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Moazin M, Altulayqi W, Tolah H, Alkeraithe F. A successful open neocystolithotomy in studer neobladder with Mitrofanoff for multiple large neobladder stones: A case report and review of the literature. Urol Case Rep 2023; 50:102474. [PMID: 37455777 PMCID: PMC10338960 DOI: 10.1016/j.eucr.2023.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Urolithiasis is a rare complication of orthotopic neobladder after cystectomy. We report a case of a 25-year-old female with studer neobladder and Monti valve presenting with recurrent urinary tract infections, abdominal pain, and difficult catheterization. Imaging revealed multiple large stones in the neobladder. Neocystolitholapaxy and neocystolithotripsy failed, leading to an open neocystolithotomy with retrieval of 14 large stones. Stone composition analysis showed struvite (30%), carbonate apatite (46%), and whitlockite (24%). Neobladder repair with omental interposition was performed. Follow-up confirmed an intact neobladder without leaks. Neobladder stones may be asymptomatic, and open neocystolithotomy is an effective treatment for multiple neobladder stones.
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Affiliation(s)
- Maher Moazin
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Waleed Altulayqi
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamza Tolah
- Alrayan Medical Colleges, Medina, Saudi Arabia
| | - Fawaz Alkeraithe
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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SARIKAYA K, ŞENOCAK Ç, SADİOĞLU FE, ÇİFTÇİ M, BOZKURT ÖF. Urinary tract stone surgery in patients with urinary diversion and vesicostomy: a single center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.843304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Öztürk M, McDermott JC, Laeseke PF, Nakada SY, Hedican SP, Best SL, Kleedehn MG. Management of Indiana pouch stones through a percutaneous approach: A single center experience. Turk J Urol 2019; 45:366-371. [PMID: 31509509 DOI: 10.5152/tud.2019.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We present our experience of the treatment of reservoir stones using a percutaneous approach in patients with Indiana pouch urinary diversions. MATERIAL AND METHODS Patients who were treated percutaneously for Indiana pouch reservoir stones between January 2008 and December 2018 were identified from the hospital database, and their data were retrospectively analyzed. Patient charts were reviewed for stone burden, surgery details, and postoperative complications. The Indiana pouch was punctured under a direct ultrasound guidance, and a 30F sheath was placed into the pouch. A urologist removed the stones by inserting a rigid nephroscope through the sheath. A Foley catheter was left in the pouch through the percutaneous tract and opened to drainage. RESULTS Seven patients (mean age: 47.3±14.7 years) were included. All patients were stone free after the procedure. The median stone number was 3 (range: 1-8). The mean maximum stone diameter was 24.4±4.9 mm (range: 19-33 mm). Six patients were successfully treated in one session, whereas 1 patient required two treatment sessions. The median postoperative hospital admission was 1 day (range: 1-5 days). The Foley catheters were removed after a median of 18 days (range: 10-19 days). No major complications were reported. CONCLUSION The percutaneous approach for Indiana pouch reservoir stones treatment ensures direct and safe management without major periprocedural complications.
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Affiliation(s)
- Mesut Öztürk
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - John C McDermott
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Paul F Laeseke
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sean P Hedican
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Mark G Kleedehn
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Moeen AM, Safwat AS, Elderwy AA, Behnsawy HM, Osman MM, Hameed DA. Management of neobladder complications: endoscopy comes first. Scand J Urol 2017. [PMID: 28635567 DOI: 10.1080/21681805.2017.1290677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to report the functional outcome after endoscopic management of neobladder complications. MATERIALS AND METHODS Out of 197 patients who underwent radical cystectomy and orthotopic ileal neobladder reconstruction between 2007 and 2013, 30 patients with delayed postoperative complications were enrolled in this study. Complications were in the form of: eight patients with outflow obstruction, 12 with ureteroenteric stricture, nine with neobladder calculi and one with an isolated recurrent papillary tumor inside the neobladder. Patients were followed up regularly to assess the outcomes of endoscopic treatment. RESULTS The mean maximum flow rate and postvoiding residual urine after endoscopic treatment of outflow obstruction were 18.2 ± 3.9 ml/s and 28.7 ± 11 ml, respectively. Ten patients with ureteroenteric stricture showed resolution of hydronephrosis after antegrade dilatation and JJ-stent fixation, with two patients requiring open surgery owing to impassable strictures. Complete clearance of neobladder calculi occurred after endoscopic neocystolithotripsy, with two patients requiring two sessions owing to large calculi. Transurethral resection of the neobladder for isolated tumor recurrence was performed in one patient over two sessions, followed by adjuvant chemoirradiation. CONCLUSIONS Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.
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Affiliation(s)
- Ahmed M Moeen
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmed S Safwat
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Ahmad A Elderwy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Hosny M Behnsawy
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Mahmoud M Osman
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
| | - Diaa A Hameed
- a Department of Urology , Assiut Urology and Nephrology Hospital, Assiut University , Assiut , Egypt
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Endoscopic Treatment of Studer's Orthotopic Neobladder Lithiasis. Urol Case Rep 2016; 3:74-6. [PMID: 26793507 PMCID: PMC4714279 DOI: 10.1016/j.eucr.2015.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 12/01/2022] Open
Abstract
Studer's neobladder lithiasis is a rare but important long term complication of this orthotopic bladder substitute technique. We report a case of a 45 year-old male patient, submitted to a radical cystoprostatectomy with a Studer's orthotopic neobladder 4 years before, presenting bad compliance to recommended urinary habits, increased production of mucus and high post voiding residue. CT scan and urethrocystography showed a distended pouch with 2 major sacculations with narrow communication and a stone in each sacculation. A minimally invasive endoscopic technique was successfully used in the treatment of the 2 small calculus.
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Zhong W, Yang B, He F, Wang L, Swami S, Zeng G. Surgical management of urolithiasis in patients after urinary diversion. PLoS One 2014; 9:e111371. [PMID: 25360621 PMCID: PMC4216071 DOI: 10.1371/journal.pone.0111371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To present our experience in surgical management of urolithiasis in patients after urinary diversion. PATIENTS AND METHODS Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed. RESULTS The mean stone size was 4.5 ± 3.1 (range 1.5-11.2) cm. The mean operation time was 82.0 ± 11.5 (range 55-120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5 °C, and one patient (5%) suffered urine extravasations from percutaneous tract. CONCLUSIONS The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience.
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Affiliation(s)
- Wen Zhong
- Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Bicheng Yang
- Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Fang He
- Department of Gynecology and Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson, Tennessee, United States of America
| | - Sunil Swami
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Guohua Zeng
- Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
- * E-mail:
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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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[Multiple stones in atypical heterotopic reservoir in a patient with renal transplant: endourologic resolution]. Urologia 2011; 78 Suppl 18:49-53. [PMID: 22081421 DOI: 10.5301/ru.2011.8775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Urolithiasis is a frequent complication in a heterotopic reservoir and the surgical management could be a difficult problem. Open surgery is not recommended in patients with multiple previous surgeries. A less invasive technique, such as the endourologic procedures, would allow high stone-free rate and low surgical morbidity. INTRODUCTION Stone formation in the reservoir is a well-known complication of urinary diversion. The incidence of lithiasis in patients with continent urinary diversion is reported as 12-52.5%. Most patients will have multiple physical factors, such as immobility, need for self-catheterization and poor urine drainage, so that it is not certain that an intestinal reservoir is the cause of stones on its own. The management of urolithiasis in continent urinary diversion can be challenging and could be a difficult problem to solve. A less invasive technique, such as the endourologic procedures, is desiderable, especially in patients with kidney transplant and low immune defence. MATERIALS AND METHODS We present the case of a 59-year-old woman with previous history of spina bifida and with neurogenic bladder. At a pediatric age, she underwent incontinent urinary diversion using a sigmo-colic conduit. For several years she had been suffering from kidney stones and recurrent urinary infections, which led to a left nephrectomy for pyonephrosis, subsequent deterioration of renal function and dialysis. In 2004, we performed an atypical continent and self-catheterizable reservoir using the previous colic conduit detubularized and ileum-cecal tract with Mitrofanoff system conduit of 14 Fr size. Finally, kidney transplant was carried out as last surgical procedure. Recently she has come to our attention for multiple and large reservoir stones. SURGICAL TECHNIQUE preliminary exploration of the continent pouch with flexible cystoscope. Percutaneous access with Endovision° direct control through the afferent conduit with 8 Fr flexible ureteroscope. Dilation of percutaneous tract with pneumatic balloon and positioning 30 Fr Amplats sheet. Lithotripsy, with ultrasound and ballistic sources, was performed and the residual fragments were removed with grasping. At the end of the procedure, after controlling the complete clearance with flexible nephroscope and X-ray, a percutanous 12 Fr catheter and a 12 Fr Foley in the Mitrofanoff conduit were inserted. RESULTS No fever or increase serum creatinine were observed in the post-operative time. On day 3, we removed the percutaneous foley and after 7 days we performed a cystography with a normal pouch configuration; no leakage or residual fragments were observed. The woman was discarge and returned to usual self-catheterization. The first 3-month post-operative control was regular; no infections or pain were reported. CONCLUSIONS In special cases, like this one, the percutaneous procedure is preferred to open surgery for a best control of the pouch and a simple complete clearence of the fragments.
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