a split-appendix technique, 27 patients (25.4%) underwent a Monti, and 15 patients (14.2%) had the appendix used only for the urinary channel. Those patients undergoing a split-appendix technique had median operative time of 447 min compared to 619 min when a Monti channel was created. The median length of hospital stay was 9 days for the split-appendix technique compared to 12 and 13 day median hospital stay when the appendix was used only for the urinary channel or a Monti was created, respectively. There was no difference seen in revision free survival of the channel following surgery of any of the channels with median follow-up of 44.5 months. However, there were more subfascial revisions of urinary CCC in those that underwent a Monti (5 patients, 18.5%) compared to other bowel segments (0 patients). CONCLUSIONS Utilizing a split-appendix approach for creation of urinary and fecal CCCs does not affect 30-day complications or long-term revision rates compared to other established techniques. This technique minimizes the potential surgical morbidity of a bowel anastomosis and provide shorter operative times, when feasible, at time of simultaneous creation of fecal and urinary CCC.
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Affiliation(s)
- Michael Daugherty
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA.
| | - Andrew Strine
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Jason Frischer
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - William R DeFoor
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Eugene Minevich
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Curtis Sheldon
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Pramod Reddy
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Brian VanderBrink
- Division of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
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22
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Application of the "Yang-Monti principle" in children with iatrogenic ureteral injuries. J Pediatr Urol 2021; 17:543.e1-543.e7. [PMID: 34034956 DOI: 10.1016/j.jpurol.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iatrogenic ureteral injuries in children are rare, due to its retroperitoneal position. The Yang -Monti ileal substitution serves as a good surgical option in such injuries associated with long segment defects of the ureter. OBJECTIVES To review our experience using the Yang Monti principle of ileal ureter substitution in children with long segment ureteric defects and analyse its intermediate term outcomes. STUDY DESIGN This was a prospective study, conducted from 2014 to 2019. All children with iatrogenic ureteral injuries with delayed presentations, undergoing the Yang Monti principle of ileal ureter substitution, were included (as illustrated in summary image). These injuries were divided into upper, mid, and distal ureteral injuries and were diagnosed based on a standardized protocol. At follow up, findings of the CT urogram, functional isotope renogram, and renal functions were the key points monitored. The demographic, clinical profile, operative, post-operative complications and follow up data were collated and analyzed. RESULTS 22 children were diagnosed with iatrogenic ureteral injuries. Of these, 14 children with delayed presentations underwent the Yang Monti principle of ileal ureter substitution. The primary pathology was gangrenous appendicitis (9 cases), calculus cholecystitis (3 cases) and torsion ovary (2 cases). Laparoscopic procedures were the commonest approach for the injury (10). The average age was 11.5 years, with a male predominance. The right ureter was affected in 12 cases. The average time to detection was 7 days. All children underwent an ultrasound guided nephrostomy tube insertion at presentation and the mid ureter (9) was most affected. The mean length of ureteric injury was 3.75 cm. Intra operatively, one ileal segment (2), two ileal segments (11) and three ileal segments (1) were used according to the length of the ureteric defect. Complications were urinary tract infections (2), adhesions (3) and leak (2) which were conservatively managed with no redo surgeries. The median follow up period was 4 years. At follow up CT urogram and isotope diuretic renogram were normal, with preserved renal functions and no metabolic complications in all. DISCUSSION & CONCLUSION In children associated with iatrogenic ureteral injuries of long lengths, the "Yang Monti ileal substitution" serves as a good and simple option with lesser complications permitting the preservation of the renal function at follow up.
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Functional Results, Complications Associated with the Serosa-lined Tunnel, and Quality of Life with a Cross-folded Ileal Reservoir Combined with an Afferent Tubular Isoperistaltic Segment for Heterotopic Continent Urinary Diversion: An Observational Long-term Cohort Analysis. Eur Urol Focus 2021; 7:869-876. [DOI: 10.1016/j.euf.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022]
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Saito K, Kinoshita Y, Takahashi Y, Kobayashi T, Arai Y, Ohyama T, Yokota N. Usefulness of the Monti-Malone procedure as a reconstruction of the antegrade continence enema procedure: a case report. Surg Case Rep 2021; 7:112. [PMID: 33956239 PMCID: PMC8102661 DOI: 10.1186/s40792-021-01197-5] [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: 02/22/2021] [Accepted: 05/03/2021] [Indexed: 11/14/2022] Open
Abstract
Background The antegrade continence enema (ACE) procedure is effective for severe constipation in patients with spina bifida and can improve quality of life (QOL). The Monti–Malone procedure (MM), which is a method of creating an enema tract from the colon, has been reported as an alternative to the ACE procedure when the appendix cannot be used. We report the usefulness of MM as a reconstruction of the antegrade continence enema procedure. Case presentation Our patient was a 22-year-old man with congenital spina bifida and hydrocephalus. Ventriculoperitoneal (VP) shunt surgery was performed immediately after birth, and preventative appendectomy was carried out during VP shunt repair when 4 months old. At 5 years of age, the ACE procedure using a balloon-button gastrostomy tube was performed for intractable chronic constipation. Simple management was expected, but after 17 years of age, he experienced increased stool leakage around the gastrostomy tube and his QOL declined due to difficulty in managing the ACE. Therefore, reconstruction of the ACE procedure by MM was performed. After reconstruction, the ACE performed well without any complications. The patient is currently satisfied because management of the ACE is easier than before, and his QOL has markedly improved without stool leakage and dermatitis. Conclusions MM is less likely to cause complications and is useful as a reconstruction of the ACE procedure.
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Affiliation(s)
- Koichi Saito
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan.
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
| | - Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, Japan
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Ali-El-Dein B, El-Hefnawy AS, D' Elia G, El-Mekresh MM, Shokeir AA, Gad H, Bazeed MA. Long-term Outcome of Yang-Monti Ileal Replacement of the Ureter: A Technique Suitable for Mild, Moderate Loss of Kidney Function and Solitary Kidney. Urology 2021; 152:153-159. [PMID: 33359492 DOI: 10.1016/j.urology.2020.09.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To present long-term outcome of Yang-Monti ileal ureter, with a focus on patients with mild/moderate loss of kidney function and solitary kidney. PATIENTS AND METHODS Between March 2001 and December 2019, Yang-Monti ileal ureter was performed on 36 patients with ureteric defects and median age 46.5 years. Of these, 4, 14, 15 and 3 patients had stage 1, stage 2, stage 3a and stage 4a chronic kidney disease, respectively; 6 had solitary kidney. Patients were regularly followed for complications, morphological, and functional outcome. RESULTS Ureteric stricture etiology was iatrogenic (16), Bilharzial (7), tuberculous (4), retroperitoneal fibrosis (5), malignancy (3), and gunshot injury (1). The median (range) ureteric defect length was 11 (8-16) cm. Four grade 1/2 postoperative Clavien-Dindo complications were noted. Median follow-up was 68 months (range 12-215). Intestinal obstruction developed in 1 patient and urinary tract infection in 10. At last follow-up, serum creatinine, split renographic clearance, and estimated glomerular filtration rate showed significant improvement compared to preoperative values, in the whole series, in cases with chronic kidney disease (stages 2, 3a and 3b) and solitary kidney. Four cases with chronic kidney disease (stage 3) showed deterioration of the kidney function parameters. Magnetic resonance urography showed improvement of hydronephrosis in most patients. No metabolic complications were noted. CONCLUSION Yang-Monti Ileal ureter is durable and effective in improving kidney function with few complications. It can be safely used in cases of mild/moderate kidney function loss and solitary kidney. A threshold eGFR <40 mL/min/1.73 m2 is considered relative contraindication.
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Affiliation(s)
- Bedeir Ali-El-Dein
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed S El-Hefnawy
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gianluca D' Elia
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohsen M El-Mekresh
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hosam Gad
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud A Bazeed
- Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Hubscher CH, Wyles J, Gallahar A, Johnson K, Willhite A, Harkema SJ, Herrity AN. Effect of Different Forms of Activity-Based Recovery Training on Bladder, Bowel, and Sexual Function After Spinal Cord Injury. Arch Phys Med Rehabil 2020; 102:865-873. [PMID: 33278365 DOI: 10.1016/j.apmr.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate whether the urogenital and bowel functional gains previously demonstrated post-locomotor step training after chronic spinal cord injury could have been derived due to weight-bearing alone or from exercise in general. DESIGN Prospective cohort study; pilot trial with small sample size. SETTING Urogenital and bowel scientific core facility at a rehabilitation institute and spinal cord injury research center in the United States. PARTICIPANTS Men and women (N=22) with spinal cord injury (American Spinal Injury Association Impairment Scale grades of A-D) participated in this study. INTERVENTIONS Approximately 80 daily 1-hour sessions of either stand training or nonweight-bearing arm crank ergometry. Comparisons were made with previously published locomotor training data (step; N=7). MAIN OUTCOME MEASURES Assessments at both pre- and post-training timepoints included cystometry for bladder function and International Data Set Questionnaires for bowel and sexual functions. RESULTS Cystometry measurements revealed a significant decrease in bladder pressure and limited improvement in compliance with nonweight-bearing exercise but not with standing. Although International Data Set questionnaires revealed profound bowel dysfunction and marked deficits in sexual function pretraining, no differences were identified poststand or after nonweight-bearing exercise. CONCLUSIONS These pilot trial results suggest that, although stand and weight-bearing alone do not benefit pelvic organ functions after spinal cord injury, exercise in general may contribute at least partially to the lowering of bladder pressure and the increase in compliance that was seen previously with locomotor training, potentially through metabolic, humoral, and/or cardiovascular mechanisms. Thus, to maximize activity-based recovery training benefits for functions related to storage and emptying, an appropriate level of sensory input to the spinal cord neural circuitries controlling bladder and bowel requires task-specific stepping.
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Affiliation(s)
- Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY.
| | - Jennifer Wyles
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Anthony Gallahar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Kristen Johnson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
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Tessi C, Burek CM, Sager C, Szklarz MT, Vásquez M, López Imizcoz F, Ruiz J, Weller S, Gomez Y, Corbetta JP. Bladder Volume Assessment in Pediatric Patients With Neurogenic Bladder: Is Ultrasound an Accurate Method? Urology 2020; 147:250-255. [PMID: 33053401 DOI: 10.1016/j.urology.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To define the accuracy of ultrasound to determine bladder volume in pediatric patients with neurogenic bladder (NB). METHODS Retrospective analysis of children with NB in treatment with urethral clean intermittent catheterization. EXCLUSION CRITERIA bladder surgeries, and catheterization through a channel different than urethra. Bladder volume was measured with ultrasound using the formula: anteroposterior bladder diameter by side to side diameter by distance from dome to outlet tract by 0.523 (cm3). In the same act, the patient was performed urethral catheterization and the drained volume was measured in millimeters. Finally, postvoid residual volume (PVR) was assessed with ultrasound. RESULTS We performed 318 measurements in 299 patients, mean age was 9.95 years (standard deviation: 4.6), 59% were female. Most frequent etiologies of NB were myelomeningocele and lipomyelomeningocele. Mean ultrasound-determined bladder volume was 213.9cm3 (range: 20-899 cm3) and mean bladder volume drain through catheterization was 336.4 mL (range: 30-1480 mL; P : .0001). In 67.3% of the patients (n: 214) PVR was not significant, and their mean ultrasound volume was 212.7 mL and the volume evacuated by catheterization was 339.9 mL (P : .0001). In all age groups ultrasound-determined bladder volume was statistically lower than catheterized bladder volume (P : .0001). The mean percentage error of the ultrasound-determined bladder volume was 15.58% ± 44.09. Linear regression analysis and Bland-Altman plot showed low agreement between both measurement techniques. CONCLUSION In children with NB, ultrasound-determined bladder volume was statistically lower than catheterized bladder volume measured at the same moment, and this relation persisted regardless of sex, age, and the presence of PVR.
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Affiliation(s)
- Catalina Tessi
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
| | - Carol M Burek
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Cristian Sager
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María T Szklarz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Mariana Vásquez
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Felicitas López Imizcoz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Javier Ruiz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Santiago Weller
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Yesica Gomez
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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Kurian JJ, Sen S, Kishore R, Srinivas R. Urethro vaginal injuries associated with pelvic fracture - A spectrum of clinical presentation and management. J Pediatr Urol 2020; 16:470.e1-470.e6. [PMID: 32536568 DOI: 10.1016/j.jpurol.2020.05.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Blunt trauma to the paediatric pelvis is associated with urethral rupture, sometimes even without a bony fracture. While such rupture of the male urethra has received considerable mention, female urethral injury is both less common and has received less attention. OBJECTIVE We describe 4 cases of urethro vaginal injury associated with pelvic fracture, its varied presentations and the modalities employed in its management. PATIENTS AND METHODS A retrospective study was done to identify 4 patients who presented to our institution between 2007 and 2018. All 4 girls suffered a loss of a urethral segment ranging from the distal urethra (n = 2) to complete urethral loss (n = 2) and rupture of the bladder neck in one. All 4 girls also had associated vaginal injury resulting in varied clinical presentation including total urinary incontinence, urocolpos, vaginal voiding via an acquired hypospadias and urinary retention with late onset haematocolpos. All were managed initially with SPC and three of them underwent urethral substitution with Monti ileal tube in two and vestibular mucosal flap in one. The hypospadiac neo-meatus was continent and was left alone. The ruptured vagina was repaired by rectus muscle interposition, direct suturing, posterior vaginal U flap or colonic patch. An appendicular Mitrofanoff was added for safety in 2 girls. RESULTS Follow up was done till June 2019 (range 1-12 years). All patients voided satisfactorily and were fully continent. Normal menstrual function was present in the 3 post pubertal children. CONCLUSION A traumatic force capable of causing urethral injury may often result in associated vaginal injury and should not be overlooked. Thus urinary retention is not the only presentation of urethral injury in girls. Fistulation to the vagina may result in continent or incontinent vaginal voiding if the vagina has not been transected and urocolpos/haematocolpos in those with vaginal transection. Various modalities maybe employed to maintain continuity of the urethra and vagina including use of bowel and local flaps.
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Affiliation(s)
- Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, 632004, India.
| | - Sudipta Sen
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, 632004, India
| | - Ravi Kishore
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, 632004, India.
| | - Rohith Srinivas
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, 632004, India.
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Robot-assisted continent urinary diversion according to the Mitrofanoff principle: results of a bicentric study. World J Urol 2020; 39:2073-2079. [PMID: 32691146 DOI: 10.1007/s00345-020-03361-2] [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: 12/15/2019] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the outcomes of continent urinary diversion according to the Mitrofanoff principle by robot-assisted laparoscopic surgery in terms of continence, catheterization and repeat surgery. METHODS All adult patients who underwent procedures for continent urinary diversion via a robot-assisted laparoscopic route between October 2014 and November 2018 were enrolled retrospectively. Abdominal continence and clean intermittent catheterization ability were noted, as well as patient characteristics, details of the technique, intra- and perioperative parameters, and complications. RESULTS Ten patients were included. Bladder-sphincter disorders were due to neurological causes in nine patients, and one patient had idiopathic bladder sphincter dyssynergia. A continent catheterizable channel was created using the appendix in six cases and the ileum in four cases. The median operative duration was 245 min (IQR 228-370). Two patients had a Clavien 3 complication requiring laparoscopy to separately drain a haematoma and a pelvic abscess. The median follow-up was 21 months (IQR 17-27). Abdominal continence without further intervention was obtained in 6/10 patients (60%). Two patients needed an open revision of the continent urinary diversion, one required injection of Deflux® and one an intradetrusorian injection of botulinum toxin type A (Botox®). Further surgery was needed for two patients to improve urethral continence. At the end of follow-up, all patients were continent and clean intermittent catheterization was possible. CONCLUSION Continent urinary diversion performed according to the Mitrofanoff principle is possible via a robot-assisted laparoscopic route and yields good outcomes on abdominal continence in the short term in patients with clean intermittent catheterization ability.
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Soyer T. Prevention and management of complications in various antegrade enema procedures in children: a review of the literature. Pediatr Surg Int 2020; 36:657-668. [PMID: 32185458 DOI: 10.1007/s00383-020-04635-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/26/2022]
Abstract
The antegrade continence enema (ACE) procedures are successful surgical options to achieve bowel cleaning in children with faecal incontinence due to a neuropathy or an anorectal malformation and an intractable constipation. The reversed and orthotopic appendicocecostomy, tubularized ileal conduit and the tubularized cecal flap are frequently applied procedures in the treatment of faecal incontinence (FI). The most common complications are the stoma stenosis, leakage, prolapse, adhesive obstruction and the difficulty in catheterization. Each procedure has its own advantages and disadvantages with different complication rates. The postoperative complications of ACE procedures may reduce patient compliance and quality of life. Most of these complications can be preventable and are easy to manage. This review aimed to discuss the prevention and management strategies for various ACE procedure complications.
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Affiliation(s)
- Tutku Soyer
- Department of Paediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Wu B, Pan C, Yao Z, Zhu X, Bai S. A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy. World J Surg Oncol 2020; 18:72. [PMID: 32278349 PMCID: PMC7151641 DOI: 10.1186/s12957-020-01831-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study is to describe a modified technique in ileal orthotopic bladder substitution with a new ureteroileal anastomosis. Case presentation After a classic open radical cystectomy with bilateral pelvic lymphadenectomy was performed extraperitoneally, a 56-cm ileal segment was used to construct the spheroidal shape bladder substitution. The 8-cm long proximal and distal ends of the ileal segment were used as afferent limbs. Two-centimeter ileal segments of afferent limbs were detubularized and transversally tubularized. The elongated ileal tube was anastomosed with the ureter in an end-to-end fashion. The pathway of the ureteroileal anastomosis was placed between the abdominal cutaneous fat and the anterior rectus muscular sheath. Perioperative data and long-term functional outcomes were assessed. Between December 2011 and December 2015, seven male patients underwent this procedure with a median 46 (30–77) months follow-up in our hospital. There was no difference between preoperative and postoperative estimated glomerular filtration rates (Z = − 1.693, P = 0.09). One of 14 sides had ureteroileal anastomotic stenosis; two of 14 sides in one patient had ureteroileal anastomotic stenosis caused by invasion of pelvic recurrence 15 months postoperatively. Reflux was completely prevented by placing pressure on the corresponding point on the abdominal surface when voiding urine in all patients. Conclusions We describe a feasible technique modification in detail, which provides some advantages for effective anti-reflux by mechanical finger pressing and abdominal contraction, a low incidence of stricture, and ease for a secondary operation in the long-term follow-up period.
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Affiliation(s)
- Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Chunyu Pan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
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Xiong S, Zhu W, Li X, Zhang P, Wang H, Li X. Intestinal interposition for complex ureteral reconstruction: A comprehensive review. Int J Urol 2020; 27:377-386. [PMID: 32189401 DOI: 10.1111/iju.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/11/2020] [Indexed: 12/21/2022]
Abstract
Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and mid-ureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and long-term follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.
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Affiliation(s)
- Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Weijie Zhu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - He Wang
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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Abstract
Cystectomy and urinary bladder substitution are rare in children but may be necessary in some cases of bladder exstrophy, in the setting of malignancy, or in other settings in which the bladder is severely dysfunctional. This article details advances in surgical techniques in creating continent urinary diversions in this specialized pediatric population.
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Affiliation(s)
- Jennifer E Reifsnyder
- Division of Pediatric Urology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, 11040, USA
| | - Moneer K Hanna
- Division of Pediatric Urology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, 10065, USA
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[Continent cystostomies - indications, surgical technique, complications and management]. Prog Urol 2019; 29:929-935. [PMID: 31451400 DOI: 10.1016/j.purol.2019.08.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To specifically introduce continent cystostomy - indications, surgical technique, complications and management - to the nurses working in a urology department. METHOD The present article is based on a review of the literature and author's experience in continent cystostomy. RESULTS Continent cystostomy is a neo-conduit placed between the bladder and the anterior abdominal wall using the digestive tract. It is usually performed in patients with bladder voiding dysfunction who cannot undergo clean self-intermittent catheterization through the urethra. The high success rate (>84%) associated with this procedure should not hide the frequent associated complications with the conduit. CONCLUSION Even if continent cystostomy is associated with good mid- and long-term functional outcomes, it requires a close follow-up and in some cases "adjustments".
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Stein R, Zahn K, Huck N. Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction. Front Pediatr 2019; 7:236. [PMID: 31245339 PMCID: PMC6581750 DOI: 10.3389/fped.2019.00236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/28/2023] Open
Abstract
Today, there are few indications for the use of bowel in pediatric urology. This is in large extent due to the successful conservative therapy in patients with neurogenic bladder and the improved success of primary reconstruction in patients with the bladder exstrophy-epispadias complex. Only after the failure of the maximum of conservative therapy or after failure of primary reconstruction, bladder augmentation, or urinary diversion should be considered. Malignant tumors of the lower urinary tract (e.g., rhabdomyosarcomas of the bladder/prostate) are other rare indications for urinary diversion. Replacement or reconstruction of the ureter with a bowel segment is also a quite rarely performed procedure. In this review, the advantages and disadvantages of the different options for the use of bowel segments for bladder augmentation, bladder substitution, urinary diversion, or ureter replacement during childhood and adolescence are discussed.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Groenendijk IM, van den Hoek J, Blok BFM, Nijman RJM, Scheepe JR. Long-term results of continent catheterizable urinary channels in adults with non-neurogenic or neurogenic lower urinary tract dysfunction. Scand J Urol 2019; 53:145-150. [PMID: 30958079 DOI: 10.1080/21681805.2019.1596156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To evaluate the long-term results after the construction of a Continent Catheterizable Urinary Conduit (CCUC) in adults. Methods: This study retrospectively reviewed the charts of 41 adults from two tertiary centers who received a CCUC. The demographics, underlying diseases, indications for a CCUC and outcomes such as the reoperation rate and the occurrence of complications were extracted. The patient reported outcome was measured with the Patient Global Impression of Improvement (PGI-I) scale and four additional questions about continence, leakage and stomal problems. Results: Twenty-nine patients were women. The median age at surgery was 32 years, with a median follow-up of 52 months. Twenty-six patients had a neurogenic bladder. The reoperation rate was 48.8%, with a median of 10.5 months after constructing the CCUC. Superficial stomal stenosis was the most common registered complication (20 times) and stoma revision was the most often performed reoperation (12 times). Twenty-four patients completed the PGI-I; the mean improvement rating was 2 (=much better). Conclusion: The construction of a CCUC in adults is associated with a high complication and reoperation rate. The high reoperation rate is in accordance with the sparse literature. Despite this, patients reported 'much better' on the PGI-I.
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Affiliation(s)
- Ilse M Groenendijk
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Joop van den Hoek
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Bertil F M Blok
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Rien J M Nijman
- b Department of Urology, University Medical Center Groningen , Rijksuniversiteit Groningen , Groningen , The Netherlands
| | - Jeroen R Scheepe
- a Department of Urology , Erasmus Medical Center , Rotterdam , The Netherlands
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Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans. Prog Urol 2019; 29:147-155. [DOI: 10.1016/j.purol.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/10/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022]
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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Abstract
Surgical indications for individuals with neuropathic bladder include unsafe urinary storage pressures, progressive upper tract deterioration, and continued urinary incontinence that is recalcitrant to oral pharmacologic or intradetrusor injection therapy and intermittent catheterization. Bladder augmentation is currently the gold standard surgical procedure used to increase bladder capacity and reduce storage pressures but has significant long-term risks. The medical and surgical management of neuropathic bladder, as well as long-term consequences of bladder augmentation, are reviewed.
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Affiliation(s)
- Joshua D Roth
- Department of Pediatric Urology, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA.
| | - Mark P Cain
- Department of Pediatric Urology, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA
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Hampson LA, Baradaran N, Elliott SP. Long-term complications of continent catheterizable channels: a problem for transitional urologists. Transl Androl Urol 2018; 7:558-566. [PMID: 30211046 PMCID: PMC6127530 DOI: 10.21037/tau.2018.03.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25-30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, UCSF School of Medicine, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, UCSF School of Medicine, San Francisco, CA, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Tavares PM, Smaniotto GP, Bortolini T, Rosito NC, Neto BS, Rosito TE. Ileal Continent Reservoir: A Feasible Option for Bladder Augmentation and Urinary Diversion. Urology 2018; 120:253-257. [PMID: 29958971 DOI: 10.1016/j.urology.2018.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 06/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To present the results of technique of continent urinary diversion, described by Macedo, that allows the configuration of a tunnel with a flap of the ileal tube at the same segment created for the reservoir. METHODS From January 2006 to November 2016, 29 patients were underwent a urinary diversion by Macedo's technique. Patients' demographics, hospitalization time, surgical time, follow up, continence rate, reservoir capacity, and postoperative complications were evaluated. RESULTS Sixty-nine percent were male and the median age was 16.9 years. The main etiology was meningomyelocele (69.1%). The mean surgical time was 4.2 hours (standard deviation [SD] 0.9 range 2.9-6.3). The median length of hospital stay was 10 days (interquartile range: 11.3 range 5-51). The mean follow up was 3.3 years (SD 2.2 range 0.3-9.8). Procedure in the bladder neck was performed in 12 patients (41.3%). A continence rate of the catheterizable conduit was 82.8%.The reservoir capacity increased from 134.4 to 364.4 ml (P <.0001). The continence rate improved significantly (20 vs 74%, P <.0001). There was no change in glomerular filtration rates in the long term (143.1 vs 147, P = .45). Morbidity rate was 58% (25 complications in 17 patients), 72% occurred within the first 60 days and 60% were classified as Clavien-Dindo I or II. CONCLUSION Except for publications from the original author, this is the first series described. The outcomes are similar, adding important data with respect to this technique. They show that the ileal reservoir is feasible, reproducible, and with good results.
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Affiliation(s)
- Patric Machado Tavares
- Urology Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Guilherme Pereira Smaniotto
- Urology Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiago Bortolini
- Urology Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nicolino Cesar Rosito
- Pediatric Surgery Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Brasil Silva Neto
- Urology Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiago Elias Rosito
- Urology Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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The Double Dutch technique: A new way of creating an ileocystoplasty with a lengthy catheterizable ileal tube. J Pediatr Urol 2018; 14:255.e1-255.e6. [PMID: 29499975 DOI: 10.1016/j.jpurol.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 12/12/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION A tubularized conduit from an open 2-cm vascularized ileal segment is a frequently used technique to create a continent catheterizable channel in cases of an inappropriate or absent appendix. In the long term, many patients experience catheterization problems with the classic ileal segment tube, and even more with spiral or double-segment tubes. OBJECTIVE The objective of this paper was to introduce an ileocystoplasty modification combined with a long ileal segment tube that has better support by surrounding tissue than other lengthy ileal segment tubes. Briefly summarized, this newly introduced method begins with isolating approximately 30 cm of ileum and dividing it into two parts. Two strips are then created and closed as a double-length tube. The ileal segments are opened antimesenterically and closed over the tube in the middle. The lower part of the tube is implanted with a submucosal tunnel in the bladder wall, and the ileal patch is then anastomosed with the bladder. The tube is anastomosed to the umbilicus in an ordinary way without any traction (see Summary Fig.). STUDY DESIGN Between May 2005 and November 2012 the new technique was used at the current institution in nine children who needed an ileocystoplasty (mean age: 9 years and 3 months). Underlying etiology was neurogenic bladder in seven cases and epispadias in two. RESULTS All patients ultimately had stomas without leakage or strictures. During follow-up, three of nine tubes developed stenoses that were corrected; four stomas in total had some sort of surgical revision. Median follow-up was 93 months. Intermittent catheterization was uncomplicated in all at this time. DISCUSSION With this modification of the standard technique it seemed to be possible to create a more stable channel. The blood supply of the tube was secured by completely embedding the mesentery of the tube. Limitations included the small number of patients treated so far. CONCLUSION The lengthy tubes appeared to be straight and well supported by the surrounding tissues, which prevented kinking and sacculation. It is hoped that this technique will have better results and fewer complications at long-term follow-up.
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Liu D, Zhou H, Hao X, Cao H, Ma L, Zhou X, Tao T, Cheng W, Feng Z. Laparoscopic Yang-Monti Ureteral Reconstruction in Children. Urology 2018; 118:177-182. [PMID: 29751025 DOI: 10.1016/j.urology.2018.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the clinical outcome of surgical treatment for long ureteral defect in children, we evaluated our experience of managing 6 children with the long defect utilizing laparoscopic ureteral reconstruction technique using Yang-Monti technique. MATERIALS AND METHODS Six children with long ureteral defect who underwent laparoscopic Yang-Monti ureteral reconstruction between January 2013 and March 2016 were reviewed. The diagnosis and outcomes of long ureteral defects were reviewed based on clinical and imaging data. We assessed preoperative clinical data and outcomes, and analyzed the experience of laparoscopic Yang-Monti ureteral reconstruction. RESULTS The mean age of the patients was 8.5 years. The etiology of the ureteral defect was failed pyeloplasty in 4 patients, failed pyeloplasty and ureteral reimplantation in 1, and trauma in 1. The mean defect length was 5.83 cm. All operations were performed successfully with no serious intraoperative complications and no conversion. The average operative time was 314 minutes, the average intraoperative blood loss was 25 mL, the average drain removal was 3.83 days, the average start of oral feeding was 5.17 days, and the average postoperative hospital stay was 7.17 days. Six patients suffered Clavien I and II complications postoperatively and were managed conservatively. Two patients suffered Clavien III complications postoperatively and were managed by replacing stent. A diuretic T1/2 showed the improvement of differential renal function without urinary obstruction in all patients. CONCLUSION Laparoscopic Yang-Monti ureteral reconstruction is safe and feasible in children with an excellent outcome.
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Affiliation(s)
- Dehong Liu
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China.
| | - Xuemei Hao
- Department of Anesthesiology, PLA Army General Hospital, Beijing, China
| | - Hualin Cao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Lifei Ma
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
| | - Wei Cheng
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China; Department of Pediatric Surgery, Beijing United Family Hospital, Beijing, China
| | - Zhichun Feng
- Department of Pediatrics, Bayi Children's Hospital Affiliated to PLA Army General Hospital, Beijing, China
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Mogorovich A, Selli C, De Maria M, Manassero F, Durante J, Urbani L. Clinical reappraisal and state of the art of nephropexy. Urologia 2018; 85:135-144. [PMID: 29637838 DOI: 10.1177/0391560317749191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.
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Affiliation(s)
- Andrea Mogorovich
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Cesare Selli
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Maurizio De Maria
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Jacopo Durante
- 1 Division of Urology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Lucio Urbani
- 2 Department of Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, Fisch M. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies. Asian J Urol 2018; 5:101-106. [PMID: 29736372 PMCID: PMC5934506 DOI: 10.1016/j.ajur.2018.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 11/03/2022] Open
Abstract
Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment. Left untreated they are associated with severe short- and long-term complications such as urinoma, septic state, renal failure, and loss of a renal unit. Treatment depends on timing of diagnosis, as well as extent of injury, and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts. While recent advances in ureteral tissue engineering are promising the topic is still underreported. Historically a domain of open surgery, laparoscopic and robotic-assisted approaches have proven their feasibility in small case series, and are increasingly being utilized as means of reconstructive surgery. This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hubscher CH, Herrity AN, Williams CS, Montgomery LR, Willhite AM, Angeli CA, Harkema SJ. Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury. PLoS One 2018; 13:e0190998. [PMID: 29385166 PMCID: PMC5791974 DOI: 10.1371/journal.pone.0190998] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs' pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). STUDY DESIGN Prospective cohort study; pilot trial with small sample size. METHODS Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. RESULTS Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. CONCLUSIONS These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions. TRIAL REGISTRATION ClinicalTrials.gov NCT03036527.
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Affiliation(s)
- Charles H. Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, United States of America
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
| | - April N. Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
| | - Carolyn S. Williams
- Department of Urology, University of Louisville, Louisville, Kentucky, United States of America
| | - Lynnette R. Montgomery
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, United States of America
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Andrea M. Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehabilitation Institute, Louisville, Kentucky, United States of America
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehabilitation Institute, Louisville, Kentucky, United States of America
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Rensing AJ, Koenig JF, Austin PF. Pre-operative risk factors for stomal stenosis with Malone antegrade continence enema procedures. J Pediatr Urol 2017; 13:631.e1-631.e5. [PMID: 29248276 DOI: 10.1016/j.jpurol.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Malone antegrade continence enema (MACE) procedure remains an effective tool in providing independence to patients with refractory constipation. Appendiceal, ileal and colonic segments are all used depending upon the patient's individual anatomy and surgeon's preference. Unfortunately, MACE stomal stenosis (SS) remains a frustrating complication. It was hypothesized that SS is associated with the type of efferent limb used for MACE construction. OBJECTIVE To perform a retrospective risk analysis of the pre-operative factors that correlated with postoperative stomal stenosis. MATERIALS AND METHODS The study reviewed 39 consecutive patients treated with MACE by a single surgeon at the present institution. Collected data included: the type of channel construction, stoma site, pre-operative body mass index (BMI) z-score, pre-operative diagnosis, and development of SS. Stomal stenosis was defined as a documented inability to catheterize, requirement of a Chait tube, or a subsequent stomal revision. An odds ratio (OR) analysis was performed to evaluate the association with the development of SS. RESULTS Stomal stenosis developed in 19 patients (49%) with an average follow-up of 4.7 years. The majority of patients had a diagnosis of myelomeningocele (90%), and there was no significant difference in gender distribution (54% males, 46% females). The distribution types of MACE efferent limbs consisted of appendicocecostomy in 20 (51%), cecal-wall flap in 16 (41%) and ileocecostomy in three patients (8%). Neither type of efferent limb, nor stomal location were significant predictors of postoperative SS. Pre-operative obesity (BMI ≥95%), however, demonstrated a significant risk of SS compared to non-obese patients (OR 4.44, 95% CI 1.08-18.4, P = 0.04). DISCUSSION This was a single-institution study of a relatively small number of patients. However, examining consecutive patients with a common surgeon can minimize technique variability. Also, the rates of stenosis in this cohort were higher than most. This may have been due to a more broad definition (unable to catheterize). These findings complement recent literature showing an increased complication rate for the obese pediatric patient. CONCLUSION Stomal stenosis remains a frustrating complication following creation of the MACE stoma. In the present series, neither a cecal wall flap, nor the stomal site location contributed to SS. Obesity was the only identified statistically significant risk factor that led to SS.
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Affiliation(s)
- A J Rensing
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J F Koenig
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - P F Austin
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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Polm PD, de Kort LM, de Jong TP, Dik P. Techniques Used to Create Continent Catheterizable Channels: A Comparison of Long-term Results in Children. Urology 2017; 110:192-195. [DOI: 10.1016/j.urology.2017.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
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Abstract
Pediatric urinary diversion is performed for a unique set of indications with many options to consider. Although surgical intervention has decreased in necessity overall due to advances in expectant management, it remains an important tool. There are many options and various factors to consider in choosing the right type of diversion for an individual and these patients require lifelong follow-up with a pediatric urologist and eventually an adult urologist. This article provides a detailed review of the most relevant techniques used by pediatric urologists for urinary diversion.
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Affiliation(s)
- Jeffrey D Browning
- Department of Urology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 700, Pittsburgh, PA 15213, USA
| | - Heidi A Stephany
- Department of Urology, University of California, Irvine and Children's Hospital of Orange County, 505 S. Main Street, Orange, CA 92868, USA.
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