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Liang H, Sun H, Chen J. A modified ureteroileal anastomosis can reduce ureteroileal anastomotic stricture after ileal conduit. Int Urol Nephrol 2024; 56:2235-2241. [PMID: 38347248 DOI: 10.1007/s11255-024-03965-2] [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: 11/11/2023] [Accepted: 01/30/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Ileal conduit is commonly employed as a urinary diversion procedure for patients with bladder cancer after radical cystectomy. Studies have reported that ureteroileal anastomotic stricture remains a serious complication following ileal conduit diversion. The aim of this study was to introduce a novel modified technique for ureteroileal anastomosis and evaluate postoperative complications, with a specific focus on the incidence of ureteroileal anastomotic stricture. METHODS A prospective single-center, single-surgeon cohort study was conducted on 29 consecutive patients who underwent laparoscopic radical cystectomy with ileal conduit urinary diversion between February 2017 and April 2021. A descriptive statistical analysis was performed where intraoperative variables and postoperative complications were assessed. RESULTS All 29 operations were successful with an average operation time of 372.9 ± 94.3 min. The mean follow-up time was 39.62 ± 15.93 months. No cases of UIAS occurred. Three patients (10.3%) had febrile urinary tract infection, three patients (10.3%) had a transient small bowel obstruction, one patient (3.4%) had ileal anastomotic fistula, one patient (3.4%) had ileal conduit leakage, and one patient (3.4%) died 2 months after surgery due to multiple respiratory diseases. One patient (3.4%) had a mild left ureteral obstruction and CT indicated the obstruction site was in front of the iliac vessels where the left ureter had transposed to the right. CONCLUSION The modified ureteroileal anastomosis can reduce the incidence of UIAS.
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Affiliation(s)
- Hao Liang
- Department of Urology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China.
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Nakagawa R, Izumi K, Toriumi R, Aoyama S, Kamijima T, Makino T, Naito R, Iwamoto H, Yaegashi H, Kawaguchi S, Shigehara K, Nohara T, Mizokami A. Does radical cystectomy have a better prognosis than bladder conservative treatment in the real world? Int J Urol 2024; 31:628-636. [PMID: 38358066 DOI: 10.1111/iju.15422] [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: 11/15/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare the prognosis and quality of life between radical cystectomy and bladder conservative treatment for muscle invasive bladder cancer in the real world. MATERIALS AND METHODS Patients treated for muscle invasive bladder cancer without metastases were retrospectively evaluated for overall survival, progression-free survival, and rehospitalization. RESULTS Of the 141 patients, 62 underwent bladder conservative treatment and 79 underwent radical cystectomy. Patients who underwent radical cystectomy had significantly better progression-free survival (HR: 1.83, 95% CI: 1.12-3.00; p < 0.01) and overall survival (HR: 1.82, 95% CI: 0.99-3.34; p = 0.03) than those who underwent conservative treatment. However, there was no significant difference in prognosis between patients who refused to undergo radical cystectomy and those who underwent. In addition, rehospitalization rates for complications and additional treatment were significantly higher in patients who received conservative treatment (69.3% vs. 34.2%; p < 0.01), and the length of hospital stay was also prolonged compared to patients who received radical cystectomy (26 vs. 9 days; p = 0.03). CONCLUSIONS Overall, conservative treatment had a significantly poorer prognosis than radical cystectomy, but there was no significant difference in prognosis when comparing patients who refused radical cystectomy and received conservative treatment with those who received radical cystectomy. However, hospitalization rates and length of stay were significantly worse for patients who chose conservative treatment, which may lead to a decline in quality of life.
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Affiliation(s)
- Ryunosuke Nakagawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Ren Toriumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shuhei Aoyama
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Taiki Kamijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Satyal U, Valentine H, Liu D, Slifker M, Lallas CD, Trabulsi EJ, Bukavina L, Szeto L, Hoffman-Censits JH, Mouw KW, Faltas BM, Grivas P, Ibragimova I, Porten SP, Van Allen EM, Geynisman DM, Parker DC, O'Neill JP, Drevik J, Christianson SS, Ginzburg S, Correa AF, Uzzo RG, Ross EA, Zibelman MR, Ghatalia P, Plimack ER, Kutikov A, Abbosh PH. Urine Biopsy as Dynamic Biomarker to Enhance Clinical Staging of Bladder Cancer in Radical Cystectomy Candidates. JCO Precis Oncol 2024; 8:e2300362. [PMID: 38865671 DOI: 10.1200/po.23.00362] [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: 07/12/2023] [Revised: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 06/14/2024] Open
Abstract
PURPOSE There is significant interest in identifying complete responders to neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) to potentially avoid removal of a pathologically benign bladder. However, clinical restaging after NAC is highly inaccurate. The objective of this study was to develop a next-generation sequencing-based molecular assay using urine to enhance clinical staging of patients with bladder cancer. METHODS Urine samples from 20 and 44 patients with bladder cancer undergoing RC were prospectively collected for retrospective analysis for molecular correlate analysis from two clinical trials, respectively. The first cohort was used to benchmark the assay, and the second was used to determine the performance characteristics of the test as it correlates to responder status as measured by pathologic examination. RESULTS First, to benchmark the assay, known mutations identified in the tissue (MT) of patients from the Accelerated Methotrexate, Vinblastine, Doxorubicin, Cisplatin trial (ClinicalTrials.gov identifier: NCT01611662, n = 16) and a cohort from University of California-San Francisco (n = 4) were cross referenced against mutation profiles from urine (MU). We then determined the correlation between MU persistence and residual disease in pre-RC urine samples from a second prospective clinical trial (The pT0 trial; ClinicalTrials.gov identifier: NCT02968732). Residual MU status correlated strongly with residual disease status (pT0 trial; n = 44; P = .0092) when MU from urine supernatant and urine pellet were assessed separately and analyzed in tandem. The sensitivity, specificity, PPV, and NPV were 91%, 50%, 86%, and 63% respectively, with an overall accuracy of 82% for this second cohort. CONCLUSION MU are representative of MT and thus can be used to enhance clinical staging of urothelial carcinoma. Urine biopsy may be used as a reliable tool that can be further developed to identify complete response to NAC in anticipation of safe RC avoidance.
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Affiliation(s)
| | | | - David Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | | | - Costas D Lallas
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA
| | | | - Lauren Szeto
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Jean H Hoffman-Censits
- Department of Urology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Kent W Mouw
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Bishoy M Faltas
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Petros Grivas
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| | | | - Daniel C Parker
- Department of Urology, University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK
| | | | - Johnathan Drevik
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA
| | | | - Serge Ginzburg
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA
| | | | | | | | | | | | | | | | - Philip H Abbosh
- Fox Chase Cancer Center, Philadelphia, PA
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA
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Loverro M, Aloisi A, Tortorella L, Aletti GD, Kumar A. Trends and current aspects of reconstructive surgery for gynecological cancers. Int J Gynecol Cancer 2024; 34:426-435. [PMID: 38438169 DOI: 10.1136/ijgc-2023-004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Gynecologic cancers can lead to gynecologic tract destruction with extension into both the gastrointestinal and urinary tracts. Recurrent disease can also affect the surrounding bony pelvis and pelvic musculature. As opposed to advanced ovarian cancer, where cytoreduction is the goal, in these scenarios, an oncologic approach to achieve negative margins is critical for benefit. Surgeries aimed at achieving a R0 resection in gynecologic oncology can have a significant impact on pelvic anatomy, and require reconstruction. Overall, it appears that these types of radical surgery are less frequently performed; however, when required, multidisciplinary teams at high-volume centers can potentially improve short-term morbidity. There are few data to examine the long-term, quality-of-life outcomes after reconstruction following oncologic resection in advanced and recurrent gynecologic cancers. In this review we outline considerations and approaches for reconstruction after surgery for gynecologic cancers. We also discuss areas of innovation, including minimally invasive surgery and the use of 3D surgical anatomy models for improved surgical planning.In the era of 'less is more', pelvic exenteration in gynecologic oncology is still indicated when there are no other curative-intent alternatives in persistent or recurrent gynecological malignancies confined to the pelvis or with otherwise unmanageable symptoms from fistula or radiation necrosis. Pelvic exenteration is one of the most destructive procedures performed on an elective basis, which inevitably carries a significant psychologic, sexual, physical, and emotional burden for the patient and caregivers. Such complex ultraradical surgery, which requires removal of the vagina, vulva, urinary tract, and/or gastrointestinal tract, subsequently needs creative and complex reconstructive procedures. The additional removal of sidewall or perineal structures, like pelvic floor muscles/vulva, or portions of the musculoskeletal pelvis, and the inclusion of intra-operative radiation further complicates reconstruction. This review paper will focus on the reconstruction aspects following pelvic exenteration, including options for urinary tract restoration, reconstruction of the vulva and vagina, as well as how to fill large empty spaces in the pelvis. While the predominant gastrointestinal outcome after exenteration in gynecologic oncology is an end colostomy, we also present some novel new options for gastrointestinal tract reconstruction at the end.
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Affiliation(s)
- Matteo Loverro
- Department of Gynecology and Obstetrics, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Alessia Aloisi
- European Institute of Oncology IRCCS Library, Milan, Italy
| | - Lucia Tortorella
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Damiano Aletti
- Department of Gynecology, European Institute of Oncology, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Berndl F, Frerichmann J, Berndl T. Prevention and management of urinary tract infections after cystectomy. Curr Opin Urol 2023; 33:200-205. [PMID: 36861762 DOI: 10.1097/mou.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW To give an overview of the most relevant recent literature about urinary tract infections (UTI) after radical cystectomy and to discuss them in the context of new individualized therapy approaches and possible preventive measures. RECENT FINDINGS UTI following radical cystectomy is a common complication associated with significant morbidity and readmission risk. Recent literature focuses on the identification of risk factors and the optimization of management. The risk factors most commonly associated with increased risk for UTI were perioperative blood transfusions and orthotopic neobladder (ONB). Furthermore, the effect of perioperative antibiotic regimens on rates of postoperative infections has been studied, but no consistent significant changes in UTI rates have yet been identified. Guidelines should be based on urologic studies and, wherever appropriate, should be uniform in design to encourage more frequent adherence. Furthermore, understanding the pathomechanisms leading to the development of UTI after radical cystectomy needs to be more central to discussions. SUMMARY Uniform definition of UTI, characteristics of bacterial pathogens involved, and type and duration of antibiotics used and identification of clinical risk factors must be the focus of well designed prospective studies to enable reduction of the most common complication after radical cystectomy.
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Managing Pelvic Organ Prolapse After Urinary Diversion or Neobladder. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Wang Y, Lu X, Gao Y, Liu N, Jiang H, Chen S, Chen M. The predictive value of prognostic nutritional index on early complications after robot-assisted radical cystectomy. Front Surg 2022; 9:985292. [DOI: 10.3389/fsurg.2022.985292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectiveThe purpose of the study was to evaluate the predictive value of prognostic nutritional index (PNI) on early complications (within 30-day) after robot-assisted radical cystectomy (RARC) and urinary diversion.Patients and methodsPatients underwent RARC and urinary diversion between November 2018 and December 2021 in our centre were screened in this retrospective study. Baseline characteristics and perioperative data were recorded. Early complications after surgery were classified according to Clavien-Dindo system. Univariate and multivariate logistic analysis were performed to decide the potential factors associated with post-RARC complications. The receiver operating characteristic (ROC) curve was conducted to determine the predictive value of PNI on early overall and major complications after RARC.ResultsOverall 139 men and 13 women with a median age of 69 years and mean BMI of 24.4 kg/m2 were included in this study. As for urinary diversion, most patients (n = 111, 73%) received cutaneous ureterostomy, 36 patients (23.7%) underwent orthotopic neobladder and 5 patients (3.3%) received ileal conduit. The incidence of postoperative complication rate was 44.7%, which included 82.2% minor complications and 17.8% major complications. Further univariate and multivariate logistic analyses demonstrated that hypertension (OR = 2.96, 95% CI: 1.24–7.07, P = 0.015), PNI (OR = 0.73, 95% CI: 0.62–0.86, P < 0.001), and CCI (OR = 1.44, 95% CI: 1.01–2.06, P = 0.047) were independent risk factors of early complications after RARC. Moreover, PNI (OR = 0.72, 95% CI: 0.60–0.86, P < 0.001) was also the predictor of major complications after RARC. The ROC curve demonstrated that PNI (AUC = 0.829; AUC = 0.840) has a great predictive value in early overall and major complications after RARC.ConclusionPNI can be an early alert for RARC patients thus aiding in closer monitoring and postoperative management.
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Rios-Doria E, Filippova OT, Straubhar AM, Chi A, Awowole I, Sandhu J, Broach V, Mueller JJ, Gardner GJ, Jewell EL, Zivanovic O, Leitao MM, Long Roche K, Abu-Rustum NR, Sonoda Y. A modern-day experience with Brunschwig's operation: Outcomes associated with pelvic exenteration. Gynecol Oncol 2022; 167:277-282. [PMID: 36064678 PMCID: PMC10204127 DOI: 10.1016/j.ygyno.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies. METHODS This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010-12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31-180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis. RESULTS Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication-49 early, 1 late, and 47 both. Fifty experienced a major complication-22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively. CONCLUSION The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care.
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Affiliation(s)
- Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alli M Straubhar
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ibraheem Awowole
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University, Ife, Nigeria
| | - Jaspreet Sandhu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Yang Y, Wang J, Wang L, Wu Q, Ling L, Yang Y, Ning S, Xie Y, Cao Q, Li L, Liu J, Ling Q, Zang J. Magnetic soft robotic bladder for assisted urination. SCIENCE ADVANCES 2022; 8:eabq1456. [PMID: 36001667 PMCID: PMC9401625 DOI: 10.1126/sciadv.abq1456] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
The poor contractility of the detrusor muscle in underactive bladders (UABs) fails to increase the pressure inside the UAB, leading to strenuous and incomplete urination. However, existing therapeutic strategies by modulating/repairing detrusor muscles, e.g., neurostimulation and regenerative medicine, still have low efficacy and/or adverse effects. Here, we present an implantable magnetic soft robotic bladder (MRB) that can directly apply mechanical compression to the UAB to assist urination. Composed of a biocompatible elastomer composite with optimized magnetic domains, the MRB enables on-demand contraction of the UAB when actuated by magnetic fields. A representative MRB for a UAB in a porcine model is demonstrated, and MRB-assisted urination is validated by in situ computed tomography imaging after 14-day implantation. The urodynamic tests show a series of successful urination with a high pressure increase and fast urine flow. Our work paves the way for developing MRB to assist urination for humans with UABs.
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Affiliation(s)
- Youzhou Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Liu Wang
- CAS Key Laboratory of Mechanical Behavior and Design of Materials, Department of Modern Mechanics, University of Science and Technology of China, Hefei 230026, PR China
| | - Qingyang Wu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Le Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Yueying Yang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Shan Ning
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Yan Xie
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Quanliang Cao
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Liang Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Jianfeng Zang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
- The State Key Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
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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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Lu X, Jiang H, Wang D, Wang Y, Chen Q, Chen S, Chen M. Early Warning Models to Predict the 90-Day Urinary Tract Infection Risk After Radical Cystectomy and Urinary Diversion for Patients With Bladder Cancer. Front Surg 2022; 8:782029. [PMID: 35127802 PMCID: PMC8814316 DOI: 10.3389/fsurg.2021.782029] [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: 09/23/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To develop and validate a nomogram of the 90-day urinary tract infection (UTI) risk for patients with bladder cancer undergoing radical cystectomy (RC) and urinary diversion. Patients and Methods The predictive nomogram was based on a retrospective study on the consecutive patients who underwent RC and urinary diversion for bladder cancer between January 2014 and March 2021. The incidence and microbiology of UTI were reported. The univariate and multivariate logistic analyses were conducted to determine independent risk factors associated with UTI. The predictive accuracy and discriminatory ability of the established nomogram were evaluated by the concordance index (C-index) and decision curve analysis (DCA). The performance of the model was validated internally. Results A total of 220 patients were included and the incidence of UTI within 90 days was 27.3%. The most commonly identified pathogens were Enterococcus (42.0%), Escherichia coli (21.70%), and Candida (13.0%). Urinary diversion type, Charlson comorbidities index (CCI), stricture, and prognostic nutritional index (PNI) were included in the nomogram. The C-index of the nomogram for predicting UTI was 0.858 (95% CI: 0.593–0.953). In the validation cohort, the nomogram also showed high-predictive accuracy. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) index indicated that PNI led to improvement in predictive ability. Conclusion The proposed early warning model shows great accuracy in predicting the incidence of 90-day UTI after RC and urinary diversion in patients with bladder cancer.
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Affiliation(s)
- Xun Lu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
| | - Hua Jiang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
| | - Dong Wang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
| | - Yiduo Wang
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
| | - Qi Chen
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
- Department of Interventional Radiology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
- Shuqiu Chen
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
- *Correspondence: Ming Chen
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Ławkowska K, Rosenbaum C, Petrasz P, Kluth L, Koper K, Drewa T, Pokrywczynska M, Adamowicz J. Tissue engineering in reconstructive urology-The current status and critical insights to set future directions-critical review. Front Bioeng Biotechnol 2022; 10:1040987. [PMID: 36950181 PMCID: PMC10026841 DOI: 10.3389/fbioe.2022.1040987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/13/2022] [Indexed: 03/05/2023] Open
Abstract
Advanced techniques of reconstructive urology are gradually reaching their limits in terms of their ability to restore urinary tract function and patients' quality of life. A tissue engineering-based approach to urinary tract reconstruction, utilizing cells and biomaterials, offers an opportunity to overcome current limitations. Although tissue engineering studies have been heralding the imminent introduction of this method into clinics for over a decade, tissue engineering is only marginally applied. In this review, we discuss the role of tissue engineering in reconstructive urology and try to answer the question of why such a promising technology has not proven its clinical usability so far.
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Affiliation(s)
- Karolina Ławkowska
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Clemens Rosenbaum
- Department of Urology Asklepios Klinik Barmbek Germany, Urologist in Hamburg, Hamburg, Germany
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Piotr Petrasz
- Department of Urology Voivodeship Hospital Gorzów Wielkopolski, Gorzów Wielkopolski, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Luis Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt am Main, Germany
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Krzysztof Koper
- Department of Clinical Oncology and Nursing, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Tomasz Drewa
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Marta Pokrywczynska
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Jan Adamowicz
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
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13
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Evaluation and Management of Genitourinary Emergencies in Patients with Cancer. Emerg Med Int 2021; 2021:4511968. [PMID: 34367695 PMCID: PMC8337163 DOI: 10.1155/2021/4511968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/10/2021] [Accepted: 07/17/2021] [Indexed: 02/03/2023] Open
Abstract
Background Genitourinary emergencies in cancer patients are common. Most cancer treatments are administered in the outpatient setting, and patients with complications often visit the emergency department. However, there is no recent emergency medicine literature review focusing on genitourinary emergencies in the oncologic population. Objective of the review. To increase awareness of common genitourinary emergencies in patients with cancer and enable the prompt recognition and appropriate management of these conditions. Discussion. Genitourinary emergencies in patients with cancer require a multidisciplinary approach to treatment. The most common genitourinary emergencies in patients with cancer are related to infection, obstructive uropathy, hemorrhagic cystitis, and complications associated with urinary diversions. The treatment approach in patients with infections, including viral infections, is similar to those without cancer. Understanding the changes in the anatomy of patients with urinary diversions or fistulas can help with the management of genitourinary emergencies. Conclusions Familiarization with the uniqueness of genitourinary emergencies in patients with cancer is important for emergency physicians.
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Sharma S, Mandhani A, Bose S, Basu B. Dynamically crosslinked polydimethylsiloxane-based polyurethanes with contact-killing antimicrobial properties as implantable alloplasts for urological reconstruction. Acta Biomater 2021; 129:122-137. [PMID: 33979672 DOI: 10.1016/j.actbio.2021.04.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
A large population of patients is reported to suffer from urinary bladder-associated irreversible physiological disorders, rationalizing a continuous surge for structural and functional substitutes of urinary tissues, including ureters, bladder-wall, and urethra. The current gold standard for bladder reconstruction, an autologous gastrointestinal graft, is proven not to be an ideal substitute in the clinic. While addressing this unmet clinical need, a unique platform of antimicrobial polydimethyl siloxane-modified polyurethanes (TPU/PDMS) is designed and developed for its potential application as a urological implant. To the best of our knowledge, this study reports for the first time the successful integration of varying contents of PDMS within the molten polyurethane matrix using in situ crosslinking methodology. Thus, compatibilized binary blends possess clinically relevant viscoelastic properties to sustain high pressure, large distensions, and surgical manipulation. Furthermore, different chemical strategies are explored to covalently incorporate quaternized moieties, including 4-vinyl pyridine (4-VP), branched-polyethyleneimine (bPEI) as well as bPEI-grafted-(acrylic acid-co-vinylbenzyltriphenyl phosphonium chloride) (PAP), and counter urinary tract infections. The modified compositions, endowed with contact killing surfaces, reveal nearly three log reduction in bacterial growth in pathogenically infected artificial urine. Importantly, the antimicrobial TPU/PDMS blends support the uninhibited growth of mitochondrially viable murine fibroblasts, in a manner comparable to the medical-grade polyurethane. Collectively, the obtained results affirmed the newly developed polymers as promising biomaterials in reconstructive urology. STATEMENT OF SIGNIFICANCE: The clinical procedure for end-stage bladder disease remains replacement or augmentation of the bladder wall with a section of the patient's gastrointestinal tract. However, the absorptive and mucus-producing epithelium of intestinal segment is liable to short- and long-term complications. The dynamically crosslinked polydimethyl siloxane-based polyurethanes proposed herein, and the associated synthesis strategies to induce polycation grafted non-exhaustive contact-killing surfaces against uropathogents, have a significant clinical prospect in reconstructive urology. As an 'off-the-shelf' available alloplastic substitute, these blends offer the potential to circumvent the challenges associated with non-urinary autografts or scaffold based regenerative engineering and, thereby, shorten as well as simplify the surgical treatment. The targeted application has been conceived for a bladder patch to assist in various urinary diseases including, bladder carcinoma, refractory overactive bladder, interstitial cystitis, etc. However, given the ease of fabrication, moldability and the wide spectrum of mechanical properties that could be encompassed, these blends also present the possibility to be manifested into artificial ureteral or urethral conduits.
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Affiliation(s)
- Swati Sharma
- Materials Research Centre, Indian Institute of Science, Bangalore-560012, India
| | - Anil Mandhani
- Urology and Kidney Transplant Institute, Medanta-The Medicity, Gurgaon-12200, India
| | - Suryasarathi Bose
- Department of Materials Engineering, Indian Institute of Science, Bangalore-560012, India.
| | - Bikramjit Basu
- Materials Research Centre, Indian Institute of Science, Bangalore-560012, India; Center for Biosystems Science and Engineering, Indian Institute of Science, Bangalore-560012, India.
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15
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Lampel A, Schultz-Lampel D. [Urinary diversion after uro-oncologic interventions in women: the right procedure for the right patient]. Aktuelle Urol 2021; 52:268-275. [PMID: 33906240 DOI: 10.1055/a-1377-2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Bladder carcinoma is a relatively rare tumour in women. The even rarer constellation of an invasive carcinoma or a high-risk situation when cystectomy is indicated requires adequate urinary diversion.The individual underlying circumstances of tumour and patient and the experience and preferences of the surgeon determine the choice of urinary diversion.A variety of alternatives are available for bladder replacement. The first decision to be made is between incontinent or continent urinary diversion. There is no general solution that fits all patients, but an individual solution must be found based on adequate information. Options include incontinent drainage with an ostomy, e. g. ureterocutaneostomy or ileum conduit, and the much more complex techniques of the continent variants of orthotopic or heterotopic replacement.Experience with continent diversion is significantly limited in women compared with men. In particular, the orthotopic connection to the urethra reveals gender-specific differences.All in all, clear inclusion or exclusion criteria for the different techniques have to be respected. Especially in cases when quality of life or body image play a crucial role, it is difficult to decide which type of urinary diversion is appropriate. This requires extensive experience on the part of the surgeon regarding the various options of surgical methods as well as knowledge and control of consecutive complications.
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Affiliation(s)
- Alexander Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
| | - Daniela Schultz-Lampel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Klinik für Urologie und Kinderurologie, Villingen-Schwenningen
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16
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Dsouza LB, Hussein RJH. Urinary Diversion and Metabolic Acidosis: A Case Report. Cureus 2021; 13:e14638. [PMID: 34079665 PMCID: PMC8159343 DOI: 10.7759/cureus.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Urinary diversion, a surgical technique to redirect urine usually after cystectomy, and its complications are potential challenges to physicians and early recognition decreases mortality and morbidity. A 45-year-old male with a history of type 2 diabetes mellitus and hypertension for over three years underwent urinary diversion as a treatment for invasive bladder cancer and was discharged ambulatory with an indwelling Foleys catheter. The patient returned to the emergency room with a primary complaint of hematuria. The patient was noted to be frail-looking, dehydrated and tachycardic. Laboratory results yielded an acute kidney injury reflected by the elevated creatinine, hyperkalemia and a venous blood gas demonstrating a hyperchloremic metabolic acidosis. The patient had bilateral distended renal calyces by ultrasound and irrigation of bladder through a three-way Foley showed to have large thick clots. The patient was admitted under the surgical intensive care unit after involving appropriate sub-specialties. The patient was started on sodium bicarbonate infusion, broad-spectrum antibiotics and a urinary catheter in place to monitor urine output. The patient's acidosis steadily improved with correction of his laboratory parameters, transferred out of ICU and the remaining stay in the medical ward was uneventful. The purpose of this case report is to help demonstrate the association between urinary diversion and the type of acidosis that subsequently develops in relation to this surgical procedure.
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17
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Fonseca R, Santos JC, Lopes FA, Peyroteo I, Silva A, Gaspar FP, Mota RL. Endourological approach in patients with anatomical urinary tract challenges. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211007733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This article reports our experience managing neoplasms, stenosis and urolithiasis in patients with anatomical variations of the urinary system, using an endourological approach, either with an antegrade access or with combined access. Patients and methods: A retrospective review was performed using medical records of all patients who underwent percutaneous endourological treatment at our institution between 2014 and 2019. Those with such urinary anatomical variations were selected. Results: Out of 185 patients, 10 were identified. The study group included patients with urinary diversion, renal transplantation and congenital anomalies. Patients were divided into two sets, A and B, based on the presence or absence of urolithiasis, respectively. In set A, the median operative time was 213 minutes (standard deviation ( SD)=65.91 minutes). Only one patient had lithiasis in the first postoperative evaluation. Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Regarding set B, the median operation time was 75 minutes ( SD=66.89 minutes). Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Conclusions: Patients with anatomical tract challenges currently have a longer life expectancy and are therefore prone to urological complications in their unusual structures. Treatment of urological complications is essential, and minimal invasive procedures should be considered to resolve them and to reduce morbidity. Level of evidence: Not applicable.
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Affiliation(s)
- Rita Fonseca
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - José C Santos
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Filipe A Lopes
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Inês Peyroteo
- Department of Urology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Portugal
| | - Andreia Silva
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Frederico P Gaspar
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Renato L Mota
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
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Badeński A, Bjanid O, Badeńska M, Chmiela B, Adamczyk P, Kudela G, Moskal G, Szczepańska M. A "mysterious ghost kidney stone" in an 8-year-old boy with a solitary right kidney, obstructive megaureter, and ureterostomy: Answers. Pediatr Nephrol 2021; 36:865-868. [PMID: 32696263 PMCID: PMC7910256 DOI: 10.1007/s00467-020-04709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrzej Badeński
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800, Zabrze, Poland.
| | - Omar Bjanid
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Marta Badeńska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Bartosz Chmiela
- Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Piotr Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Kudela
- Department of Paediatrics Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, ul. Medyków 16, 40-752 Katowice, Poland
| | - Grzegorz Moskal
- Department of Advanced Materials and Technologies, Faculty of Materials Engineering, Silesian University of Technology, ul. Krasińskiego 8, 40-019 Katowice, Poland
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, ul. 3 Maja 13/15, 41-800 Zabrze, Poland
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19
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de Vlaming A, Mathews KG, Hash JA, Keenihan EK, Sommer S, Borst L, Vaden SL. Creation of a Continent Urinary Bladder Reservoir Vascularized by Omentum as a Possible Surgical Option for Canine Trigonal/Urethral Urothelial Carcinoma. J INVEST SURG 2020; 35:481-495. [PMID: 33371755 DOI: 10.1080/08941939.2020.1864797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgical procedures that maintain continence with minimal complication following resection of trigono-urethral urothelial carcinoma (UC) are limited in canines; therefore, palliative options are often pursued. A feasible tumor resection option may improve disease control and survival. The study's objective was to evaluate a continent urine reservoir created from the urinary bladder body and vascularized solely by omentum. We hypothesized that a viable urine reservoir could be created, and staged omentalization would provide improved vascularity. Nine normal female Beagles were randomized to one of three groups. Group A urinary bladders were transected cranial to the ureteral papillae to create a closed bladder vesicle which was concomitantly omentalized. Group B underwent omentalization two weeks prior to vesicle creation. Based on Group A and B results, Group C underwent neoureterocystostomy and omentalization followed by neoreservoir formation and tube cystostomy 2 weeks later. Serial ultrasounds and histopathology confirmed adequate omental neovascularization in Groups B and C with continent Group C neoreservoirs maintained for 2 months. Some pylectasia and ureteral dilation was documented in all Group C dogs at variable timepoints. Progressive hydroureteronephrosis developed in 2/6 kidneys. Transient azotemia was noted in only 1 Group C dog, although all developed treatable urinary tract infections. The sample size is limited, and the efficacy of this technique in providing disease control for UC is unknown. However, this novel option could allow for primary UC resection while providing continence and limiting complications. Postoperative local or systemic adjuvant therapy, ultrasonographic neoreservoir monitoring, and BRAF analysis would be indicated.
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Affiliation(s)
- Annemarieke de Vlaming
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Kyle G Mathews
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Jonathan A Hash
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Erin K Keenihan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Samantha Sommer
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Luke Borst
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Shelly L Vaden
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Martínez-Gómez C, Angeles MA, Martinez A, Malavaud B, Ferron G. Urinary diversion after pelvic exenteration for gynecologic malignancies. Int J Gynecol Cancer 2020; 31:1-10. [PMID: 33229410 PMCID: PMC7803898 DOI: 10.1136/ijgc-2020-002015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/03/2022] Open
Abstract
Pelvic exenteration combines multiple organ resections and functional reconstruction. Many techniques have been described for urinary reconstruction, although only a few are routinely used. The aim of this review is to focus beyond the technical aspects and the advantages and disadvantages of each technique, and to include a critical analysis of continent techniques in the gynecologic and urologic literature. Selecting a technique for urinary reconstruction must take into account the constraints entailed by the natural history of the disease, patient characteristics, healthcare institution, and surgeon experience. In gynecologic oncology, the Bricker ileal conduit is the most commonly employed diversion, followed by the self-catheterizable pouch and orthotopic bladder replacement. Continent and non-continent diversions present similar immediate and long-term complication rates, including lower tract urinary infections and pyelonephritis (5–50%), ureteral stricture (3–27%), urolithiasis (5–25%), urinary fistula (5%), and more rarely, vitamin B12 deficiency and metabolic acidosis. Urinary incontinence for the ileal orthotopic neobladder (50%), stoma-related complications for the Bricker ileal conduit (24%), difficulty with self-catheterization (18%) for the continent pouch, and induction of secondary malignancy for the ureterosigmoidostomy (3%) are the most relevant technique-related complications following urinary diversion. The self-catheterizable pouch and orthotopic bladder require a longer learning curve from the surgical team and demand adaptation from the patient compared with the ileal conduit. Quality of life between different techniques remains controversial, although it would seem that young patients may benefit from continent diversions. We consider that centralization of pelvic exenteration in referral centers is crucial to optimize the oncologic and functional outcomes of complex ablative reconstructive surgery.
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Affiliation(s)
- Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.,Team 1, Tumor Immunology and Immunotherapy, Cancer Research Center of Toulouse (CRCT) - INSERM UMR 1037, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.,Team 1, Tumor Immunology and Immunotherapy, Cancer Research Center of Toulouse (CRCT) - INSERM UMR 1037, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France .,Team 19, ONCOSARC - Oncogenesis of Sarcomas, Cancer Research Center of Toulouse (CRCT) - INSERM UMR 1037, Toulouse, France
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21
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Cicione A, De Nunzio C, Lombardo R, Trucchi A, Manno S, Lima E, Tubaro A. Complications and quality of life of ileal conduit, orthotopic neobladder and ureterocutaneostomy: systematic review of reports using the Clavien-Dindo Classification. MINERVA UROL NEFROL 2020; 72:408-419. [PMID: 32734749 DOI: 10.23736/s0393-2249.20.03641-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Radical cystectomy (RC) and urinary diversion (UD) are two steps of the same surgical procedure involving likely complications and important impact on quality of life (QoL). The literature was reviewed to identify recent studies reporting UDs complications occurred 90 days after surgery and graded by Clavien-Dindo Classification System (CCS). EVIDENCE ACQUISITION A comprehensive systematic Medline search was performed in PubMed/Medline, Embase and Scopus databases to identify reports published in English starting from 2013 using key words related to review outcome (i.e. neobladder, ileal conduct, ureterocutaneostomy, cystectomy, QoL). Complications were defined as minor or major whether the CCS grade was ≤2 or ≥3, respectively. Then, manuscripts references were screened to identify unfounded studies. Only studies using CCS to report surgical complications were considered. EVIDENCE SYNTHESIS Retrieved studies were reported according to two main items of complications and QoL. About UDs complications, fourteen studies were identified incorporating overall 4436 patients. Up to 50% of patients experienced at least one low-grade complications (CCS≤2) requiring pharmacological treatment to be healed. On the other hand, high-grade complications (CCS≥3) occurred in 0.7-42% of cases and required surgical interventions (CCS 3a and 3b) or life support (CCS=4). Finally, mortality (CCS=5) rated between 0.4-7%. Regarding QoL, six studies were analyzed with overall 445 patients. Most of them were retrospective and showed conflicting results whether the external UDs were better than neobladder in term of impact on QoL. CONCLUSIONS The use of a standardized system such as CCS improves analyses of literature. However, rigorous patient selection for UD type makes unable a randomized comparison between UDs in terms of complications and QoL impact.
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Affiliation(s)
- Antonio Cicione
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Trucchi
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Stefano Manno
- Department of Urology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Estevao Lima
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Malangone-Monaco E, Wilson K, Diakun D, Tayama D, Satram S, Ogale S. Cost of cystectomy-related complications in patients with bladder cancer in the United States. Curr Med Res Opin 2020; 36:1177-1185. [PMID: 32314606 DOI: 10.1080/03007995.2020.1758927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To describe healthcare utilization and cost associated with the short-term and long-term complications of cystectomy among commercially insured bladder cancer patients in the United States.Materials and methods: This retrospective, observational cohort study evaluated adults with bladder cancer receiving a transurethral resection of bladder tumor followed by a partial or radical cystectomy procedure using U.S. administrative claims from the 2005-2015 IBM MarketScan Commercial and Medicare Supplemental databases. Bladder cancer patients were classified into two cohorts: partial cystectomy or radical cystectomy. Cystectomy complications were identified during the cystectomy admission, short-term period, and long-term period. Complication-related utilization and cost outcomes were reported in aggregate during the cystectomy admission and per patient per month (PPPM) during the short-term and long-term follow-up periods.Results: Of 5136 patients who received a cystectomy, 488 (9.5%) received partial cystectomy and 4648 (90.5%) received radical cystectomy. The mean (SD) costs of complications during the cystectomy admission were $11,728 ($43,380) for radical cystectomy and $4657 ($25,668) for partial cystectomy. In the short-term period, PPPM complication-related healthcare costs were $638 [$3793] for partial cystectomy and $2681 [$14,705] for radical cystectomy. In the long-term period, PPPM complication-related healthcare costs were $544 [$2580] for partial cystectomy and $1619 [$7874] for radical cystectomy.Conclusions: Cystectomy-related complications, especially with radical cystectomy, present a substantial financial burden to patients and payers immediately after surgery as well as in the long term. Targeted interventions which improve clinical outcomes but reduce substantial costs associated with cystectomy for bladder cancer are needed.
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23
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Yang DY, Boorjian SA, Westerman MB, Tarrell RF, Thapa P, Viers BR. Persistent, long-term risk for ureteroenteric anastomotic stricture formation: the case for long term follow-up. Transl Androl Urol 2020; 9:142-150. [PMID: 32055478 DOI: 10.21037/tau.2019.09.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Up to one in ten patients undergoing cystectomy with urinary diversion develop a ureteroenteric stricture (UES). Despite unrecognized ureteral obstruction contributing to infection, nephrolithiasis, and/or progression of kidney disease, the long-term natural history and risk factors associated with UES remains understudied. Herein, we report our single institutional experience with the long-term incidence, clinical presentation, and risk factors associated with UES formation following urinary diversion. Methods We reviewed 2,285 patients who underwent RC with urinary diversion between 1980-2008. UES was defined as radiographic evidence of ureteral obstruction at the level of the ureteroenteric anastomosis. The diagnosis of benign UES was confirmed by pathology. UES-free survival was estimated using the Kaplan-Meier method. The association between clinicopathologic features and the development of a UES were assessed using multivariable models. Results A total of 192 (8%) patients developed a benign UES, at a median of 7 months (IQR 4-24) following RC, with 5% occurring after 10 years. Seventy seven percent of patients exhibited signs and/or symptoms of ureteral obstruction. Patients who developed a UES had a greater body mass index (BMI) (28 vs. 27), operative time (330 vs. 301 minutes) and were more likely to experience a <30-day Clavien ≥3 complication (all P<0.05). Receipt of abdominal radiation and smoking history were not significantly associated with UES stricture risk. On multivariable analysis, only greater BMI (per 1-unit increase) (OR 1.06, 95% CI: 1.02-1.09; P=0.0009) and <30-day Clavien ≥3 complication (OR 2.85, 95% CI: 1.90-4.28; P<0.0001) were associated with the development of a UES. Development of UES was associated with renal function deterioration. Conclusions UES was identified in 8% of patients following RC with urinary diversion, with the majority presenting with symptoms. While the majority of these occur in the first 2 years after surgery, a patients' risk for the development of this complication persists beyond 10 years. Due to the adverse sequelae of UES, long-term functional and imaging surveillance following urinary diversion is warranted, and early reconstruction should be considered.
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Affiliation(s)
- David Y Yang
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Prabin Thapa
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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24
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Stromyer ML, Southerland MR, Satyal U, Sikder RK, Weader DJ, Baughman JA, Youngs WJ, Abbosh PH. Synthesis, characterization, and biological activity of a triphenylphosphonium-containing imidazolium salt against select bladder cancer cell lines. Eur J Med Chem 2020; 185:111832. [PMID: 31718944 PMCID: PMC7224591 DOI: 10.1016/j.ejmech.2019.111832] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 01/26/2023]
Abstract
Imidazolium salts have shown great promise as anticancer materials. A new imidazolium salt (TPP1), with a triphenylphosphonium substituent, has been synthesized and evaluated for in vitro and in vivo cytotoxicity against bladder cancer. TPP1 was determined to have a GI50 ranging from 200 to 250 μM over a period of 1 h and the ability to effectively inhibit bladder cancer. TPP1 induces apoptosis, and it appears to act as a direct mitochondrial toxin. TPP1 was applied intravesically to a bladder cancer mouse model based on the carcinogen N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN). Cancer selectivity of TPP1 was demonstrated, as BBN-induced tumors exhibited apoptosis but normal adjacent urothelium did not. These results suggest that TPP1 may be a promising intravesical agent for the treatment of bladder cancer.
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Affiliation(s)
- Michael L Stromyer
- Department of Chemistry, The University of Akron, 190 East Buchtel Commons, Akron, OH, 44325, USA
| | - Marie R Southerland
- Department of Chemistry, The University of Akron, 190 East Buchtel Commons, Akron, OH, 44325, USA
| | - Uttam Satyal
- Molecular Therapeutics Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Rahmat K Sikder
- Molecular Therapeutics Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - David J Weader
- Department of Chemistry, The University of Akron, 190 East Buchtel Commons, Akron, OH, 44325, USA; Molecular Therapeutics Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Jessi A Baughman
- Department of Chemistry, The University of Akron, 190 East Buchtel Commons, Akron, OH, 44325, USA
| | - Wiley J Youngs
- Department of Chemistry, The University of Akron, 190 East Buchtel Commons, Akron, OH, 44325, USA.
| | - Philip H Abbosh
- Molecular Therapeutics Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
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25
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[Optimizing the management of bladder cancer in older patients]. Prog Urol 2019; 29:849-864. [PMID: 31771768 DOI: 10.1016/j.purol.2019.08.273] [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: 08/01/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022]
Abstract
AIM To define and present potential improvements for the management of bladder cancer in older patients. METHOD Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly. RESULTS The oncological principles of medico-surgical management of bladder cancer do not differ according to age. On the other hand, the patient comorbidities have been likely to alter the tolerance of these treatments. At the NMIBC stages, no adaptation of the standard treatment has demonstrated any interest. At the MIBC stages, the prognosis was improved by geriatric multidisciplinary perioperative management. CONCLUSION The indications and principles of surgical treatments must be identical regardless of the patient age. At the NMIBC stages, adjuvant therapy, including BCG therapy, should not be questioned because of the age of the patient. On the other hand, at the localized MIBC stages, neoadjuvant and adjuvant chemotherapy should not be considered as a standard and their indications assessed individually after geriatric assessment.
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26
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Tsai LH, Li WJ, Chen GH, Hsieh PF, Chang CH. Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion: Two case reports. Medicine (Baltimore) 2019; 98:e17222. [PMID: 31593079 PMCID: PMC6799691 DOI: 10.1097/md.0000000000017222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC). PATIENT CONCERNS A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit. DIAGNOSIS Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion. INTERVENTIONS The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found. OUTCOMES Both patients recovered smoothly after second operation. LESSONS The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.
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27
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De Nunzio C, Cicione A, Izquierdo L, Lombardo R, Tema G, Lotrecchiano G, Minervini A, Simone G, Cindolo L, D’Orta C, Ajami T, Antonelli A, Dellabella M, Alcaraz A, Tubaro A. Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy: The Role of the Frailty Index. Clin Genitourin Cancer 2019; 17:402-407. [DOI: 10.1016/j.clgc.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
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Taylor J, Meng X, Renson A, Smith AB, Wysock JS, Taneja SS, Huang WC, Bjurlin MA. Different models for prediction of radical cystectomy postoperative complications and care pathways. Ther Adv Urol 2019; 11:1756287219875587. [PMID: 31565072 PMCID: PMC6755632 DOI: 10.1177/1756287219875587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Radical cystectomy for bladder cancer has one of the highest rates of
morbidity among urologic surgery, but the ability to predict postoperative
complications remains poor. Our study objective was to create machine
learning models to predict complications and factors leading to extended
length of hospital stay and discharge to a higher level of care after
radical cystectomy. Methods: Using the American College of Surgeons National Surgical Quality Improvement
Program, peri-operative adverse outcome variables for patients undergoing
elective radical cystectomy for bladder cancer from 2005 to 2016 were
extracted. Variables assessed include occurrence of minor, infectious,
serious, or any adverse events, extended length of hospital stay, and
discharge to higher-level care. To develop predictive models of radical
cystectomy complications, we fit generalized additive model (GAM), least
absolute shrinkage and selection operator (LASSO) logistic, neural network,
and random forest models to training data using various candidate predictor
variables. Each model was evaluated on the test data using receiver
operating characteristic curves. Results: A total of 7557 patients were identified who met the inclusion criteria, and
2221 complications occurred. LASSO logistic models demonstrated the highest
area under curve for predicting any complications (0.63), discharge to a
higher level of care (0.75), extended length of stay (0.68), and infectious
(0.62) adverse events. This was comparable with random forest in predicting
minor (0.60) and serious (0.63) adverse events. Conclusions: Our models perform modestly in predicting radical cystectomy complications,
highlighting both the complex cystectomy process and the limitations of
large healthcare datasets. Identifying the most important variable leading
to each type of adverse event may allow for further strategies to model
cystectomy complications and target optimization of modifiable variables
pre-operative to reduce postoperative adverse events.
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Affiliation(s)
- Jacob Taylor
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Xiaosong Meng
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Audrey Renson
- Department of Clinical Research, NYU Langone
Hospital, Brooklyn, NY, USA
| | - Angela B. Smith
- Department of Urology, Lineberger Comprehensive
Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - James S. Wysock
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - Samir S. Taneja
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
| | - William C. Huang
- Divison of Urologic Oncology, Department of
Urology, NYU Langone Health, New York, NY, USA
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29
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English WJ, Doganay E, Nair MS. Adhesional small bowel obstruction following robotic pelvic surgery: challenges in management and outcome improvement. ANZ J Surg 2019; 89:1174-1175. [PMID: 31522480 DOI: 10.1111/ans.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- William J English
- Department of General Surgery, Division of Surgery and Cancer, North Middlesex University Hospital NHS Trust, London, UK.,National Bowel Research Centre, Blizard Institute, London, UK
| | - Emre Doganay
- Department of General Surgery, Division of Surgery and Cancer, North Middlesex University Hospital NHS Trust, London, UK
| | - Manojkumar S Nair
- Department of General Surgery, Division of Surgery and Cancer, North Middlesex University Hospital NHS Trust, London, UK
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30
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Janke HP, de Jonge PK, Feitz WF, Oosterwijk E. Reconstruction Strategies of the Ureter and Urinary Diversion Using Tissue Engineering Approaches. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:237-248. [DOI: 10.1089/ten.teb.2018.0345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Heinz P. Janke
- Department of Urology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul K.J.D. de Jonge
- Department of Urology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wout F.J. Feitz
- Department of Urology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Science, Radboud University Medical Center, Nijmegen, The Netherlands
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31
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Alemozaffar M, Nam CS, Said MA, Patil D, Carney KJ, David S, Master VA. Avoiding the Need for Bowel Anastomosis during Pelvic Exenteration-Urinary Sigmoid or Descending Colon Conduit-Short and Long Term Complications. Urology 2019; 129:228-233. [PMID: 30922975 DOI: 10.1016/j.urology.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/11/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To educate surgeons of distal colon urinary diversion as an alternative to ileal conduit. To assess perioperative outcomes of distal colon conduit in pelvic exenteration including conduit-related, gastrointestinal, infectious, metabolic, and wound complications within 30 days, 31-89 days, and greater than 90 days from the time of surgery. MATERIALS AND METHODS Forty-one patients who underwent distal colon urinary diversion for malignancy, fistula, or neurogenic bladder were identified in our IRB approved database from 1/2007 to 7/2017. RESULTS Twenty-six (63.4%) were male with mean age of 54.1 years. Complications were stratified by early (≤30 days), intermediate (31-89 days), and late (≥90 days). Within 30 days, 2 (4.9%) had partial small bowel obstructions requiring nasogastric tube (NGT) placement and total parenteral nutrition (TPN); 8 (19.5%) prolonged ileus with 6 (14.6%) requiring TPN and 5 (12.2%) requiring NGT placement; 1 (2.4%) enterocutaneous fistula; 1 (2.4%) conduit hemorrhage, 10 (24.4%) treated urinary tract infections (UTIs). Between 31 and 89 days, 1 patient (2.4%) had urinary conduit leak and 3 (7.3%) treated UTIs. At ≥90 days, 2 (4.9%) had partial small bowel obstructions requiring NGT placement, 4 (9.8%) ureterocolonic strictures and 1 (2.4%) parastomal hernia, 3 (7.3%) treated UTIs. Readmission rate in ≤30 days was 10 (24.4%), 31-89 days was 13 (31.7%), and 90+ days was 16 (39%). Long-term metabolic complications at ≥90 days included 16 (39%) with hypokalemia, 10 (24.4%) with hyperchloremia, and 14 (34.1%) with metabolic acidosis. CONCLUSION Distal colon urinary conduit is a relatively safe and feasible option and obviates the need for small bowel anastomosis and possible associated complications.
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Affiliation(s)
- Mehrdad Alemozaffar
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Catherine S Nam
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
| | - Mohammed A Said
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - K Jeff Carney
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Sam David
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
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32
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Lago V, Poveda I, Padilla-Iserte P, Simón-Sanz E, García-Granero Á, Pontones JL, Matute L, Domingo S. Pelvic exenteration in gynecologic cancer: complications and oncological outcome. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1055-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Introduction
Pelvic exenteration (PE) is indicated in cases of unresponsive, recurrent pelvic cancer or for palliative intent. Despite the fact that the surgery is associated with a high rate of morbidity, it is currently the only real option that can effect a cure.
Material and methods
Patients who underwent PE between January 2011 and July 2017 in our centre were retrospectively reviewed. Data related to surgery, complications and outcomes were recorded.
Results
Twenty-three patients were included. PE was performed due to recurrent gynaecological cancer, persistence of disease and after first diagnosis in 19 (82%), 2 (9%) and 2 patients (9%), respectively. Total PE was performed in 15 cases (65%), followed by anterior PE in 5 cases (22%) and posterior PE in 3 cases (13%). Early grade II, III and IV complications occurred in 15 (65%), 5 (22%) and 2 patients (9%), respectively. No mortality was observed within 30 days. Medium-late grade II, III, IV and V complications occurred in 15 (65%), 11 (48%), 3 (13%) and 2 cases (9%), respectively. Two patients died after > 30-day period from surgery-related complications. The overall survival (OS) and disease-free survival (DFS) at 48 months after PE was 41.6% and 30.8% respectively.
Conclusions
PE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II–V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE.
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Kovell RC, Brooks DC, Haddad D, Terlecki R. Morbidity Associated with Urinary Diversion in the United States: A Contemporary Evaluation Using the NSQIP Database. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert C. Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David C. Brooks
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Devin Haddad
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Wayan Y, Ayu PD, Gde OAA, Wayan N, Widyadharma IPE. Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016. Open Access Maced J Med Sci 2018; 6:1647-1651. [PMID: 30337981 PMCID: PMC6182542 DOI: 10.3889/oamjms.2018.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/08/2018] [Accepted: 09/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year’s survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.
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Affiliation(s)
- Yudiana Wayan
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Pratiwi Dinar Ayu
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Oka A A Gde
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - Niryana Wayan
- Department of Surgery, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
| | - I Putu Eka Widyadharma
- Department of Neurology, Medical Faculty, Udayana University-Sanglah General Hospital, Bali, Indonesia
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Zuiverloon TCM, van Kessel KEM, Bivalacqua TJ, Boormans JL, Ecke TH, Grivas PD, Kiltie AE, Liedberg F, Necchi A, van Rhijn BW, Roghmann F, Sanchez-Carbayo M, Schmitz-Dräger BJ, Wezel F, Kamat AM. Recommendations for follow-up of muscle-invasive bladder cancer patients: A consensus by the international bladder cancer network. Urol Oncol 2018; 36:423-431. [PMID: 29496372 DOI: 10.1016/j.urolonc.2018.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
RATIONALE Several guidelines exist that address treatment of patients with nonmetastatic muscle-invasive bladder cancer (MIBC). However, most only briefly mention follow-up strategies for patients and hence the treating physician is often left to infer on what the preferred follow-up schema would be for an individual patient. Herein, we aim to synthesize recommendations for follow-up of patients with MIBC for easy reference. METHODS A multidisciplinary MIBC expert panel from the International Bladder Cancer Network was assembled to critically assess currently available major guidelines on surveillance of MIBC patients. Recommendations for follow-up were extracted and critically evaluated. Important considerations for guideline assessment included both aspects of oncological and functional follow-up-frequency of visits, the use of different imaging modalities, the role of cytology and molecular markers, and the duration of follow-up. OUTCOME An International Bladder Cancer Network expert consensus recommendation was constructed for the follow-up of patients with MIBC based on the currently available evidence-based data.
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Affiliation(s)
- Tahlita C M Zuiverloon
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands; University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Kim E M van Kessel
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MA
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | | | - Petros D Grivas
- Department of Hematology/Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Anne E Kiltie
- Department of Oncology, University of Oxford, Oxford, UK
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Lund, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bas W van Rhijn
- Division of Surgical Oncology (Urology), Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marta Sanchez-Carbayo
- Lucio Lascaray Research Center, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Bernd J Schmitz-Dräger
- Department of Urology, Friedrich-Alexander University, Erlangen and Urologie24, Nuremberg, Germany
| | - Felix Wezel
- Department of Urology, Ulm University Hospital, Ulm, Germany
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Moeen AM, Safwat AS, Gadelmoula MM, Moeen SM, Behnsawy HM, Shahat AA, Gadelkareem RA, Hameed DA, Hammouda HM. Does the site of the orthotopic neobladder outlet matter? A prospective randomized comparative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:847-852. [PMID: 29429598 DOI: 10.1016/j.ejso.2018.01.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the results of urethral anastomosis to a button hole and to the lowest part of the anterior suture line during orthotopic neobladder substitution. METHODS From January 2012 to December 2015, 87 consecutive male patients with invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder. Patients were randomly divided into two groups; group I (44 patients), the outlet was created as a button-hole at the most dependent part of the pouch, group II (43 patients), the lowest 1 cm of the anterior suture line of the pouch was left open as an outlet. Patients were randomly assigned to either group using computer-generated random numbers (JMP, Version 12.0.1; SAS Institute, Cary, NC, USA) via a sealed envelope. The functional outcomes of both groups were compared especially at the urethro-enteric anastomosis. RESULTS There were no intraoperative complications. Early postoperative complications occurred in 9 patients (5 in group I and 4 in group II, p = 0.484). Prolonged urinary leakage persisted for 11 and 14 days in 2 patients in group I and 10 and 16 days in 2 patients in group II. Delayed postoperative complications occurred in 11 patients (5 [12.5%] in group I and 6 [15.6%] in group II) (p = 0.711). Three patients developed urethro-enteric strictures (2 in group I and 1 in group II) (p = 0.571). CONCLUSION The "non-hole" technique of urethral anastomosis was not associated with a significant increase in the complication rate when compared to the commonly performed "hole" technique.
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Affiliation(s)
- Ahmed M Moeen
- Department of Urology, Assiut University, Assiut, Egypt
| | - Ahmed S Safwat
- Department of Urology, Assiut University, Assiut, Egypt.
| | | | - Seham M Moeen
- Department of Anesthesiology and Intensive Care, Assiut University, Assiut, Egypt
| | | | | | | | - Diaa A Hameed
- Department of Urology, Assiut University, Assiut, Egypt
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Yang X, An C, Liu S, Cheng T, Bunpetch V, Liu Y, Dong S, Li S, Zou X, Li T, Ouyang H, Wu Z, Yang W. Soft Artificial Bladder Detrusor. Adv Healthc Mater 2018; 7:e1701014. [PMID: 29334188 DOI: 10.1002/adhm.201701014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/25/2017] [Indexed: 11/11/2022]
Abstract
Developing soft devices for invasive procedures bears great importance for human health. The softness and large strain actuation of responsive hydrogels promise the potential to fabricate soft devices, which can attach on and assist to the function of organs. The key challenges lie in the fabrication of soft devices with robust actuating ability and biocompatibility to the attached organ. This paper presents a solution that integrates the thermoresponsive hydrogel membrane with flexible electronics and silk scaffold into a balloon-like soft device. As an example, the actuation assisting function of this soft device for shrinking an animal bladder is presented. The mechanical behaviors of the balloon-like soft device are experimentally and theoretically investigated. The concepts are applicable to other applications such as soft implants, soft robotics, and microfluidics.
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Affiliation(s)
- Xuxu Yang
- Soft Matter Research Center Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province Department of Engineering Mechanics Zhejiang University Hangzhou Zhejiang 310027 P. R. China
| | - Chengrui An
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative medicine School of Medicine Zhejiang University Hangzhou 310027 China
- Zhejiang Provincial Key Research Institute of Medical Materials and Tissue Engineering Hangzhou 310000 China
| | - Shuting Liu
- Department of Information Science and Electronic Engineering Zhejiang University Hangzhou 310027 China
| | - Tingyu Cheng
- Soft Matter Research Center Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province Department of Engineering Mechanics Zhejiang University Hangzhou Zhejiang 310027 P. R. China
| | - Varitsara Bunpetch
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative medicine School of Medicine Zhejiang University Hangzhou 310027 China
- Zhejiang Provincial Key Research Institute of Medical Materials and Tissue Engineering Hangzhou 310000 China
| | - Yixiao Liu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative medicine School of Medicine Zhejiang University Hangzhou 310027 China
- Zhejiang Provincial Key Research Institute of Medical Materials and Tissue Engineering Hangzhou 310000 China
| | - Shurong Dong
- Department of Information Science and Electronic Engineering Zhejiang University Hangzhou 310027 China
| | - Shijian Li
- College of Computer Science Zhejiang University Hangzhou 310027 China
| | - Xiaohui Zou
- Clinical Research Center The First Affiliated Hospital School of Medicine Zhejiang University Hangzhou 310003 China
| | - Tiefeng Li
- Soft Matter Research Center Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province Department of Engineering Mechanics Zhejiang University Hangzhou Zhejiang 310027 P. R. China
| | - Hongwei Ouyang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative medicine School of Medicine Zhejiang University Hangzhou 310027 China
- Zhejiang Provincial Key Research Institute of Medical Materials and Tissue Engineering Hangzhou 310000 China
| | - Zhaohui Wu
- College of Computer Science Zhejiang University Hangzhou 310027 China
| | - Wei Yang
- Soft Matter Research Center Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province Department of Engineering Mechanics Zhejiang University Hangzhou Zhejiang 310027 P. R. China
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Przydacz M, Corcos J. Revisiting Ureterosigmoidostomy, a Useful Technique of Urinary Diversion in Functional Urology. Urology 2018; 115:14-20. [PMID: 29355572 DOI: 10.1016/j.urology.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 11/15/2022]
Abstract
Ureterosigmoidostomy has largely been disregarded in recent times but has now seen a resurgence of interest because of its potential applicability to newer, minimally invasive surgical techniques. The advantages of ureterosigmoidostomy over intestinal conduits are urinary continence (obviating the need for stoma and external appliances), ease, and rapidity of performance as well as acceptance by patients. Ureterosigmoidostomy has been characterized by good continence outcomes and it offers good quality of life. Possible complications are anastomosis stenosis, coloureteral reflux, electrolyte imbalance, hydronephrosis, pyelonephritis, chronic renal failure, colorectal cancer, and others. Ureterosigmoidostomy is therefore only advisable for patients ready to accept long-term follow-up.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Milbar N, Kates M, Chappidi MR, Pederzoli F, Yoshida T, Sankin A, Pierorazio PM, Schoenberg MP, Bivalacqua TJ. Oncological Outcomes of Sequential Intravesical Gemcitabine and Docetaxel in Patients with Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2017; 3:293-303. [PMID: 29152553 PMCID: PMC5676758 DOI: 10.3233/blc-170126] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Bacillus Calmette-Guérin (BCG) unresponsive/relapsing patients with non-muscle invasive bladder cancer (NMIBC) who prefer bladder preservation over radical cystectomy (RC) or those who do not qualify for surgery may be offered intravesical therapies. Gemcitabine (GEM) combined with Docetaxel (DOCE) has been offered at Johns Hopkins Hospital (JHH). Objective To evaluate experience with GEM/DOCE, to confirm safety of the regimen, to identify populations that may benefit most, and to consider the appropriate endpoints for judging efficacy of second line therapies. Methods Thirty-three patients who received full induction GEM/DOCE since 2011, per the protocol adapted from U. Iowa, were identified and characterized. Multivariable logistic regression was used to determine factors associated with recurrence. Cox proportional hazard models evaluated risk factors for disease-free survival (DFS) and high-grade recurrence-free survival (HG-RFS). Results There were no serious adverse effects of therapy. Across all patients, median follow-up time was 18.6 months with a median DFS of 6.5 months, 42% 1-year, and 24% 2-year DFS. Median HG-RFS was 17.1 months with 56% 1-year and 42% 2-year HG-RFS. Among patients initially presenting with HG-NMIBC, 46% (13/28) had HG recurrence. BCG unresponsive/relapsing patients (N = 25) displayed 49% 1-year HG-RFS and 34% 2-year HG-RFS. In total, there were 5 LG and 16 HG recurrences, with 5 progressions and 8 cystectomies among these. Conclusions GEM/DOCE is a well-tolerated therapy that deserves further study as an alternative to immediate RC for highly selected patients with HG-NMIBC. BCG naïve patients responded more effectively than BCG unresponsive/relapsing patients. As anticipated, GEM/DOCE efficacy was improved for HG only patients.
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Affiliation(s)
- Niv Milbar
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Max Kates
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meera R Chappidi
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Takahiro Yoshida
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Sankin
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark P Schoenberg
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kretschmer A, Grimm T, Buchner A, Stief CG, Karl A. Prognostic features for quality of life after radical cystectomy and orthotopic neobladder. Int Braz J Urol 2017; 42:1109-1120. [PMID: 24893915 PMCID: PMC5117966 DOI: 10.1590/s1677-5538.ibju.2015.0491] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/10/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To analyse prognostic features on quality of life (QoL) following radical cystectomy and urinary diversion via orthotopic neobladder in a single-centre patient cohort. MATERIALS AND METHODS Postoperative QoL of 152 patients was assessed retrospectively using the validated QLQ-C30 questionnaire. Potential associations of patient's quality of life including pre-and intraoperative characteristics, surgeon experience, postoperative time course, adjuvant therapies, and functional outcome were defined a priori and evaluated. Mann-Whitney-U-, Kruskal-Wallis-, Spearman correlation and post hoctesting were used. A multivariate analysis using a multiple logistic regression model was performed. A p value <0.05 was considered to be statistically significant. RESULTS Median follow-up was 48 months. Univariate analysis of prognostic features for health-related QoL revealed a significant impact of gender (p=0.019), performance status (p<0.001), experience of surgeon (>100 previous cystectomies, p=0.007), and nerve-sparing surgery (p=0.001). Patients who underwent secondary chemotherapy or radiotherapy had significant lower QLQ-C30 scores (p=0.04, p=0.02 respectively). Patients who were asymptomatic had a significantly higher quality of life (p<0.001). A significant impact of severity of incontinence based on ICIQ-SF score (p<0.001) and daily pad usage (p<0.001), existence of daytime incontinence (p<0.001), existence of urgency symptoms (p=0.007), and IIEF-5 score (p<0.001) could be observed. In multivariate analysis, independent prognostic relevance could be confirmed for preoperative ECOG performance status of 0 (p=0.020 vs. ECOG 1, p=0.047 vs. ECOG 2), experience of the respective surgeon (≥100 vs. <100 previous cystectomies, p=0.021), and daytime continence (p=0.032). CONCLUSION In the present study, we report health-related QoL outcomes in a contemporary patient cohort and confirm preoperative ECOG status, surgeon experience and daytime incontinence as independent prognostic features for a good postoperative QoL.
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Affiliation(s)
| | - Tobias Grimm
- Department of Urology, Ludwig - Maximilians - University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig - Maximilians - University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig - Maximilians - University, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig - Maximilians - University, Munich, Germany
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McIntosh AG, Li T, Ito T, Mannion J, Dziemianowicz M, Waingankar N, Haseebuddin M, Chen DYT, Greenberg RE, Viterbo R, Kutikov A, Uzzo RG, Smaldone MC, Abbosh PH. WBC Associates with Readmission Following Cystectomy. Bladder Cancer 2017; 3:95-103. [PMID: 28516154 PMCID: PMC5409152 DOI: 10.3233/blc-160088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Radical cystectomy is associated with perioperative complication rates exceeding 50% in some series. Readmission rates are increasingly used as a surgical quality metric. White blood cell count is a crude surrogate for physiologic processes which may reflect postoperative complications leading to readmission. Objective: We assessed the association between final white blood cell count at discharge and risk of readmission following radical cystectomy. Methods: Records on 477 patients undergoing radical cystectomy from 2006-2013 were reviewed. Final white blood cell count was defined as the last documented value during index admission. Univariate analysis was performed using Fisher's exact, Wilcoxon rank sum test, and Spearman's coefficient tests where appropriate. Multivariable logistic regression models were used to test the associations between final white blood cell count and readmission. Results: 34% of patients were readmitted within 90 days of surgery. Amongst this cohort, a cutoff final white blood cell count of 9000/mm3 was identified, with a significantly higher proportion of patients with values >9000/mm3 experiencing readmission than those with values≤9000/mm3 (42% vs 28%, p = 0.004). Other perioperative variables associated with an increased readmission rate included initial hospital length of stay≤10 days, and receipt of a continent diversion. Following adjustment, final white blood cell count >9000/mm3 was associated with increased risk of readmission (OR 2.09, 95% CI 1.23-3.53, p = 0.006). Conclusions: Final white blood cell count is associated with hospital readmission following radical cystectomy. This metric may provide important guidance in discharge algorithms.
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Affiliation(s)
| | - Tianyu Li
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Timothy Ito
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jason Mannion
- Temple University Health System, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Robert G Uzzo
- Fox Chase Cancer Center, Philadelphia, PA, USA.,Albert Einstein Medical Center, Philadelphia, PA, USA
| | | | - Philip H Abbosh
- Fox Chase Cancer Center, Philadelphia, PA, USA.,Albert Einstein Medical Center, Philadelphia, PA, USA
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St Clair JW, Wong ML. Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis. J Emerg Med 2017; 52:e179-e182. [PMID: 28169046 DOI: 10.1016/j.jemermed.2016.12.036] [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: 10/14/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The differential diagnosis for a non-anion gap metabolic acidosis is probably less well known than the differential diagnosis for an anion gap metabolic acidosis. One etiology of a non-anion gap acidosis is the consequence of ileal neobladder urinary diversion for the treatment of bladder cancer. CASE REPORT We present a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a urinary tract infection and ureteroenterostomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Part of the ileal neobladder surgery includes ureteroenterostomy and predisposes patients to several clinically significant metabolic derangements, including a non-anion gap metabolic acidosis. These patients have an increased chronic acid load, bicarbonate deficit, and hypokalemia, which should be appreciated when resuscitating these patients.
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Affiliation(s)
- Jesse W St Clair
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew L Wong
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Abdominal Imaging Following Urinary Reconstruction: Recommendations and Pitfalls. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krajewski W, Zdrojowy R, Tupikowski K, Małkiewicz B, Kołodziej A. How to lower postoperative complications after radical cystectomy - a review. Cent European J Urol 2016; 69:370-376. [PMID: 28127453 PMCID: PMC5260457 DOI: 10.5173/ceju.2016.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/16/2016] [Accepted: 10/13/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Lowering morbidity and mortality after RC is subject of considerable interest. Lately, many evidence-based data on improvements in operative technique, anesthetic management, and patient care have been published. In this article, we present a review of literature on how to lower postoperative complications after RC. Material and methods The Medline, and Web of Science databases were searched without a time limit on February 2016 using the terms ‘cystectomy’ in conjunction with ‘radical’, ‘bladder cancer’, ‘complications’ or ‘management’. Boolean operators (NOT, AND, OR) were also used in succession to narrow and broaden the search. The search was limited to the English, Polish and Spanish literature. Results Many complications may be avoided by appropriate patient selection and meticulous introduction of care protocols. Conclusions RC as treatment free of complications, even in the hands of an experienced urologist, does not exist. A large number of complications are acceptable in the name of good long-term results. Optimum results are possible with proper surgical technique, good patients and urinary diversion selection and proper patient management in the pre-, peri, and postoperative period.
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Affiliation(s)
- Wojciech Krajewski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Urology and Urologic Oncology Department, Wrocław Medical University, Wrocław, Poland
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Hoogenkamp HR, Pot MW, Hafmans TG, Tiemessen DM, Sun Y, Oosterwijk E, Feitz WF, Daamen WF, van Kuppevelt TH. Scaffolds for whole organ tissue engineering: Construction and in vitro evaluation of a seamless, spherical and hollow collagen bladder construct with appendices. Acta Biomater 2016; 43:112-121. [PMID: 27424084 DOI: 10.1016/j.actbio.2016.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The field of regenerative medicine has developed promising techniques to improve current neobladder strategies used for radical cystectomies or congenital anomalies. Scaffolds made from molecularly defined biomaterials are instrumental in the regeneration of tissues, but are generally confined to small flat patches and do not comprise the whole organ. We have developed a simple, one-step casting method to produce a seamless large hollow collagen-based scaffold, mimicking the shape of the whole bladder, and with integrated anastomotic sites for ureters and urethra. The hollow bladder scaffold is highly standardized, with uniform wall thickness and a unidirectional pore structure to facilitate cell infiltration in vivo. Human and porcine bladder urothelial and smooth muscle cells were able to attach to the scaffold and maintained their phenotype in vitro. The closed luminal side and the porous outside of the scaffold facilitated the formation of an urothelial lining and infiltration of smooth muscle cells, respectively. The cells aligned according to the provided scaffold template. The technology used is highly adjustable (shape, size, materials) and may be used as a starting point for research to an off-the-shelf medical device suitable for neobladders. STATEMENT OF SIGNIFICANCE In this study, we describe the development of a simple, one-step casting method to produce a seamless large hollow collagen-based scaffold mimicking the shape of the whole bladder with integrated anastomotic sites for ureters and urethra. The hollow bladder scaffold is highly standardized with uniform wall thickness and a unidirectional pore structure to facilitate cell infiltration in vivo. The closed luminal surface and the porous exterior of the scaffold facilitated the formation of a urothelial lining and infiltration of smooth muscle cells, respectively. The applied technology is highly adjustable (shape, size, materials) and can be the starting point for research to an off-the-shelf medical device suitable for neobladders.
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Ghosh A, Somani BK. Recent Trends in Postcystectomy Health-related Quality of Life (QoL) Favors Neobladder Diversion: Systematic Review of the Literature. Urology 2016; 93:22-6. [PMID: 27015941 DOI: 10.1016/j.urology.2015.12.079] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022]
Abstract
The study aims to review the current evidence for quality of life posturinary diversion surgery comparing neobladder to other types of diversion. A review of literature from inception to July 2015 for all English-language articles was done. Based on our inclusion criteria, 22 studies (2450 patients) were included. Whereas none of the prospective studies showed any quality of life (QoL) advantage with ileal conduit diversion, 3 of the 5 prospective studies and 4 of the 6 studies published after 2011 show better QoL outcomes with neobladder than other urinary diversion types. All prospective studies published after 2011 have shown neobladder to have superior QoL outcomes than its comparators. Recent trends indicate that orthotopic neobladder postcystectomy is associated with better QoL outcomes compared to other urinary diversion types.
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Affiliation(s)
- Anngona Ghosh
- University Hospital Southampton NHS Trust, Southampton, UK
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Sloff M, Simaioforidis V, Geutjes PJ, Hoogenkamp HR, van Kuppevelt TH, Daamen WF, Oosterwijk E, Feitz WF. Novel tubular constructs for urinary diversion: a biocompatibility study in pigs. J Tissue Eng Regen Med 2016; 11:2241-2249. [DOI: 10.1002/term.2122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/13/2015] [Accepted: 11/06/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Marije Sloff
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | | | - Paul J. Geutjes
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Henk R. Hoogenkamp
- Department of Biochemistry; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Toin H. van Kuppevelt
- Department of Biochemistry; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Willeke F. Daamen
- Department of Biochemistry; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Egbert Oosterwijk
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Wout F. Feitz
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
- Radboud University Medical Centre; Amalia Children's Hospital; Nijmegen The Netherlands
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Mani J, Vallo S, Brandt MP, Gust KM, Bartsch C, Daechert J, Tsaur I, Bartsch G, Haferkamp A. What should be the patient's preference regarding the choice of hospital in the case of radical cystectomy? Evaluation of early complications after open radical cystectomy in a medium and high volume setting in one hospital. Patient Prefer Adherence 2016; 10:2181-2187. [PMID: 27822019 PMCID: PMC5094608 DOI: 10.2147/ppa.s103217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery. HYPOTHESIS A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy. MATERIALS AND METHODS Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien-Dindo classification. RESULTS Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (P<0.001). When placing patients into subgroups, significantly more complications in period A were also seen concerning sex (male, P<0.001; female, P=0.003), age (<70 years, P<0.001; >70 years, P≤50.001) tumor grade (low grade, P<0.001; high grade, P≤0.001), and UD (ileal conduit, P<0.001; neobladder, P<0.001). In a multivariable analysis, age (P=0.031) and type of UD (P=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (P=0.0417), age (P=0.041), and the time periods (A/B) (P<0.001) show a significant association with the presence of complications. CONCLUSION This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic outcome and quality of life.
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Affiliation(s)
- Jens Mani
- Department of Urology, Goethe University Hospital, Frankfurt am Main
- Correspondence: Jens Mani, Department of Urology, Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany, Tel +49 69 6301 7107, Fax +49 69 6301 7108, Email
| | - Stefan Vallo
- Department of Urology, Goethe University Hospital, Frankfurt am Main
| | | | - Kilian M Gust
- Department of Urology, Goethe University Hospital, Frankfurt am Main
| | - Claudia Bartsch
- Department of Urology, Goethe University Hospital, Frankfurt am Main
| | - Johannes Daechert
- Department of Urology, Goethe University Hospital, Frankfurt am Main
| | - Igor Tsaur
- Department of Urology, Goethe University Hospital, Frankfurt am Main
| | - Georg Bartsch
- Department of Urology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, Goethe University Hospital, Frankfurt am Main
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49
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[Cystectomy and urinary diversion: Technique and support]. Prog Urol 2015; 25:900-6. [PMID: 26475233 DOI: 10.1016/j.purol.2015.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022]
Abstract
Cystectomy and urinary diversion (Bricker ileal conduit or neobladder) are common modalities of care in urology requiring their attention. Oncological surgery as well as functional disorders in particular for neurogenic bladder are the main directions. The optimal decision must be multidisciplinary and requires the fundamental of stomatherapy that urology teams need to know in order to improve the management of the care plan. After cystectomy whose surgical approach depends on the cause (oncological vs other causes), urinary diversions may be non continent (cutaneous ureterostomy or Bricker ileal conduit) or continent (ileal neobladder most of the time.) The monitoring and patient's support remain two most important steps, particularly in cases of bladder diversion to monitor (protection of upper urinary tract, neobladder capacity) and patient education (learning of continence and good emptying). The choice of many surgical techniques must be adapted to the characteristics of the patient, after an informed discussion with the patient.
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50
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Metcalfe C, Loh-Doyle J, Chopra S, Abreu AL, Satkunasivam R, Azhar R, Simma-Chiang V, Dunn M. The Impact of Transtomal Rigid Endoscopy in Continent Cutaneous Urinary Diversions. Urology 2015; 87:60-3. [PMID: 26449165 DOI: 10.1016/j.urology.2015.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 08/28/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if transtomal rigid endoscopy damages the continence mechanism of continent cutaneous reservoirs. We report the largest and longest series to date from a single institution demonstrating the safety of transtomal rigid endoscopy. MATERIALS AND METHODS We conducted an institutional review board-approved retrospective review of a prospectively accrued database of all patients with urinary diversions that underwent rigid endoscopic procedures for various reasons between 2000 and 2013. Pre- and postoperative continence, difficulty with catheterization, and need for surgical revision post procedure were evaluated. RESULTS From 2000 to 2013, 71 patients with continent cutaneous diversions underwent 191 endoscopic procedures by a single surgeon. Mean follow-up was 603 days. Mean age was 58.4 years. The mean number of procedures per patient was 2.7 (1-7). All procedures were performed by gaining access through the stoma with an offset rigid nephroscope and a 28-30Fr access sheath. Two patients reported incontinence postoperatively; 1 patient was treated conservatively by way of indwelling catheter for 1 week and full continence returned. The second patient had small-volume incontinence preoperatively that worsened postoperatively. The procedure uncovered an existing efferent limb-cutaneous fistula. Patients undergoing repeated procedures were not at any higher risk of incontinence. There were no patients that had difficulty with catheterization postoperatively. No surgical revisions were required for worsened continence postoperatively. CONCLUSION Transtomal rigid endoscopic procedures do not negatively affect the continence mechanism in continent cutaneous diversions. Transtomal rigid endoscopy allows for safe endoscopic access in these difficult to treat patients.
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Affiliation(s)
- Charles Metcalfe
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Jeffery Loh-Doyle
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Sameer Chopra
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Andre L Abreu
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Raj Satkunasivam
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Raed Azhar
- Institute of Urology, University of Southern California, Los Angeles, CA
| | | | - Matthew Dunn
- Institute of Urology, University of Southern California, Los Angeles, CA.
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