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Miyaoka R, Azal Neto W, Pedro RN. Novel Endourological technique for a better navigation in incontinent urinary diversion (ileal conduit) during Double J stent removal. Urol Case Rep 2023; 51:102549. [PMID: 37692765 PMCID: PMC10483506 DOI: 10.1016/j.eucr.2023.102549] [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: 07/30/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Assessing ileal conduit for double J stents removal after radical cystectomy is not always a straightforward task as navigation inside the ileal loop can be challenging to manage due to the difficulty to maintain a waterfilled environment and its long and tortuous aspect. Methods We present a novel technique using a flexible ureteroscope that aims to ease this common demand with simple and readily available tools. Results This technique has been successfully utilized in 2 patients now. No complications were documented. Conclusion We propose a novel surgical technique to improve endoscopic navigation in incontinent ileal loop urinary diversion.
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Affiliation(s)
- Ricardo Miyaoka
- Division of Urology, Faculty of Medical Sciences, State University of Campinas – UNICAMP, Cidade Universitária Zeferino Vaz, Rua Vital Brasil, 80, CEP 13083-888, Campinas, SP, Brazil
- Clínica Urologia Campinas, Av. Francisco Glicério, 2331, salas 63/64, edifício Glicerio Office, Vl. Itapura, CEP 13020-210, Campinas, SP, Brazil
| | - Wilmar Azal Neto
- Division of Urology, Faculty of Medical Sciences, State University of Campinas – UNICAMP, Cidade Universitária Zeferino Vaz, Rua Vital Brasil, 80, CEP 13083-888, Campinas, SP, Brazil
| | - Renato Nardi Pedro
- Division of Urology, Faculty of Medical Sciences, State University of Campinas – UNICAMP, Cidade Universitária Zeferino Vaz, Rua Vital Brasil, 80, CEP 13083-888, Campinas, SP, Brazil
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Albisinni S, Aoun F, Mjaess G, Abou Zahr R, Diamand R, Porpiglia F, Esperto F, Autorino R, Fiori C, Tubaro A, Roumeguère T, DE Nunzio C. Contemporary management of benign uretero-enteric strictures after cystectomy: a systematic review. Minerva Urol Nephrol 2021; 73:724-730. [PMID: 34308609 DOI: 10.23736/s2724-6051.21.04463-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Uretero-enteric stricture (UES) is a common post-operative complication after radical cystectomy with urinary diversion. The aim of this systematic review is to discuss the contemporary management of benign UES after cystectomy and to compare the different surgical approaches. EVIDENCE ACQUISITION A systematic review was performed from January 2000 through January 2021. Search engines used included PubMed, Embase and Medline databases. Search query was: ((ureteroileal OR uretero-ileal OR ureteroenteric OR ureteroenteric) AND (stricture OR stenosis)) AND (management OR treatment). Study selection followed the PRISMA statement. Studies tackling management of UES, either through open, endoscopic, laparoscopic or robot-assisted approaches, were included in our systematic review. EVIDENCE SYNTHESIS Forty-one studies were finally included in this systematic review. No prospective studies were found; all included studies were retrospective. Open surgical repair had a 78-100% success rate, a significant rate of complications, and a low recurrence rate (6-8%). Endourological management decreased complication rate, length-of-stay, and blood loss, with however lower success (15-50%) and higher recurrence rates (62%-91%) compared to open surgery. Robotic assisted surgery showed comparable success rates to open surgery (80-100%), while limiting the number of major complications and hospital length-of-stay. CONCLUSIONS Surgical management of UES remains challenging. Open surgery maintains a role given its high success rate, at the cost however of a significant morbidity. On the other hand, endourological procedures offer a favorable and low complication risk, but a low long-term success rate. Robotic-assisted surgery is emerging with a valid resolution of UES as it offers comparable success rates to an open approach, while reducing surgical morbidity. Head-to-head comparisons are awaited to confirm these findings.
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Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium -
| | - Fouad Aoun
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Rawad Abou Zahr
- Urology Department, University Clinics of Brussels, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Urology Department, University Clinics of Brussels, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Porpiglia
- Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | | | | | - Cristian Fiori
- Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | - Andrea Tubaro
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Cosimo DE Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
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Sakai Y, Tsuyuguchi T, Sugiyama H, Hayashi M, Senoo JI, Kusakabe Y, Yasui S, Mikata R, Yokosuka O. Comparison of endoscopic papillary balloon dilatation and endoscopic sphincterotomy for bile duct stones. World J Gastrointest Endosc 2016; 8:395-401. [PMID: 27247706 PMCID: PMC4877531 DOI: 10.4253/wjge.v8.i10.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 02/05/2023] Open
Abstract
Endoscopic treatment for bile duct stones is low-invasive and currently considered as the first choice of the treatment. For the treatment of bile duct stones, papillary treatment is necessary, and the treatments used at the time are broadly classified into two types; endoscopic papillary balloon dilatation where bile duct closing part is dilated with a balloon and endoscopic sphincterotomy (EST) where bile duct closing part is incised. Both procedures have advantages and disadvantages. Golden standard is EST, however, there are patients with difficulty for EST, thus we must select the procedure based on understanding of the characteristics of the procedure, and patient backgrounds.
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Abstract
Endoscopic ultrasound (EUS) has been developed since the early 1980s. Its clinical role in the diagnosis of gastrointestinal wall lesions and staging of gastrointestinal and lung cancer has evolved over the last two decades. Initially, it was either used as an imaging tool for gastrointestinal wall lesions or for staging of gastrointestinal tumours. However, in combination with fine-needle aspiration under real-time scanning, EUS is now being used in tissue sampling for diagnosis. In addition, EUS may be used therapeutically in coeliac plexus neurolysis or pseudocyst drainage. This review concentrates on the current applications of EUS.
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Affiliation(s)
- Grant R Caddy
- Department of Gastroenterology, St Vincent's Hospital, Victoria, Australia
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Thiruchelvam N, Harrison M, Page AC. The double wire technique: an improved method for treating challenging ureteroileal anastomotic strictures and occlusions. Br J Radiol 2007; 80:103-6. [PMID: 17495059 DOI: 10.1259/bjr/72561092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Up to 10% of patients who undergo ileal conduit urinary diversion may go on to develop ureteroileal anastomotic stenosis (UIAS); this can lead to recurrent urinary tract infections and deterioration in renal function. Classical management has been open revision of the anastomosis. We describe a novel technique that allows balloon dilatation and ureteral stent placement in a retrograde fashion. All patients in this study had undergone radical cystectomy and ileal conduit formation with Wallace type end-to-end refluxing uretero-intestinal anastomosis. After initial retrograde loopogram, a 6F MPA-1 catheter and an 0.035 inch extra stiff guide was passed to the distal ostium. Subsequently, a customised 8F bright tip MPA-1 guiding catheter was advanced over the guide wire which allowed effective splinting of the equipment to facilitate greater control of a second catheter and guide wire combination to access the stenotic or occluded anastomosis. Results show that a total of ten anastomoses were treated; nine anastomoses were successfully treated with a primary retrograde approach with no intra or post-procedural complications. After a mean follow-up of 19 months (5-33 months), as assessed by ascending loopograms, all anastomoses remained open. In conclusion, morbidity of open surgery has resulted in the popularization of endourological techniques in treating anastomotic stenoses. However, key to these endourological techniques is access to the anastomosis; typically, this has been via a percutaneously placed nephrostomy. The ideal route to the anastomosis is via a retrograde approach; we have illustrated a safe and successful novel technique that utilized two guidewires and a guiding catheter, allowing retrograde ureteral access.
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Affiliation(s)
- N Thiruchelvam
- Department of Urology, Royal Hampshire County Hospital, Winchester, Hampshire, UK
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Eloubeidi MA, Varadarajulu S, El-Galley R, Bueschen AJ, Eltoum I. EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach. Gastrointest Endosc 2006; 64:450-3. [PMID: 16923503 DOI: 10.1016/j.gie.2006.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 02/25/2006] [Indexed: 12/10/2022]
Abstract
BACKGROUND Diagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult. OBJECTIVE A new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer. DESIGN Case series, part of a large prospective study on EUS-guided FNA. PATIENTS Three patients who had undergone total cystectomy and ileal conduit construction for bladder cancer underwent EUS-guided FNA through the ileal conduit for evaluation of suspected tumor recurrence at the site of anastomosis of the distal ureter and the ileal conduit. MAIN OUTCOME MEASUREMENTS The feasibility, diagnostic accuracy, and safety profile of EUS-guided FNA is assessed. OBSERVATIONS EUS-guided FNA through the ileal conduit was technically feasible in all 3 patients. By EUS, the mass appeared as an irregularly shaped, hypoechoic lesion that was extrinsic to the lumen of the ileum. A diagnosis of recurrent transitional cell cancer was made in 2 patients and anastomotic stricture was found in 1 patient. Both patients with tumor recurrence received palliative chemotherapy, and the patient with an anastomotic stricture was managed by placement of a nephrostomy stent. No complications were encountered. LIMITATIONS Small number of enrolled subjects; short duration of follow-up. CONCLUSIONS EUS-guided FNA through the ileal conduit is technically feasible, safe, and establishes diagnosis in patients suspected of tumor recurrence after complete cystectomy for bladder cancer.
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Affiliation(s)
- Mohamad A Eloubeidi
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
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Zammit PA, German K. A novel technique for ureteric access in ileal conduits. BJU Int 2003; 92:491-2. [PMID: 12930450 DOI: 10.1046/j.1464-410x.2003.t01-3-04336.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zammit P, German K. A novel technique for ureteric access in ileal conduits. BJU Int 2003. [DOI: 10.1046/j.1464-410x.2003.t01-3-04336.x-i2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zammit P, German K. A novel technique for ureteric access in ileal conduits. BJU Int 2003. [DOI: 10.1046/j.1464-410x.2003.t01-2-04336.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liangpunsakul S, Chadalawada V, Rex DK, Maglinte D, Lappas J. Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis. Am J Gastroenterol 2003; 98:1295-8. [PMID: 12818272 DOI: 10.1111/j.1572-0241.2003.07471.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Wireless capsule endoscopy (WCE) is a new technology for small bowel imaging. AIM To report our initial experience with sensitivity of high quality enteroclysis in patients with small bowel ulcers detected by WCE. METHODS Medical records of all patients referred for WCE from December, 2001 to April, 2002 at our institution were reviewed. All patients had negative upper and lower endoscopies and small bowel barium studies before WCE. RESULTS There were 40 patients (19 female, mean age 57.3 yr) during this study period. Three patients had multiple small bowel ulcers detected by WCE. One with ileal ulcers and abdominal pain had an enteroclysis at another hospital before WCE. Review of the study at our institution showed that it was of excellent quality and was normal. Two patients with chronic iron deficiency anemia had multiple small bowel ulcers and were referred after WCE for a repeat small bowel barium study by biphasic enteroclysis performed by experienced GI radiologists. The radiologists were told in advance of the WCE findings. Both studies were considered technically to be of perfect quality. Despite this, both studies were negative. All 3 patients improved after therapy for Crohn's disease. CONCLUSIONS Our data indicates that WCE may be more sensitive for small bowel ulcers than the best enteroclysis available.
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Affiliation(s)
- Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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