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Thakker PU, Refugia JM, Wolff D, Casals R, Able C, Temple D, Rodríguez AR, Tsivian M. Ileal Conduit versus Cutaneous Ureterostomy after Open Radical Cystectomy: Comparison of 90-Day Morbidity and Tube Dependence at Intermediate Term Follow-Up. J Clin Med 2024; 13:911. [PMID: 38337606 PMCID: PMC10856161 DOI: 10.3390/jcm13030911] [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: 12/31/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien-Dindo (C.D.) complication rates (Minor C.D. I-II, Major C.D. III-V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any-69% vs. 77%; minor-61% vs. 73%; major-46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.
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Affiliation(s)
- Parth U. Thakker
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Justin Manuel Refugia
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Dylan Wolff
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Randy Casals
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Corey Able
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Davis Temple
- Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Alejandro R. Rodríguez
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
| | - Matvey Tsivian
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA; (P.U.T.)
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Francolini G, Ghoshal A, Caini S, Piazzini T, Becherini C, Detti B, Di Cataldo V, Valzano M, Visani L, Salvestrini V, Olmetto E, Desideri I, Meattini I, Livi L. Quality of life after definitive treatment for bladder cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 190:110038. [PMID: 38042498 DOI: 10.1016/j.radonc.2023.110038] [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: 09/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Radical cystectomy (RC) is considered the standard treatment for muscle invasive bladder cancer (MIBC). However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g., continent cutaneous urinary diversion and orthotopic neobladder-ONB), have been proposed as alternatives to improve postoperative QoL. Trimodal therapy (TMT) emerged as alternative to surgery. To assess the impact of these treatments from the patients' perspective, we undertook a systematic review and meta-analysis of literature, focusing on studies reporting QoL data about each of the abovementioned approaches. A systematic review was carried out including all prospective and retrospective studies enrolling patientstreated with radical intent for non-metastatic MIBC from 1999 to 2021 (either RC or TMT). All studies included specifically reported QoL for one of the main treatment approaches explored (RC followed by ileal conduit urinary diversion-ICUD, ONB or TMT). Pooled analysis for EORTC QLQ-C30 and BLM-30 questionnaires showed that ONB yielded a significant advantage only for Physical Functioning (pooled mean standardized difference -0.73 SD, p-value 0.019, I 2 = 93 %) and for Emotional Functioning (pooled mean standardized difference -0.16 SD, p-value 0.029, I 2 = 0 %). A trend in favour of higher mean reported values after TMT for Global Health Score, Physical Functioning and Role Functioning was found, if compared to both RC approaches. Significant benefit for ONB if compared to ICUD was detected only for specific subdomains of QoL questionnaires. No direct comparison with TMT is available, but data suggest advantage of this approach when compared to both reconstructive scenarios.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
| | | | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Tessa Piazzini
- Biblioteca Biomedica, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Viola Salvestrini
- CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Ariafar A, Salehipour M, Zeyghami S, Rezaei M. The effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of radical cystectomy with ileal conduit urinary diversion. Arch Ital Urol Androl 2022; 94:150-154. [PMID: 35775337 DOI: 10.4081/aiua.2022.2.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Radical cystectomy (RC) has been considered the standard management of muscle-invasive bladder cancer. Despite the improvements in surgical techniques and perioperative care, RC is still associated with high perioperative morbidity and mortality. OBJECTIVE This study aims to evaluate the effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of RC with ileal conduit urinary diversion. PATIENTS AND METHODS This is a retrospective cohort study. We reviewed medical charts of 876 patients who underwent RC between 2016 and 2021. Based on the inclusion and exclusion criteria, 748 patients entered the study. According to retroperitonealization of the ureteroileal anastomosis, patients were categorized into two groups (group I without retroperitonealization of the ureteroileal anastomosis and group II with retroperitonealization of the ureteroileal anastomosis). Patients' characteristics and occurrences of any complications and high-grade complications were compared between these groups. RESULTS In comparing the complication categories between the two groups, fewer patients in group II suffered from gastrointestinal, urinary, and cardiac events (p values were 0.018, 0.021, and 0.013, respectively). Moreover, fewer patients in group II experienced any complications and high-grade complications (p values were < 0.001 and < 0.001, respectively). The length of hospital stay was also significantly shorter in group II (p < 0.001). CONCLUSIONS RC is associated with comparatively high perioperative morbidity and mortality. In the present study, 61% of the patients experienced at least one complication postoperatively. Retroperitonealization of the ureterointestinal anastomosis may decrease perioperative adverse events of RC with ileal conduit urinary diversion.
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Affiliation(s)
- Ali Ariafar
- Department of Urology, Shiraz University of Medical Sciences, Shiraz.
| | - Mehdi Salehipour
- Department of Urology, Shiraz University of Medical Sciences, Shiraz.
| | - Shahriar Zeyghami
- Department of Urology, Shiraz University of Medical Sciences, Shiraz.
| | - Mehran Rezaei
- Department of Urology, Shiraz University of Medical Sciences, Shiraz.
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Djordjevic D, Dragicevic S, Vukovic M. Mini-laparotomy radical cystectomy with limited bowel externalization during ileal conduit urinary diversion reduces the rate of postoperative complications: a match-paired, single centered analysis. Acta Chir Belg 2022:1-7. [PMID: 35019802 DOI: 10.1080/00015458.2022.2025724] [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: 11/01/2022]
Abstract
OBJECTIVE To assess the feasibility and functional outcomes of mini-laparotomy radical cystectomy (RC) in association with limited bowel externalization during ileal conduit urinary diversion. METHODS Between January 2018 and March 2020, 53 patients underwent RC plus pelvic lymph node dissection (PLND) for invasive carcinoma of the urinary bladder. This group of patients was intentionally treated utilizing the mini-laparotomy approach, with the addition of limited bowel externalization during conduit preparation and match-paired with 46 examinees from a historical series of patients who underwent conventional open RC plus PLND and ileal conduit diversion. Clinicopathological features and perioperative outcomes were examined from medical records, while postoperative pain was evaluated through the Visual Analog Scale for Pain (VAS). Mean pain scores were evaluated on postoperative days (POD) 1-3. RESULTS There was no difference in specific intraoperative complications between groups, with a median (range) incision length of 8 (5-10) cm within the first group and 16.3 (12-22.6) cm within the second group. The first group had less postoperative pain compared with patients in the second group, with mean pain scores significantly lower across POD 1-3, 3.8 (IQR: 0-6) versus 6.7 (IQR: 3.8-8.1) and 2.5 (IQR: 1-3.7) versus 4.6 (IQR: 3-6), respectively (p = .012 and .002). CONCLUSIONS By using this technique, we were able to significantly reduce patients' postoperative pain, time to bowel restitution, and hospital stay, which are major issues in minimizing short-term postoperative complications of conventional open surgery.
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Affiliation(s)
| | | | - Marko Vukovic
- Urology Clinic, Euromedic General Hospital, Belgrade, Serbia
- Urology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
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Korkes F, Fernandes E, Gushiken FA, Glina FPA, Baccaglini W, Timóteo F, Glina S. Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review. Int Braz J Urol 2022; 48:18-30. [PMID: 33861058 PMCID: PMC8691241 DOI: 10.1590/s1677-5538.ibju.2020.0892] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. MATERIALS AND METHODS A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. RESULTS The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. CONCLUSIONS CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Eduardo Fernandes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Arakaki Gushiken
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Placco Araujo Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Willy Baccaglini
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Frederico Timóteo
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Sidney Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience. Curr Oncol 2021; 28:4109-4117. [PMID: 34677266 PMCID: PMC8534632 DOI: 10.3390/curroncol28050348] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.
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Peng YL, Ning K, Wu ZS, Li ZY, Deng MH, Xiong LB, Yu CP, Zhang ZL, Liu ZW, Lu HM, Zhou FJ. Ureteral stents cannot decrease the incidence of ureteroileal anastomotic stricture and leakage: A systematic review and meta-analysis. Int J Surg 2021; 93:106058. [PMID: 34416355 DOI: 10.1016/j.ijsu.2021.106058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ileal conduit and ileal orthotopic neobladder were the most popular methods for urinary diversion following radical cystectomy. Stenting the anastomosis of ileo-ureter or ureter-neobladder was a common practice. However, it is still controversial if ureteral stents could prevent complications such as ureteroileal anastomosis stricture (UIAS) and ureteroileal anastomosis leakage (UIAL) after ureteral anastomosis. OBJECTIVES This study aims to investigate the role of the ureteral stent in preventing UIAS and UIAL. DATA SOURCES We systematically searched the related studies in PubMed, Embase, and Cochrane Library up to June 2020. STUDY ELIGIBILITY CRITERIA Cohort studies that identified the use of stent and the incidence of UIAS or UIAL were recorded. DATA SYNTHESIS Comparative meta-analysis was conducted on four cohort studies for comparison of UIAS and UIAL between the stented and nonstented groups. Besides, eleven studies which reported the events of UIAS and UIAL were used for meta-analysis of single proportion. RESULTS A total of 11 studies were qualified for analysis. Comparative meta-analysis identified that the incidence of UIAS was higher in the stented group than that in the nonstented group, but this did not reach a significant difference (odds ratio [OR]: 1.64; 95% confidence interval [CI]: 0.88-3.05; P = 0.12). Besides, there was no difference in the incidences of UIAL between the stented and the nonstented groups. On meta-analysis of single proportion, the incidence of UIAS was 7% (95% CI: 3%-10%) in the stented group and 3% (95% CI: 1%-6%) in the nonstented group. The UIAL rate was 1% (95% CI, 0%-4%) in stented patients and 2% (95% CI, 1%-4%) in nonstented patients. CONCLUSION Stenting the ureteroileal anastomosis resulted in a higher incidence of UIAS. There is no evidence to support ureteral stents could prevent the occurrence of UIAL after urinary diversion.
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Affiliation(s)
- Yu-Lu Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Kang Ning
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ze-Shen Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Yong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Min-Hua Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Long-Bin Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Chun-Ping Yu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhi-Ling Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Hui-Ming Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Fang-Jian Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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Petar K, Marko A, Almir R, Marko V. Surgical technique of uretero-ileal anastomosis in patients with bilateral duplex ureters undergoing radical cystectomy and ileal conduit urinary diversion: initial experience. Acta Chir Belg 2021; 121:295-300. [PMID: 33910483 DOI: 10.1080/00015458.2021.1920681] [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: 10/21/2022]
Abstract
BACKGROUND We present a simple technique for construction of wide ureteral plate, consisting of four ureters, incorporated in ureteroileal anastomosis of ileal conduit urinary diversion. METHODS We retrospectively reviewed the charts of six cases of ureteral duplication (five bilateral and one unilateral) and muscle-invasive bladder cancer, treated with radical cystectomy and ileal conduit diversion, at our institution from 2015 to 2020. Briefly, our technique includes construction of wide ureteral plate, consisting of four ureters from two separate ureteral units, after previous construction of right and left ureteral plates for each unit, according to the standard Wallace technique. Additionally, during construction of definite ureteral anastomotic plate, we used a modified Wallace I technique consisted of eversion of posteromedial ureteral walls of both ureteral units, with muco-mucosal running suture. RESULTS Four males and two females underwent radical cystectomy with ileal conduit for muscle invasive bladder cancer. A total of 12 complications (CDC I-III) were registered in 4/6 (66.6%) patients, whereby ten of them (83.3%) occurred within 90 days post-surgery. High-grade (CDC III) complications were registered in 33.3% of patients. Within the first three months post-surgery, hydronephrosis and high-grade vesicoureteral reflux were associated with pyelonephritis and observed in two patients (33.3%), while uretero-intestinal anastomotic stricture or leakage were not detected during follow-up in any patients. CONCLUSION Modified Wallace uretero-ileal anastomosis after radical cystectomy and ileal conduit urinary diversion is functionally and cosmetically effective way to treat patients with bilateral duplex ureters harbouring muscle invasive bladder cancer.
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Affiliation(s)
- Kavaric Petar
- Department of Urology, Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro
| | - Albijanic Marko
- Department of Urology, Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro
| | - Rebronja Almir
- Department of Urology, Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro
| | - Vukovic Marko
- Department of Urology, Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro
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9
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Djordjevic D, Vukovic M. Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients. Int Braz J Urol 2021; 47:426-435. [PMID: 33146976 PMCID: PMC7857759 DOI: 10.1590/s1677-5538.ibju.2020.0415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. MATERIALS AND METHODS Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. RESULTS Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. CONCLUSIONS The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.
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Affiliation(s)
- Dejan Djordjevic
- Department of Urology, Clinic Urology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Marko Vukovic
- Department of Urology, Clinic Urology, Clinical Centre of Serbia, Belgrade, Serbia.,Department of Urology, Clinic Urology, Clinical Centre of Montenegro, Podgorica, Montenegro
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10
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Wang Q, Tang L, Bi L, Min J, Fang L, Sun W, Yu D. Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion. BMC Urol 2021; 21:65. [PMID: 33874924 PMCID: PMC8054415 DOI: 10.1186/s12894-021-00835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to introduce a novel method for ureteroileal anastomosis, explore its clinical effectiveness, observe the incidence of postoperative anastomotic stricture, and compare the postoperative complications with those of other types of ureteroileal anastomosis reported in the literature. Methods Both ureters were first anastomosed at their distal ends and then inserted into the proximal end of the ileal loop. A postoperative follow-up analysis was performed to evaluate major complication indicators, including anastomotic stricture, anastomotic leak, and hydroureteronephrosis. Results We successfully performed ureteral distal ends anastomosis combined with end-to-end insertion into the ileum for 143 patients. The mean postoperative follow-up lasted 37 months (range: 10–68 months). There was no occurrence of an anastomotic leak. The incidence of anastomotic stricture combined with hydronephrosis, ileal conduit stones, urinary tract infection, and renal dysfunction were 2.1%, 0.7%, 2.1%, and 4.2%, respectively. Conclusion Ureteral distal ends combined and inserted into the ileum were simple to perform and helped achieve precise anastomosis with fewer postoperative complications.
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Affiliation(s)
- Qi Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Tang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jie Min
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lu Fang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Sun
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
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Favorito LA. Pediatric Urology highlighted. Int Braz J Urol 2020; 46:311-313. [PMID: 32167693 PMCID: PMC7088503 DOI: 10.1590/s1677-5538.ibju.2020.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A. Favorito
- Universidade do Estado de Rio de Janeiro, Brasil; Hospital Federal da Lagoa, Brasil
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