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Polm PD, Wyndaele MIA, Dik P, de Kort LMO. Tubularized Bladder Flap as a Continent Catheterizable Channel in Adults. Urology 2024:S0090-4295(24)00160-2. [PMID: 38471636 DOI: 10.1016/j.urology.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To describe a modified, less invasive, surgical technique to create a continent catheterizable channel (CCC) in adults: the tubularized bladder flap (TBF). MATERIALS AND METHODS We retrospectively reviewed records of patients in whom a TBF CCC was constructed at adult age between 2019 and 2023. We reported on demographics, operative outcomes, and 30-day and post-30-day complications. RESULTS A total of 11 patients (10 female) were described. The median operative time was 96 (range 90-115) minutes in patients with only TBF creation. Estimated blood loss was <100 cc in all patients. Within 30 days postoperatively, 6/11 (55%) patients developed a complication, all grade 1 Clavien Dindo. No bowel complications occurred (paralytic ileus, mechanical obstruction, or leakage/perforation). Median follow-up was 25 (range 6-56) months. In 2/11 (18%) patients surgical revision for stenosis was done; 3/11 (27%) patients underwent surgical revision for stomal leakage. CONCLUSION TBF as a means to create a CCC avoids intraperitoneal surgery, and bowel closure (appendicovesicostomy) or anastomosis (retubularized ileum). Postoperative bowel complications were not seen in any of our patients. Surgical revision rates for a TBF CCC appear to be comparable to other CCCs. Therefore, TBF could be considered in patients with sufficient bladder capacity as TBF is less invasive than other CCC techniques and avoids potential bowel complications.
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Affiliation(s)
- Pepijn D Polm
- UMC Utrecht, Department of Urology, Utrecht, The Netherlands.
| | | | - Pieter Dik
- UMC Utrecht, Department of Urology, Utrecht, The Netherlands.
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Lammers RJM, Tsachouridis G, Andersson MK, Dormeus S, Ekerhult TO, Frankiewicz M, Gunn CJ, Matuszewski M, de Mooij KL, Schroeder RPJ, Wyndaele MIA, Xing Z, De Kort LMO, de Graaf P. "What should be next in lifelong posterior hypospadias: Conclusions from the 2023 ERN eUROGEN and EJP-RD networking meeting". Neurourol Urodyn 2024. [PMID: 38289328 DOI: 10.1002/nau.25305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND A congenital disease is for life. Posterior hypospadias, the severe form of hypospadias with a penoscrotal, scrotal, or perineal meatus, is a challenging condition with a major impact on lifelong quality of life. AIM Our network meeting is aimed to identify what is currently missing in the lifelong treatment of posterior hypospadias, to improve care, quality of life, and awareness for these patients. METHODS The network meeting "Lifelong Posterior Hypospadias" in Utrecht, The Netherlands was granted by the European Joint Programme on Rare Diseases-Networking Support Scheme. There was a combination of interactive sessions (hackathons) and lectures. This paper can be regarded as the last phase of the hackathon. RESULTS Surgery for hypospadias remains challenging and complications may occur until adulthood. Posterior hypospadias affects sexual function, fertility, and hormonal status. Transitional care from childhood into adulthood is currently insufficiently established. Patients should be more involved in defining desired treatment approach and outcome measures. For optimal outcome evaluation standardization of data collection and registration at European level is necessary. Tissue engineering may provide a solution to the shortage of healthy tissue in posterior hypospadias. For optimal results, cooperation between basic researchers from different centers, as well as involving clinicians and patients is necessary. CONCLUSIONS To improve outcomes for patients with posterior hypospadias, patient voices should be included and lifelong care by dedicated healthcare professionals guaranteed. Other requirements are joining forces at European level in uniform registration of outcome data and cooperation in basic research.
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Affiliation(s)
- Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - George Tsachouridis
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Marie K Andersson
- Department of Pediatric Surgery, Sahlgrenska Academy, Women's and Children's Health, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Sarah Dormeus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teresa O Ekerhult
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Callum J Gunn
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Keetje L de Mooij
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Rogier P J Schroeder
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zhentao Xing
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O De Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Petra de Graaf
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
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Polm PD, Wyndaele MIA, de Kort LMO. Very long-term follow-up of Indiana Pouches proves durability. Neurourol Urodyn 2023. [PMID: 38032151 DOI: 10.1002/nau.25344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION An Indiana Pouch (IP) is a heterotopic, continent, urinary diversion from an ileocolonic segment. Numerous studies have investigated its long-term outcomes, albeit none extending beyond a 5-year follow-up period. IPs can be used as urinary diversion for benign indications and as such are constructed in typically young patients. As a consequence of their extended lifespan, there is a need for very long-term (>5 years) IP outcome data and comprehensive complication analysis. MATERIALS AND METHODS In this retrospective cohort study, the data of all patients attending our academic functional urology tertiary referral center for surveillance between 2015 and 2022 after an earlier IP procedure without uro-oncological indication were analyzed. The primary objective was to identify the prevalence of complications associated with IP, including stomal stenosis, ureter-pouch stenosis, pouch calculi, stomal leakage, pouch perforation, and parastomal herniation, and to determine the time span between creation of the IP and occurrence of complications. RESULTS A cohort of 33 patients (23 female) was analyzed. Median age at IP creation was 38 (range 5-62) years. Median follow-up was 258 (range 24-452) months. During follow-up, 22 (67%) patients underwent at least one surgical revision. In total, 45 revision procedures were performed. The estimated mean revision-free survival was 198 (95%-CI 144-242) months. CONCLUSION Two-thirds of our IP patients required surgical revision during very long-term follow-up. However, the mean revision-free survival was 198 months. This establishes the IP as a durable and resilient option for urinary diversion, yet underlines the need for lifelong follow-up as some of these complications and indication were subclinical. These results contribute significantly to patient counseling when discussing different options for urinary diversion, especially at a younger age.
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Affiliation(s)
- Pepijn D Polm
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands
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Poublon CG, Scholten EWM, Wyndaele MIA, Post MWM, Stolwijk-Swüste JM. Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database. Spinal Cord 2023; 61:624-631. [PMID: 37608226 DOI: 10.1038/s41393-023-00925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
STUDY DESIGN Secondary analysis of multicentre prospective observational data. OBJECTIVES To describe methods of bladder emptying at admission and discharge in patients with recently acquired spinal cord injury (SCI) and to describe predictors of bladder emptying methods at discharge. SETTING First inpatient rehabilitation in specialised rehabilitation centres in the Netherlands. METHODS Data from the Dutch Spinal Cord Injury Database collected between 2015 and 2019 were used. McNemar-Bowker test was used to evaluate if bladder emptying methods differed over time; One-Way ANOVA and Chi-Square tests to see if bladder emptying methods differed by demographic and injury-related characteristics. Binary logistic regression was used to predict the type of bladder emptying at discharge with demographic and injury-related characteristics measured at admission. RESULTS Of 1403 patients, 44.1% had cervical, 38.4% thoracic and 17.5% lumbosacral lesions at admission. AIS classification was mostly D (63.8%). The method of bladder emptying changed significantly (p < 0.001) from admission to discharge: decrease of clean intermittent assisted catheterisation (17.1% to 4.1%) and indwelling catheter (33.4% to 16.3%) and increase in clean intermittent self-catheterisation (CISC, 7.8% to 22.2%) and normal voiding (40.2% to 56.1%). Age, sex, SCI level, AIS classification and level of independence predicted the method of bladder emptying at discharge (all p < 0.001). CONCLUSIONS During first inpatient rehabilitation, the method of bladder emptying changed resulting in more patients discharged with normal voiding and CISC. Age, sex, SCI level, AIS classification and level of independence in self-care were all confirmed as factors playing a role in this change.
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Affiliation(s)
- Claire G Poublon
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Eline W M Scholten
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Yildirim H, Hennus PML, Wyndaele MIA, de Kort LMO. Do previous urethral endoscopic procedures and preoperative self-dilatation increase the risk of stricture recurrence after urethroplasty? Low Urin Tract Symptoms 2021; 14:163-169. [PMID: 34794210 PMCID: PMC9299484 DOI: 10.1111/luts.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self‐dilatation (ISD). Methods Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow‐up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed. Results Overall, 106 patients were included with a median follow‐up of 12 months (interquartile range 8‐13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis. Conclusions This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.
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Affiliation(s)
- Hilin Yildirim
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pauline M L Hennus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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