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Scheper V, Seitz AK, Kübler H, Kocot A, Kalogirou C, Schwinger M. A Propensity Score-Based Comparison regarding Renal, Functional, and Surgical Outcome of Continent Cutaneous Urinary Diversions in Patients with Benign Chronic Bladder Diseases and Patients with Bladder Cancer. Urol Int 2024:1-8. [PMID: 39154646 DOI: 10.1159/000540950] [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: 05/20/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Continent cutaneous urinary diversion post-cystectomy is an established approach addressing both oncological and functional indications. However, there is a noticeable gap of evidence when it comes to comparing outcomes between these indications, especially concerning the technique of Mainz pouch I (MPI). This study aimed to close the gap by analyzing the long-term functional and renal outcomes of patients with MPI after cystectomy due to both benign and malign bladder pathologies. METHODS In this retrospective study, we examined 173 patients, who underwent MPI surgery between 2000 and 2022. Patients were categorized into a study group (benign conditions, n = 26) and a control group (bladder cancer, n = 52) using propensity score matching. Clinical demographics, surgical outcomes, and functional/renal parameters were analyzed using unpaired t tests and χ2 tests. RESULTS Patients undergoing cystectomy with MPI due to benign bladder pathologies were significantly younger and had a lower comorbidity burden compared to those with bladder cancer. In contrast to a significantly higher incidence of chemotherapy in the oncological cohort, the long-term renal function was comparable between both populations. Surgical outcomes, revisions, and postoperative complications did not differ significantly between both groups. Nearly 90% of patients in both groups showed full continence. CONCLUSION This study demonstrates the efficacy and safety of MPI surgery in both benign and malignant conditions, proving favorable long-term renal and functional outcomes.
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Affiliation(s)
- Vincent Scheper
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
| | - Anna Katharina Seitz
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
| | - Arkadius Kocot
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
| | - Marcel Schwinger
- Department of Urology and Pediatric Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany
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Pagliara TJ, Gor RA, Liberman D, Myers JB, Luzny P, Stoffel JT, Elliott SP. Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults. Can Urol Assoc J 2017; 12:E126-E131. [PMID: 29283085 DOI: 10.5489/cuaj.4656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study aimed to describe the strategies of surgical revision for catheterizable channel obstruction and their outcomes, including restenosis and new channel incontinence. METHODS We retrospectively queried the charts of adults who underwent catheterizable channel revision or replacement from 2000-2014 for stomal stenosis, channel obstruction, or difficulty with catheterization at the Universities of Minnesota, Michigan, and Utah. The primary endpoint was channel patency as measured by freedom from repeat surgical intervention. Secondary endpoints included post-revision incontinence and complication rates. Revision surgeries were classified by strategy into "above fascia," "below fascia," and "channel replacement" groupings. RESULTS A total of 51 patients who underwent 68 repairs (age 18-82 years old; mean 45) were identified who met our inclusion criteria. Channel patency was achieved in 66% at a median 19 months post-revision for all repair types. There was no difference in patency by the type of channel being revised, but there was based on revision technique, with channel replacement and above the fascia repairs being more successful (p=0.046). Channel incontinence occurred in 40% and was moderate to severe in 12%. The type of channel being revised was strongly associated (p=0.003) with any postoperative channel incontinence. Surgical complications occurred in 29% of all revision procedures, although most were low-grade. CONCLUSIONS Surgical revision of continent catheterizable channels for channel obstruction can be performed with acceptable rates of durable patency and incontinence; however, the surgeon needs to have experience in complex urinary diversion and familiarity with a variety of surgical revision strategies.
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Affiliation(s)
| | - Ronak A Gor
- University of Minnesota, Minneapolis, MN; United States
| | | | | | - Patrik Luzny
- University of Utah, Salt Lake City, UT; United States
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Reuvers SH, van den Hoek J, Blok BF, de Oliveira Barbosa TC, Wolffenbuttel KP, Scheepe JR. 20 years experience with appendicovesicostomy in paediatric patients: Complications and their re-interventions. Neurourol Urodyn 2016; 36:1325-1329. [DOI: 10.1002/nau.23045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/13/2016] [Indexed: 11/09/2022]
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Eswara JR, Kielb S, Koyle MA, Wood D, Wood HM. The Recommendations of the 2015 American Urological Association Working Group on Genitourinary Congenitalism. Urology 2016; 88:1-7. [DOI: 10.1016/j.urology.2015.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 10/30/2015] [Accepted: 11/14/2015] [Indexed: 11/27/2022]
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Du K, Mulroy EE, Wallis MC, Zhang C, Presson AP, Cartwright PC. Enterocystoplasty 30-day outcomes from National Surgical Quality Improvement Program Pediatric 2012. J Pediatr Surg 2015; 50:1535-9. [PMID: 25957024 DOI: 10.1016/j.jpedsurg.2015.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/08/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Enterocystoplasty is an important procedure in the management of children with difficult neurogenic bladder. We report on short-term complications as captured by National Surgical Quality Improvement Program (NSQIP) Pediatric. METHODS We analyzed NSQIP Pediatric 30-day perioperative data on 114 patients who underwent enterocystoplasty in 2012 and compared those with and without complications. RESULTS Neurogenic bladder was the most common diagnosis. The proportion of the children who underwent two or more procedures was 71.9%, in addition to enterocystoplasty, most commonly appendicovesicostomy. Median length of hospital stay was 8 days (mean 9.7 days, range 2 to 46 days). Thirty-day complication rate was 33.3%, and the most common complications were urinary tract infections (9.6%), wound complications (8.7%), blood transfusions (6.1%), and sepsis (3.5%). Reoperation rate and readmission rate were 9.6% and 13.2%, respectively. No statistically significant differences in perioperative characteristics were found between children with and without postoperative complications. Addition of appendicovesicostomy or bladder neck continence procedures was not associated with significantly increased complications. CONCLUSION Enterocystoplasty is associated with significant perioperative morbidity, and reasonable expectations should be set during preoperative counseling.
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Affiliation(s)
- Kefu Du
- Division of Urology, University of Utah, 30 North 1900 East Room 3b110, Salt Lake City, UT 84132, USA.
| | - Elisabeth E Mulroy
- Division of Urology, University of Utah, 30 North 1900 East Room 3b110, Salt Lake City, UT 84132, USA.
| | - M Chad Wallis
- Division of Urology, University of Utah, 30 North 1900 East Room 3b110, Salt Lake City, UT 84132, USA.
| | - Chong Zhang
- Division of Epidemiology, University of Utah, Williams Building, 295 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Angela P Presson
- Division of Epidemiology, University of Utah, Williams Building, 295 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Patrick C Cartwright
- Division of Urology, University of Utah, 30 North 1900 East Room 3b110, Salt Lake City, UT 84132, USA.
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Avallone MA, Prince MK, Guralnick ML, O’Connor RC. Long-Term Enterocystoplasty Follow-Up: Metabolic and Neoplastic Concerns. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abdelhalim A, Hafez AT. Colovesical fistula: unexpected complication 7 years after augmentation ileocystoplasty. Urology 2013; 82:1153-5. [PMID: 23830082 DOI: 10.1016/j.urology.2013.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
Augmentation enterocystoplasty has been extensively used to attain high-capacity low-pressure urinary reservoirs in patients with neuropathic bladder, exstrophy-epispadias complex, valve bladder syndrome, and contracted bladder. Enterovesical fistula might occur as an early complication after enterocystoplasty. We report the case of a 16-year-old boy, who presented with chronic watery diarrhea 7 years after augmentation ileocystoplasty. A colovesical fistula was diagnosed. We discuss the clinical presentation, management plan, and operative findings.
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[Bladder and bowel function in children with congenital spinal lipomatus malformations. A retrospective study of 114 cases]. Prog Urol 2012; 22:291-300. [PMID: 22515926 DOI: 10.1016/j.purol.2011.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/04/2011] [Accepted: 12/04/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To clarify bladder and bowel function of children with lipomas of the conus, without, before and after neurosurgery. PATIENTS AND METHODS Retrospective analysis of 114 children with a lipomas of the conus, followed in our pediatric neuro-urology department from 1993 to 2010. Several data were collected: bladder and bowel symptoms, bladder and anorectal continence, neurosurgical indication and age, clinical modification after neurosurgery, investigations carried out in pre- and post-surgery treatment, associated bladder and bowel treatment. RESULTS Forty-nine of the 77 children (63.6%) operated on had never been seen before surgery in our neuro-urology department. Seventy-seven children (67.5%) underwent a neuro-surgery, 60% indicated due to a neurogenic bladder. Before neurosurgery, 66 children (85.7%) had spontaneous miction. Five children (6.5%) had bladder intermittent catheterization. Forty of these patients (56.3%) were continent. After neurosurgery and a specialized consultation in neuro-urology, 54 children (70.1%) were continent. Thirty-seven children (48%) had spontaneous miction. Thirty-seven children (48%) had bladder intermittent catheterization and drug of overactive detrusor. Fifty-two children (67.5%) were constipated after surgery. Seventy-seven percent of the treatments for bowel symptoms were effective in terms of continence. CONCLUSION The existence of a neurogenic bladder was one of the main indications for neurosurgery. These results suggest that the complexity of care requires neurosurgical, urological surgeon and neuro-urology physician to achieve the explorations and urinary and digestive treatment in order to preserve renal function and both continences.
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DeLong J, Tighiouart H, Stoffel J. Urinary Diversion/Reconstruction for Cases of Catheter Intolerant Secondary Progressive Multiple Sclerosis With Refractory Urinary Symptoms. J Urol 2011; 185:2201-6. [DOI: 10.1016/j.juro.2011.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Indexed: 12/30/2022]
Affiliation(s)
- Jessica DeLong
- Department of Urology, Lahey Clinic, Burlington, Massachusetts
| | - Hocine Tighiouart
- Biostatistics Research Center, Tufts University Medical Center, Boston, Massachusetts
| | - John Stoffel
- Department of Urology, Lahey Clinic, Burlington, Massachusetts
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Elshal AM, Abol-Enein H, Sarhan O, Hafez AT, Mosbah A, Abdel-Latif M, Ghaly AM, Ghoneim MA. Catheterizable serous lined urinary outlet in children and adolescents: a choice when other treatments fail. J Urol 2011; 185:1083-7. [PMID: 21256517 DOI: 10.1016/j.juro.2010.10.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the functional outcome of continent catheterizable outlet using the serous lined extramural tunnel technique as a continence mechanism in children and adolescents. MATERIALS AND METHODS We retrospectively studied all patients who underwent continent catheterizable stoma using the serous lined extramural technique between May 1993 and March 2008. Patient records were reviewed for age, sex, indication for surgery, surgical details and postoperative course. All patients were evaluated for continence with emphasis on frequency of clean intermittent catheterization. Urodynamic evaluation was done for patients with leaking stoma. Stoma related complications were also recorded. RESULTS A total of 37 boys and 23 girls 3 to 18 years old underwent continent catheterizable stoma using the serous lined extramural technique. Total bladder substitution was performed in 13 patients using continent ileal W-shaped reservoir, and 47 patients underwent augmentation ileocystoplasty mounted with serous lined outlet. The outlet channel was appendix in 39 patients (65%), tapered ileal segment in 13 (21.5%) and Monti ileal tube in 8 (13.5%). After a median followup of 43 months (range 10 to 180) 55 patients (91.6%) achieved continence, with catheterization frequency of 3 to 5 times during the daytime and 1 to 2 times at night. Stoma related complications were leaking stoma in 5 patients (8.4%), stomal stenosis in 6 (10%), parastomal hernia in 2 (3.3%) and reservoir stones in 8 (13.3%). Reoperation rate was 18.3% (11 patients). CONCLUSIONS The serous lined continent outlet seems to be a durable and efficient technique for treating children with incontinence, with an acceptable complication rate.
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Mourtzinos A, Stoffel JT. Management goals for the spina bifida neurogenic bladder: a review from infancy to adulthood. Urol Clin North Am 2010; 37:527-35. [PMID: 20955904 DOI: 10.1016/j.ucl.2010.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with spina bifida require longitudinal urological care as they transition from childhood to adolescence and then to adulthood. Issues important to urological health, such as protection of the upper tracts and prevention of incontinence, need vigilant follow-up throughout the patient's life. As the child ages, additional issues such as sexual functioning also become increasingly important for social integration. Despite this need for regular assessment, many adult patients with spina bifida lose coordinated urological care after leaving specialized pediatric spina bifida clinics. Consequently, urologists frequently encounter an adult patient with spina bifida in practice and they need to understand the basic urological treatment goals and potential complications for this population.
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Affiliation(s)
- Arthur Mourtzinos
- Department of Urology, Lahey Clinic, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA
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