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Baboudjian M, Gondran-Tellier B, Michel F, Abdallah R, Rouy M, Gaillet S, Sichez PC, Boissier R, Bladou F, Lechevallier E, Karsenty G. Miami Pouch: A Simple Technique for Efficient Continent Cutaneous Urinary Diversion. Urology 2021; 152:178-183. [PMID: 33581233 DOI: 10.1016/j.urology.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report a contemporary series of Miami pouch (MP) enriched with a full technical description and step-by-step video to contribute to wider use. PATIENTS AND METHODS A retrospective charts review of all patients who had a MP at our center between January 2016 and December 2017 was performed. The MP technique uses the terminal 15cm of ileum and the right colon to build an intestinal heterotopic pouch located in the right iliac fossa and connected to the skin by an efferent catheterizable tube. Primary outcome was continence defined as the absence of leakage between clean intermittent self-catheterization (CISC) with a maximal interval of 4 hours between each CISC. RESULTS Fifteen patients had MP during the study period. Thirty-day postoperative Clavien III complications were observed in 2 (13.3%) patients. At 39 months of median follow-up, continence was obtained for all patients except for 2 patients whom reported intermittent night-time leakages due to long intervals (5 to 7 hours) between 2 CISC. No significant alteration of renal function was reported and no stenosis of the efferent tube neither difficulty to perform CISC was observed. CONCLUSIONS For patients who are candidates for radical cystectomy and not eligible for orthotopic neobladder, intestinal heterotopic pouch with a cutaneous continent urinary diversions as MP may be a reliable alternative. Patients should be informed of the existence of a valid alternative to ileal conduit since it may fit their expectations of a preserved body image without urine collecting appliances.
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Affiliation(s)
- Michael Baboudjian
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France.
| | - Bastien Gondran-Tellier
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Floriane Michel
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Rony Abdallah
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Mathieu Rouy
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Sarah Gaillet
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Pierre Clement Sichez
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Romain Boissier
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Frank Bladou
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille University, APHM, La Conception Academic Hospital, Department of Urology and Renal transplantation, Marseille, France
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Daneshmand S, Ahmadi H. Conversion from incontinent conduit to continent cutaneous reservoir after renal transplant. Urology 2013; 81:1086-9. [PMID: 23490526 DOI: 10.1016/j.urology.2012.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/18/2012] [Accepted: 10/20/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the technique and outcomes of conversion of incontinent stoma to continent colonic reservoir after renal transplantation (RT). METHODS From 2004 to 2009, 2 patients who underwent kidney transplants and incontinent stomas underwent takedown of their urostomy with construction of a right colon continent cutaneous pouch with an appendiceal catheterizable stoma. The conduit was used as an afferent limb and anastomosed to the distal ileal portion of the reservoir with ileocecal valve serving as the antireflux mechanism. Thus no ureteral anastomosis was necessary. RESULTS Both patients had an uneventful postoperative course and are now completely continent. There have been no interval infections or renal graft deterioration with short term follow-up. CONCLUSION Continent cutaneous urinary diversion after RT is feasible and can lead to a significant improvement in the quality of life. Further follow-up is necessary to ascertain the long-term results of this form of diversion.
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Affiliation(s)
- Siamak Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089-2211, USA.
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Suriano F, Daneshmand S, Buscarini M. Use of nonabsorbable staples for urinary diversion: a step in the wrong direction. Urol Int 2012; 90:125-9. [PMID: 22777143 DOI: 10.1159/000339377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of bowel segments incorporated into the urinary tract is well established in urological surgery. OBJECTIVE To describe and compare the use of absorbable and nonabsorbable staples for creation of a urine reservoir after radical cystectomy. MATERIALS AND METHODS This review is based on a systematic Medline search assessing the period 1950-2010. RESULTS Use of the autosuture stapling device for the construction of the urinary diversion significantly reduces operating time. Johnson and Fuerst reported its use for the first time to construct a ureteroileocutaneous urinary diversion in 1973. However, many studies demonstrated that exposed metal staples represent a nidus for stone formation when they are in direct contact with urine, particularly in urinary diversions such as Kock pouch and ileal conduit. Stone formation has been attributed in part to the use of nonabsorbable artificial materials, such as metal staples and Marlex mesh, strictures of the pouch and accumulation of mucus. The treatment options for pouch calculi include observation for spontaneous passage, extracorporeal shockwave lithotripsy, percutaneous or endoscopic lithotripsy/lithotomy. CONCLUSIONS Historically, the mean time to stone formation with nonabsorbable material (staples, Marlex mesh) is 34 months. None of the studies on use of nonabsorbable staples in urinary diversion has such a long follow-up. Until further studies with more appropriate observation time are completed, the use of nonabsorbable staples for continent and noncontinent urinary diversion should be discouraged.
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Affiliation(s)
- Francesca Suriano
- Campus Bio-Medico, University of Rome, Rome, Italy. f.suriano @ unicampus.it
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Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal Indiana pouch continent cutaneous urinary diversion. Urology 2012; 79:1073-8. [PMID: 22386752 DOI: 10.1016/j.urology.2011.12.050] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 12/28/2011] [Accepted: 12/29/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the functional outcomes and complications for patients with bladder cancer undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion. METHODS From February 2004 to March 2010, 34 patients underwent robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction. After surgery, the complications were identified, categorized, and graded using an established 5-grade modification of the original Clavien grading system, and continence was assessed. Descriptive statistics were used in evaluating the outcomes. Fischer's exact test was used in the comparison of early and late Clavien grade III complications. RESULTS Overall, 175 (123 early and 52 late) complications after surgery were reported in 32 (94%) of 34 patients. Within 90 days of surgery, 31 (91%) of 34 patients experienced ≥ 1 early complication. Of 34 patients, 15 (44%) reported ≥ 1 late complications (>90 days). Most (85% and 69%, respectively) early and late complications were graded as minor (grade II or less). Fewer patients with early complications required an additional intervention (grade III) compared with patients with late complications (14% vs 31%; P = .116). The most common complication in both intervals was infection, reported in 22% and 37% of patients with early and late complications, respectively. The continence data for 31 patients at a mean follow-up of 20.1 months (median 12.0) showed that all but 1 patient (97%) had daytime and nighttime continence. CONCLUSION Patients undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction have comparable complication rates and functional outcomes compared with patients in the open series.
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Ardelt PU, Woodhouse CRJ, Riedmiller H, Gerharz EW. The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature. BJU Int 2011; 109:288-97. [PMID: 21645197 DOI: 10.1111/j.1464-410x.2011.10242.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To critically assess the biophysical properties and current status of outlet formation in heterotopic intestinal urinary diversion. As despite three decades of clinical experience with continent cutaneous urinary diversion through bowel segments, no consensus has been reached for the optimal efferent segment although its function largely determines patient satisfaction. METHODS A comprehensive Medline literature search using the Medical Subject Headings database (search terms: continent urinary diversion followed by either efferent segment, nipple, Mitrofanoff, Yang-Monti, Benchekroun, tapered ileum, intussuscepted ileum, Kock pouch, T-valve, or Ghonheim) was conducted to identify all full-length original articles addressing the various principles and techniques of outlet formation as well as their outcomes and complications. Examined series were published in English between 1966 and 2010. All studies were systematically evaluated using a checklist (study design, number of patients, etc.) and rated according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (LoE). RESULTS While there was a continuous flow of publications over the last three decades, the vast majority of studies were retrospective case series with numerous confounding factors and poorly defined, non-standardized outcomes (LoE, 3). Only a few investigations compare different efferent segments (LoE, 2a). No randomized studies exist. The major biophysical principles are based on the use of flap, nipple, and hydraulic valves. Vermiform appendix, intussuscepted ileal nipple, and the Yang-Monti tube are the most popular techniques and have well-established data on outcomes, complications, and failure rates. Artificial sphincter systems and tissue engineering have provided disappointing results thus far. Most reconstructive strategies are subject to a process of on-going improvement. CONCLUSIONS The continuous quest for optimization has not led to a single universally applicable efferent segment in continent cutaneous urinary diversion. While all techniques have their unique set of advantages and disadvantages, they will always remain a compromise. Success depends on selecting the optimal strategy for individual patients. A major change in principles in the near future is unlikely.
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Affiliation(s)
- Peter U Ardelt
- Department of Urology, Albert-Ludwigs-University Medical School, Freiburg, Germany.
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Ganesan T, Khadra MH, Wallis J, Neal DE. Vitamin B12 malabsorption following bladder reconstruction or diversion with bowel segments. ANZ J Surg 2002; 72:479-82. [PMID: 12123505 DOI: 10.1046/j.1445-2197.2002.02460.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vitamin B12 is absorbed exclusively in the terminal ileum the resection of which may produce malabsorption of B12. The present study aimed to determine whether the length or specific segment of the intestine used in bladder reconstruction affects the overall incidence of B12 malabsorption. It was also aimed at the reasonable way of following these patients. METHODS Seventy patients who underwent urinary reconstruction between 1988 and 1997 were studied: 28 had undergone orthotopic reconstruction, 14 had ileal conduit diversion, 8 had continent diversion and 20 had undergone enterocystoplasty. The median follow up was 65 months (10-137 months). Indications for operation included carcinoma of the bladder, neurogenic bladder dysfunction, idiopathic detrusor instability and interstitial cystitis. Schilling tests were performed, and serum B12 level and haematological indices were measured. RESULTS Patients were classified depending on whether the ileocaecal junction was used. Group 1 included ileal conduit and entero-cystoplasty where 15-20 cm of ileum, 15-20 cm from ileocaecal junction was used. Group 2 consisted of orthotopic reconstruction and continent diversions where the ileocaecal segment was used. Group 3 comprised patients in whom long ileal segments (50-60 cm) had been used for reconstruction. Five patients in group 1 and one in group 2 had low B12 levels, but none had developed neuropathy or megaloblastic anaemia. One patient in group 1, and six patients in group 2 had low Schilling tests indicating intestinal malabsorption of B12. No patient in group 3 had a low B12 or an abnormal Schilling test. CONCLUSION This study showed that use of ileocaecal segments results in intestinal malabsorption of B12. The length of ileum alone does not seem to be the determinant factor in causing B12 deficiency or B12 malabsorption.
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Affiliation(s)
- Thirumalai Ganesan
- Department of Urology, Manchester Royal Infirmary, Manchester, United Kingdom.
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Sait K, Stuart G, Nation J, Ghatage P. Urolithiasis following formation of a continent urostomy: case report and review of the literature. Gynecol Oncol 2000; 77:330-3. [PMID: 10785490 DOI: 10.1006/gyno.2000.5750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Formation of urinary stones in a continent urostomy (Indiana pouch) has been described as a late complication. Management of a patient with symptomatic multiple large stones and review of the literature are outlined. CASE REPORT A 32-year-old woman presented with recurrent urinary tract infections and pyelonephritis 6 years after a total pelvic exenteration and creation of a continent urostomy for central recurrent carcinoma of the cervix after radical pelvic radiation. Multiple large stones were found to be the underlying etiology. Laparotomy, enterocystotomy, and removal of stones were performed without apparent complication. CONCLUSION It is recommended that for single calculi or multiple small stones, electroshock wave lithotripsy or the percutaneous endoscopic approach be considered. For larger stones the use of laparotomy and enterocystostomy may be appropriate.
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Affiliation(s)
- K Sait
- Department of Gynecology, The University of Calgary, Alberta, Canada
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Terai A, Ueda T, Kakehi Y, Terachi T, Arai Y, Okada Y, Yoshida O. Urinary Calculi as a Late Complication of the Indiana Continent Urinary Diversion: Comparison with the Kock Pouch Procedure. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66541-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Akito Terai
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Ueda
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiro Terachi
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Yoichi Arai
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Yusaku Okada
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Osamu Yoshida
- Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Urinary Calculi as a Late Complication of the Indiana Continent Urinary Diversion. J Urol 1996. [DOI: 10.1097/00005392-199601000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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