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Objective:To compare the perioperative complications and prognosis of intracorporeal and extracorporea lileal conduit urinary diversion(ICUD or ECUD)following robot-assisted radical cystectomy(RARC).Methods:The data of 95 patients who underwent RARC treatment in Nanjing Drum Tower Hospital from March 2016 to June 2019 were retrospectively analyzed. Among them, 37 underwent ICUD and 58 underwent ECUD. In the ICUD group, there were 32 males and 5 females, aged(68.0±7.8) years, body mass index (BMI) of (24.1±3.4) kg/m 2, American Society of Anesthesiologists(ASA)score of 1-2 in 4 cases(10.8%), ASA score of 3-5 in 33 cases(89.2%), preoperative hemoglobin of(126.5±14.2)g/L, albumin of(39.0±2.2)g/L, and C-reactive protein of 4.0(2.0-8.5) mg/L. In the ECUD group, there were 53 males and 5 females, aged(67.5±9.0)years, BMI of(24.2±3.6)kg/m 2, ASA score of 1-2 in 16 cases(27.6%), ASA score of 3-5 in 42 cases (72.4%) , preoperative hemoglobin of(129.0±12.4)g/L, albumin (38.2±3.1) g/L, and C-reactive protein of 4.9 (3.1-14.4) mg/L. There was no significant difference in preoperative data between the two groups ( P>0.05). The two groups underwent RARC and pelvic lymph node dissection similarly. The ICUD group underwent a total intracorporeal ileal conduit and the ECUD group underwent extracorporeal ileal conduit with direct vision through a median incision in the lower abdomen.There were 32 cases (86.5%) and 46 cases (79.3%) undergoing expanded pelvic lymph node dissection in the ICUD group and the ECUD group respectively, and the difference was not statistically significant ( P=0.374). The complications were graded according to the Clavien-Dindo grading system. The perioperative complications and prognosis of the two groups were compared. Results:The operation time of the ICUD group and the ECUD group were (430±63) min vs. (410±69) min, respectively ( P=0.163). The estimated blood loss were (435±233) ml vs. (388±277) ml, respectively ( P=0.182). Intraoperative blood transfusion were 10 cases (27.0%) and 12 cases (20.7%)( P=0.475). None of the above differences were statistically significant. Postoperative albumin of the ICUD group and the ECUD group were (31.5±2.4) g/L vs. (31.0±2.8) g/L ( P=0.387), postoperative C-reactive protein were 30.9 (10.4-52.1) mg/L vs.29.5 (14.4-58.5) mg/L ( P=0.655) and postoperative hemoglobin were (110.0±13.8) g/L vs. (113.7±13.4) g/L ( P=0.187). The postoperative feeding recovery were 4(3-5) d vs. 4(3-5) d ( P=0.752) and the postoperative hospital stay were 13(10-19) d vs. 13(11-18) d ( P=1.000). There was no statistically significant difference in perioperative data. The postoperative pathological examination results of ICUD group and ECUD group showed that there were 17 cases (45.9%) vs.19 cases (32.8%) in T a/T 1/Tis stage, 12 cases (32.4%) vs. 18 cases (31.0%) in T 2 stage, 5 cases (13.5%) vs. 19 cases (32.8%) in T 3 stage, 3 cases (8.1%) vs. 2 cases (3.4%) in T 4 stage, respectively and the difference was not statistically significant( P=0.166). The number of lymph nodes removed were (18.2±6.7) vs.(16.5±7.9)( P=0.178) and the number of patients with positive lymph nodes were 6(16.2%) vs.11(19.0%), respectively( P=0.733). None of the patients had positive margins. There was no statistically significant difference in pathological examination overall. There were 14 cases (37.8%) in the ICUD group and 21 cases (36.2%) in the ECUD group experiencing complications within 30 days after operation and the difference was not statistically significant( P=0.872). The complications within 90 days after operation were 14 cases (37.8%) vs. 24 cases (41.4%) respectively and the difference was not statistically significant( P=0.731). Clavien-Dindo grade Ⅲ-Ⅴ complications in the two groups were 1 case (2.7%) vs.1 case (1.7%) respectively, with no significant difference ( P=0.849). One patient in the ICUD group developed an intestinal anastomotic leakage and underwent reoperation for repairing and 1 patient in the ECUD group developed mechanical intestinal obstruction and underwent reoperation. The rate of readmission within 90 days after operation of the ICUD group was lower than that of the ECUD group, but the difference was not statistically significant [3 cases (8.1%) vs. 11 cases (19.0%), P=0.090]. Postoperative follow-up was 13-53 months and the median follow-up of ICUD group and ECUD group were 19 months and 31 months respectively. There was no significant difference in the survival curve between the two groups( P=0.746). The 1-year survival rate was 91.9% in the ICUD group and 91.4% in the ECUD group. Routine re-examination of urinary system CT or B-ultrasound was performed 3 months, 6 months and 1 year after surgery. The incidence of ureteral dilatation/hydronephrosis in the ICUD group was lower than that of the ECUD group, with 4.1%(3 sides) vs. 14.7%(17 sides)( P=0.020). Conclusion:Compared with RARC+ ECUD, RARC+ ICUD does not increase the incidence of complications within 90 days after surgery and may reduce the risk of upper urinary tract dilatation.
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Introduction and Objectives: An ileal conduit (IC) is an established option for urinary diversion, despite the fact that early renal impairment (RI) sometimes occurs after surgery. The aim of this study was to investigate the incidence and risk factors of early RI.Materials and Methods: Thirty-one patients diagnosed with muscle-invasive bladder cancer who underwent RC with IC were analyzed in this study. Early RI was defined as a greater than 25% decrease in estimated glomerular filtration rate (eGFR) over the course of one year after surgery. The incidence and risk factors of early RI were evaluated.Results: The mean preoperative eGFR of the patients was 69.6 mL/min/1.73 m2. Early RI was observed in 7 (22.5%) patients. Multivariate analyses demonstrated that postoperative hydronephrosis was an independent risk factor for early RI (P=0.018). The mean intermediate-term eGFR change was −5.1 mL/min/1.73 m2 in patients with early RI and was greater than that (−2.9) in patients without early RI, although neither were statistically significantly different.Conclusion: Renal function after RC with IC decreased immediately over the course of one year, and postoperative hydronephrosis was an independent risk factor for early RI. Renal function had decreased slightly at intermediate-term follow-up with or without early RI.
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Objective@#To explore the effects of continuous care based on WeChat platform on self-care ability of patients with ileal bladder stoma.@*Methods@#A total of 80 patients with ileal conduit were recruited from a urological department of The First Affiliated Hospital of Zhengzhou university from September 2016 to October 2017. The patients were randomly divided into intervention group (n=40) and control group (n=40). Both groups received routine care, and the experimental group also used the continuation care based on WeChat platform. The outcomes of complication incidence, self-care level with stoma were evaluated at the times of 1 day before discharge, 4 weeks after discharge and 12 weeks after discharge.@*Results@#The self-care scores of the intervention group at 3 time points were 5.13 ± 2.79, 9.98 ± 2.68, and 15.65 ± 2.37, The control group were 5.35 ± 3.20, 8.13 ± 3.45, and 12.30 ± 5.93. The interaction of self-care level scores of the two groups were statistically significant (F(1.735, 67.680)=23.301, P<0.05). The incidence of complications of the intervention group at the 3 time points was 5.00%(2/40), 42.50%(17/40), and 22.50% (9/40). The control group were 0(0/40), 51.22% (21/40), and 63.41% (26/40). The incidence of complications in the two groups was statistically significant at the 12th week after discharge (χ2=14.679, P<0.05).@*Conclusions@#With continuous care based on WeChat platform, the self-care level of patients with ileal bladder stoma can be effectively improved, and reduce the incidence of complications.
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Objective To explore the effects of continuous care based on WeChat platform on self-care ability of patients with ileal bladder stoma. Methods A total of 80 patients with ileal conduit were recruited from a urological department of The First Affiliated Hospital of Zhengzhou university from September 2016 to October 2017. The patients were randomly divided into intervention group (n=40) and control group (n=40). Both groups received routine care,and the experimental group also used the continuation care based on WeChat platform. The outcomes of complication incidence,self-care level with stoma were evaluated at the times of 1 day before discharge,4 weeks after discharge and 12 weeks after discharge. Results The self-care scores of the intervention group at 3 time points were 5.13 ± 2.79, 9.98 ± 2.68, and 15.65 ± 2.37, The control group were 5.35 ± 3.20 , 8.13 ± 3.45 , and 12.30 ± 5.93. The interaction of self-care level scores of the two groups were statistically significant (F(1.735,67.680)=23.301,P＜0.05). The incidence of complications of the intervention group at the 3 time points was 5.00%(2/40), 42.50%(17/40), and 22.50% (9/40). The control group were 0(0/40), 51.22% (21/40), and 63.41% (26/40). The incidence of complications in the two groups was statistically significant at the 12th week after discharge (χ2=14.679, P＜0.05). Conclusions With continuous care based on WeChat platform, the self-care level of patients with ileal bladder stoma can be effectively improved, and reduce the incidence of complications.
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Background: Tuberculosis can affect any organ system of the body, including the genitourinary tract. Genitourinary TB is the most common form of extra pulmonary TB accounting for 27% (14- 41%) worldwide. Aim and objectives: To study distribution of GU TB in relation to age, sex, anatomical site, signs and symptoms and to study various diagnostic modalities, treatment and role of surgery in GU TB. Materials and methods: This study was a cross sectional study done at department of Urology, King George hospital, Visakhapatnam. The study was done over a period of 30 months, which was from September 2014 to February 2017. All the patients reporting to the hospital with proven genitourinary tuberculosis or diagnosed after coming to the hospital were included in the study. Total number of cases was 35. 10 were males and 25 were females. History, physical examination, laboratory and radiological investigations were done on the patients and the primary focus of the disease and organs involved are determined. All the patients received treatment as indicated. Results: Most of the patients (33 out of 35) belonged to low socio-economic status and came from rural settings. Of them 10(28.57%) were males and 25(71.43%) were females. The mean age of patients was 36 years (range 16-60years). 2 patients were <20 years, 11 patients were between 21-30 years, 11 patients were between 31-40 years, 8 patients were between 41-50 years and 3 were above 50 years. In this study, kidney was involved in 19 cases and was the most common organ involved, followed by bladder (14 cases) and ureter(10 cases). Irritative voiding symptoms were the most common symptom seen in 23 cases. Flank pain was noted in 20 cases, sterile pyuria in 22 cases and hematuria in 7 cases. Six(17.14%) out of thirty five patients had renal failure at the time of presentation and diagnosis. Nephrectomy was done in 12 cases. Nephrectomy with augmentation Immadi Chandrasekhar, Pasalapudi Anurag Jose. Clinical study and management of genitourinary tuberculosis. IAIM, 2019; 6(1): 48-57. Page 49 cystoplasty and ureteric reimplantation was done in another 6 cases. Ileal conduit was done in 6 cases. Ureteric reimplantation with psoas hitch was done in 3 cases. Conclusion: Genitourinary tuberculosis is often silent and has nonspecific clinical features. Irritative voiding symptoms are the common presentation. Kidney is the most commonly affected organ in GU TB. GU TB is a disease of young adults, with majority affected in the 3rd and 4th decades. CT scan is replacing IVU as an imaging modality of choice in GU TB. Diagnosis of GU TB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens and the difficulty to isolate or grow TB bacilli. Hence a strong clinical suspicion is necessary for correct diagnosis. Anti-tubercular therapy is the mainstay of treatment. Genitourinary tuberculosis results in sequel which may require major organ removing and reconstructive surgeries
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Introducción Y Objetivos Las derivaciones del tracto urinario abarcan una amplia gama de técnicas quirúrgicas, siendo la causa más frecuente para su uso la patología urotelial maligna. De las derivaciones urinarias no continentes heterótopicas las más utilizadas son el conducto ileal y las ureterostomias cutáneas. La elección de la técnica dependerá de la patología de base, las condiciones del paciente y la experiencia del cirujano. El objetivo de este trabajo es determinar las complicaciones tempranas (≤30 días) y tardías (>30 días) de derivaciones urinarias heterópicas no continentes (DUHNC) tipo conducto ileal (CI) vs ureterostomias cutáneas (UC). Métodos Se realizó un estudio descriptivo retrospectivo de los pacientes llevados a DUHNC tipo CI o UC, desde enero del 2008 a julio del 2016, en un centro de referencia para patología oncológica. Se evaluó: edad, género, comorbilidades, escala de Karnofsky, patología quirúrgica, sangrado, ASA, tiempo quirúrgico, estancia hospitalaria, complicaciones tempranas y tardías. Resultados De los 70 pacientes incluidos, 26 con UC y 44 con CI, prevaleciendo el género masculino en ambos grupos. El promedio de edad fue de 66 y 63 años respectivamente y el indice Karnofsky en todos los pacientes fue superior al 90%. La causa más frecuente fue patología maligna de vejiga. El tiempo quirúrgico fue mayor en los pacientes del CI, siendo estadísticamente significativo (p = 0.000). El sangrado fue similar en ambas técnicas quirúrgicas requiriendo transfusión de hemoderivados el 92,3% de los pacientes con UC y 88,6% de los CI. La estancia hospitalaria no tuvo diferencias. En cuanto a las complicaciones tempranas, la más frecuente en ambos grupos fue el choque hipovolémico (61% UC y 58% CI). De las complicaciones tardías la sepsis urinaria prevaleció en ambos grupos (34% y 18% respectivamente) y la estrechez del estoma y la anastomosis ureteroileal se presentaron en las UC y en los CI respectivamente. La mortalidad en el transoperatorio fue del 12,8%. Conclusiones Las DUHNC como las ureterostomias cutáneas o el conducto ileal son técnicas quirúrgicas con tasas de sangrado, transfusión y estancia hospitalaria similares, pero con una menor proporción de complicaciones tanto tempranas como tardías en los pacientes llevados a conducto ileal
Introduction and Objectives The derivations of the urinary tract cover a wide range of surgical techniques, being the most frequent cause for its use the malignant urothelial pathology. Of the urinary diversions, the heterotopic continents are the ileal conduit and the cutaneous ureterostomies. The choice of technique will depend on the underlying pathology, the patient's conditions and the experience of the surgeon. The aim of this study is to determine the early complications (≤30 days) and late complications (> 30 days) of noncontinental heteropic urinary diversions (NHUD) type ileal conduit (IC) vs cutaneous ureterostomies (CU). Methods A retrospective descriptive study was conducted of patients referred to NHUD type CI or CU, from January 2008 to July 2016, in a referral center for oncological pathology. We evaluated: age, gender, comorbidities, Karnofsky scale, surgical pathology, bleeding, ASA, surgical time, hospital stay, early and late complications. Results Of the 70 patients included, 26 with CU and 44 with IC, the male gender prevailing in both groups. The average age was 66 and 63 years respectively and the Karnofsky index in all patients was over 90%. The most frequent cause was malignant pathology of the bladder. Surgical time was higher in IC patients, being statistically significant (p = 0.000). Bleeding was similar in both surgical techniques requiring transfusion of blood products 92.3% of patients with CU and 88.6% of IC. The hospital stay did not differ. Regarding the early complications, the most frequent in both groups was hypovolemic shock (61% CU and 58% CI). Of the late complications, urinary sepsis prevailed in both groups (34% and 18% respectively) and the narrowing of the stoma and the ureteroileal anastomosis were present in the CU and in the IC, respectively. The mortality in the transoperative period was 12.8%. Conclusions NHUD such as cutaneous ureterostomies or ileal conduit are surgical techniques with similar rates of bleeding, transfusion and hospital stay, but with a lower proportion of complications both early and late in patients taken to the ileal conduit.
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Humans , Male , Middle Aged , Aged , Urinary Diversion , Urinary Tract , Ureterostomy , Pathology, Surgical , Urinary Bladder , Karnofsky Performance Status , Blood-Derivative DrugsABSTRACT
<p><b>Background</b>Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.</p><p><b>Methods</b>From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.</p><p><b>Results</b>LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.</p><p><b>Conclusions</b>ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cystectomy , Methods , Laparoscopy , Methods , Retrospective Studies , Treatment Outcome , Urinary Bladder , General Surgery , Urinary Bladder Neoplasms , General Surgery , Urinary Diversion , MethodsABSTRACT
Objective To compare the impact of bowel preparation on postoperative complications of patients undergoing radical cystectomy(RC) with ileal conduit diversion(ICD) by meta-analysis.Methods All literature were collected from VIP,CNKI,WanFang Data,CBMdisc,Pubmed,Medline,Embase dated from inception to April 2016.Then literature were grouped into mechanical bowel preparation and nonmechanical bowel preparation,whose differences in the wound,intestinal function,infection and other complications were compared.Results Three RCTs,four cohort studies and 656 cases were taken into account.No statistical difference was observed in the wound infection,wound dehiscence,fascia dehiscence,intestinal obstruction,anastomosis fistula,intestinal fistula,urinary leakage,death of indicators between the two groups.Conclusion Preoperative mechanical bowel preparation did not reduce the occurrence of postoperative complications of the patients with RC undergoing ICD.
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Objective To evaluate the clinical efficacy and security of retroperitoneal laparoscopic ureterolithotomy(RLUL) for impacted ureteral calculi after radical cystectomy and ileal conduit.Methods 5 patients with unilateral impacted ureteral calculi after radical cystectomy and ileal conduit received RLUL were selected,and a retrospective study was performed for manner,duration of surgery,complications and length of stay and other indicators,and the treatment effect was evaluated.Results All procedures were successful and the mean operation time was (82.0±27.7)min,the extubation time was (5.4±1.1)d,hospitalization time was (10.0±2.9)d.Postoperative follow up for 6-48 months,there were no obvious complications.Conclusion The RLUL showed satisfactory availability and security for management ureteral calculi after radical cystectomy and ileal conduit.
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Objective To discuss the necessity of closing the peritoneum during the operation of ileal conduit after the radical cystectomy.Methods We retrospectively analyzed the clinical data of 395 patients with bladder cancer who received radical cystectomy from Jan.2014 to Sep.2016.The amount of male was 327,female was 68.The mean age was (65.8 ± 9.7) years old.Patients were divided into four groups according to the surgical method of cystectomy and urinary diversion.In group A,patients,including 78 males and 9 females,were received open radical cysectomy (ORC) with extraperitoneal ileal conduit.The mean age was (67.8 ± 9.2) years old.In the preoperative clinical staging,66 cases were less than T2 and 21 cases were more than T2.Preoperative pathological grade in 83 cases and low grade in 4 cases.In group B,patients,including 31 males and 2 females,were accepted ORC with ileal conduit without peritoneum closure.The mean age was (67.3 ± 8.7) years old.Preoperative clinical staging showed less than T2 in 25 cases,more than T2 in 8 cases,The preoperative pathological grade showed high grade in 33 cases.In group C,patients,including 112 males and 27 females,were accpeted LRC with ileal conduit without peritoneum closure.The mean age was (64.3 ± 10.5)years old.The preoperative clinical staging showed less than T2 in 107 cases and more than T2 in 32 cases.The preoperative pathological grade showed high grade in 135 cases and low grade in 4 cases.In group D,patients,including 106 males and 30 females,were accepted RARC with ileal conduit without peritoneum closure.The mean age was (65.9 ±10.0)years old.Preoperative clinical staging showed less than T2 in 103 cases and more than T2 in 33 cases.The preoperative pathological grade showed high grade in 132 cases and low grade in 4 cases.Ileal conduit without peritoneum closure means completely open the peritoneum after anastomosis of the ureter and intestine in the urinary diversion surgery without shutting down the peritoneum,which is different from the extraperitoneal ileal conduit.The operating time,blood loss,blood transfusion rate,recovery time of intestinal function and perioperative complications and rate of hydronephrosis were analyzed.Results The 395 cases completed operation successfully,no LRC or RARC had been converted to ORC.The operative time was (280.1 ± 92.3) min,(233.6 ± 99.4) min,(304.8 ± 108.9) min,(364.6 ± 86.4) min in four groups,respectively (P ＜ 0.05).The blood loss in four groups were (489.1 ± 285.6) ml,(431.8 ± 233.1) ml,(373.0 ±213.7) ml,(205.6 ± 137.8) ml,respectively (P ＜0.05).The transfusion rate in four groups were 18 (20.7％),16 (48.0％),15 (10.8％),14 (10.3％),respectively (P ＜ 0.05).The mean time to flatus in four groups were (3.7 ±1.8)d,(3.6±1.0)d,(3.5±1.2)d,(2.2±1.7)d,respectively (P ＜ 0.05).While ileal obstruction rate had no statistical difference in four groups [group A 17 cases(19.5％),group B 6 cases(18.2％),group C 27 cases(19.4％),group D 19 cases(14.0％),P =0.678].Urine leakage,intestinal leakage,lymphocyst were only occurred in group A [7 cases (8.0％),2 cases (2.3％),2 cases (2.3％)].Pyelonephritis was noticed in each group,including 14 cases(16.1％)in group A,2 cases(6.1％)in group B,9 cases (6.5％)in group C,6 cases(4.4％)in group D (P ＜ 0.05).Hydronephrosis 6 months after surgery was observed in four groups,including 15 cases(17.2％)in group A,3 cases(9.1％)in group B,7 cases(5.0％)in group C,5 cases(3.7％)in group D (P ＜ 0.05).Conclusions Ileal conduit without peritoneum closure would not increase the incidence of complications,on the contrary,it would relieve the tension of anastomosis,and reduce the occurrence of complications such as urine leakage.
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Objective To evaluated the clinical value of laparoscopic techniques in radical cystectomy surgery for the treatment of bladder cancer. Methods Clinical data of 49 patients underwent radical cystectomy with Bricker ileal conduit diversion were retrospectively analyzed from October 2009 to August 2014, which laparoscopic radical cystectomy with Bricker ileal conduit 20 cases (Group A), open radical cystectomy with Bricker ileal conduit 29 cas-es (Group B). The blood loss during operation, operating time, gastrointestinal function recovery after operation, hos-pital stay after operation and complications were observed between the two groups. Results The blood loss during operation was significantly lower in Group A (416.66 ± 232.73) ml than in Group B (964.16 ± 445.73) ml ( <0.05), and hospital stay after operation was significantly lower in Group A (14.93 ± 2.72) days than in Group B (19.50 ± 3.16) days ( < 0.05), complication after operation was significantly lower in Group A than in Group B ( < 0.05). The operating time and gastrointestinal function recovery has no significantly difference between the two groups. Conclusions Laparoscopic radical cystectomy have advantages of minimal invasion, less blood loss, rapid recovery and less postoperative complications. It is a safe and effective surgical method. Long term effect need evaluated by follow up.
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Objective To assess the perioperative safety and postoperative function of the pure 3-dimensional laparoscopic cystectomy and urinary diversion (P3DLC-UD).Methods From April 2014 to July 2015,P3DLC-UD was performed in 15 patients diagnosed with the bladder cancer in our center (orthotopic ileal neobladder for 8 cases and ileal conduit for 7 cases).Perioperative data,postoperative continence and overall survival rate were retrospectively analyzed.Results Fifteen patients underwent P3DLC-UD successfully as planned,with 8 patients underwent orthotopic ileal neobladder and 7 patients underwent ileal conduit.In neobladder group,the operative time were 300-600mmin (mean 428 min),estimated blood loss were l 00-400ml (mean 210mml),and dissected lymph nodes were 11-29 (mean 16).One patient required blood transfusion (800ml) and one patient was diagnosed of constipation.The patients were followed up for a median period of 10 months (3-15 months).The renal function was normal with serum creatinine of 36.4-99.0 μ mol/L (mean 77.3 μmol/L).One patient died of intestinal obstruction and 8 patients had no recurrence in neobladder group.As to postoperative continence,only 2 patients demanded 1 pad at daytime,while all patients needed 1 pad at nighttime.In ileal conduit group,the operative time were 300-390 min (mean 354 min),estimated blood loss were 50-400ml (mean 190ml),and dissected lymph nodes were 9-41 (mean 22),while 9-41 (mean 19) lymph nodes were got for all 15 cases.Two patients were diagnosed with urinary infection after the surgery.The patients were followed up for a median period of 5 months (1-9 months).The renal function was normal with serum creatinine of 36.4-74.0 μmol/L (mean 60.8 μmol/L).One patient died of cerebral infarction,and 1 patient found distant metastases in lung and died of cancer after chemotherapy during the follow-up period.There were no recurrent tumors of the other 5 patients in ileal conduit group.Conclusions P3DLC-UD is safe and feasible.More extensive,longer-term randomized trials are required to comprehensively assess the appropriateness and potential of this technique.
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We report a patient with Leriche syndrome who had ileal conduit and a right lower quadrant stoma. A 47-year-old man with a history of bladder cancer had undergone radical total cystectomy with formation of an ileal conduit and right lower quadrant stoma 2 years previously. CT scanning revealed total occlusion of the distal aorta. He experienced right lower leg pain after 30 m of walking. Through a repeat midline laparotomy incision, the abdominal aorta was dissected with a transperitoneal approach. To avoid dissection around the ileal conduit, the retroperitoneum was incised (open) at the right of the ascending colon and at the left of the sigmoid colon. A prosthetic graft (Interguard 14×7 mm) was pulled bilaterally through these incisions, to the external iliac arteries. Abdominal aorto-bilateral external iliac artery bypass grafting was performed and the patient was discharged without complications on the 15th postoperative day.
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Objective To improve the understanding of ileal conduit urinary diversion stomal varicose bleeding.Methods 3 male cases of ileal conduit urinary diversion stomal varicose bleeding were reported.The pathogenic mechanism,clinical features,diagnosis and treatment of this disease were reviewed and discussed with the relevant literature review.The ages were 59,45 and 68.All of them had ileal conduit urinary diversion because of muscle invasive bladder cancer.Ileal conduit urinary diversion stomal varicose bleeding were found at 6 years,6 months and 2 months after surgery.The bleeding was intermittent.All the stomal varicose were found in physical examination.The laboratory examinations showed abnormities of liver functions in all three cases.Image studies showed one with liver metastasis and two with liver cirrhosis.Portal venous hypertension was considered as the cause of bleeding.Results We controlled the bleeding by suturing the first patient's varicose.The patient was died 3 months later because of the advanced cancer.For the second patient,we controlled the bleeding by compressing the varicose.By the meantime,we reduced the portal venous hypertension with medication.The stomal varicose bleeding stopped when the liver function and the portal venous hypertension improved 2 months later.The third patient's stomal varicose were injected with sclerosants.There was no mnore stomal varicose bleeding within half-year follow-up.Conclusions Ileal conduit urinary diversion stomal varicose bleeding is usually found in the patients who have portal venous hypertension because of liver cirrhosis or liver metastasis.To control the bleeding,we can decrease the patient's portal venous hypertension.To control hemorrhage,we can use suturing,compressing,and sclerotherapy,which is an optional treatment.
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Objective To compare the health related quality of life (HRQoL) of ileal conduit versus orthotopic ileal neobladder using the FACT-BL scale.Methods One hundred and thirty patients underwent radical cystectomy and urinary diversion for invasive bladder cancer from Jan 2006 to Dec 2010 at our hospital.According to different urinary diversions,patients were divided into ileal conduit (IC) and orthotopic ileal neobladder (NB).HRQoL was assessed using FACT-BL.The following scores calculated from the FACT-BL questionnaire and list:physical well-being ( PWB ),social/family well-being ( SWB ),emotional well-being(EWB),functional well-being( FWB),overall bladder-special subscale and total FACT-BL were included.A high FACT score indicated a high level of HRQoL.The medical records of each patient were then reviewed.Clinical parameters including age,sex,type of diversion and pathological status were recorded and analyzed.Results A total of 94 questionnaires were collected,of these patients 50 had an IC and 44 had an NB.Among the respondents,the age at surgery was significantly younger in NB group than IC group (P =0.014 ).While the percent of males,follow-up years and pathological stage T3 or greater revealed no significant difference.The NB group got significantly higher scores in PWB,SWB,EWB and FACT-BL than the IC group.Which indicated that the HRQoL was higher in patients following orthotopic ileal neobladder.Conclusions The HRQoL was better in patients who followed orthotopic ileal neobladder than those who followed ileal conduit.This may indicate that orthotopic ileal neobladder should be considered first when making a decision about which urinary diversion should be used.
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Objective To discuss the technique of laparoscopie radical cystectomy with Studer orthotopic ileal neobladder. Methods Eight men with bladder cancer who were indicated for radical surgery underwent laparoscopic cysteetomy with Studer orthotopic ileal neobladder. The ages were be-tween 51 and 69 with the mean age was 57 years. Seven cases were transitional cell carcinoma and 1 case was adenocarcinoma. A 5-port approach was employed. The first step was the bilateral pevic lymphadenectomiy including obturator lymph nodes, internal and external iliac lymph nodes. Then ventral surface of the bladder was mobilized and the bilateral endopelvic fascia was incised. Next step included the stich of dorsal vein complex and dissection of both the vas deferens and seminal vesicles. Denonvillier's fascia was incised to develop the plane between the rectum and the prostate. The urethra located in the prostatic apex was divided and transected thereby completely separating the specimen. Then the specimen was placed in a packet. Finally, a 6-8 cm lower median abdominal incision was performed, through which the specimen was extracted. Construction of the Studer pouch. A portion of terminal ileum about 45cm long was isolated approximately 20cm proximal to the ileocecal valve. The ends of the isolated ileal segment were closed to restore the bowel continuity. The distal 40 cm segment of ileum was placed in a U shape and opened along the antimesenteric border. The two medial borders were then oversewn and the bottom was folded over to form a neobladder. The ureters were anastomosed to the nonineised 5 cm portion of ileum. Finally, the neobladder was put into the abdomi-nal cavity and the anastomosis between the neck of the neobladder and the end of the remaining ure-theral was performed with interrupted suture. Results All the procedures were successful. The time of the operation was 6-8 h with the mean estimated blood loss 420(200-800)ml. Complication included 1 case of right ureteral indigitation in neobladder. The postoperative histopathology revealed 7 cases of pT2 and 1 cases of pT3. No positive margin was found. The follow-up (3 - 12 months) showed no recurrence. Conclusions The technique of laparoseopic radical cystectomy is feasible with the advantages of smaller incision and less blood loss. Studer orthotopic ileal neobladder has the ad-vantages of simple skill, antireflux, better postoperative urination.
ABSTRACT
Introducción: Existen múltiples razones por las cuales se hace necesario realizar una cistectomía radical, aunque claramente la principal es indiscutidamente el cáncer vesical. El conducto ileal u operación de Bricker ha sido, tradicionalmente, la forma más utilizada de derivación urinaria supravesical. A través de múltiples publicaciones se conocen las limitaciones y complicaciones de esta cirugía, principalmente en el largo plazo. Material y métodos: El presente estudio presenta una revisión retrospectiva de los pacientes sometidos a cistectomía y reemplazo vesical, en el Hospital Militar de Santiago, entre los años 1982 y 2008. De estos reemplazos vesicales, 23 fueron operaciones de Bricker, 4 operaciones de Studer y 1 Indiana. Se detallan las complicaciones precoces y tardías ocurridas durante el tiempo de seguimiento. Resultados: En términos generales, la serie muestra que la operación de Bricker tiene una tasa de complicaciones precoces de un 26 por ciento y de complicaciones tardías de un 17,4 por ciento. Conclusión: Consideramos que la operación de Bricker constituye una adecuada alternativa de derivación urinaria, con un índice de complicaciones aceptable en el largo plazo.
Introduction: Currently, radical cystectomies are perfomed for many reasons, but bladder cancer is still considered to be the most important one. The ileal conduit or Brickers diversion is the most common supravesical urinary diversion technique. Limitations and long term complications of this surgical technique are well known. Material and Methods: In this study we present a retrospective review of patients submitted to radical cystectomy and bladder replacement at the Hospital Militar de Santiago between 1982 and 2008. Of 28 cystectomies, 23 ileal conduits, 4 Studer procedures and 1 Indiana procedure were performed. Perioperative and long term complications are described. Results: The study shows that Brickers procedure has an early complication rate of 26 percent and a late complication rate of 17.4 percent. Conclusions: This study shows that ileal conduit seems to be a good alternative of urinary diversion, with an acceptable rate of short and long term complications.
Subject(s)
Humans , Male , Female , Cystectomy/adverse effects , Cystectomy/methods , Urinary Diversion/adverse effects , Urinary Bladder Diseases/surgery , Cystitis/surgery , Postoperative Complications , Retrospective Studies , Follow-Up Studies , Time Factors , Urinary Bladder Fistula/surgery , Urinary Incontinence/surgeryABSTRACT
PURPOSE: The present study was performed to assess the risk factors for urolithiasis in patients receiving ileal conduit urinary diversion due to a certain underlying etiology. MATERIALS AND METHODS: This study included 43 patients (35 males and 8 females), who had undergone ileal conduit urinary diversion with a post-operative duration of at least 6 months, and 54 age-matched normal controls. Urine samples (24-hour) were collected on an outpatient basis without any dietary restriction when the patients were free of urinary tract infection or antibiotics medication. The urinary analytes, comprising of the urine volume, sodium, phosphorus, uric acid, creatinine, calcium, magnesium, oxalate and citrate, were investigated. These data were compared with the original values, and the values adjusted according to the creatinine level for both sexes. RESULTS: Not all the serum analytes significantly differed between the patients and controls. In the 35 male patients, the mean urinary excretion of oxalate was significantly greater than in the control group, which was converse to that of the citrate and uric acid (p=0.001, p<0.001 and p=0.001, respectively). Unexpectedly, the urinary excretion of calcium in the male patients was lower than in the controls (p<0.001), resulting in a significant decrease in the ratio of calcium to oxalate (p<0.001). Among the urinary analytes, the excretions of sodium, phosphorus, uric acid, citrate and oxalate were significantly correlated with that of urinary creatinine. The excretions of oxalate and citrate were different when adjusted according to the urinary creatinine excretion between the male patients and the controls. In the 8 female patients, decreases in the excretions of magnesium and citrate were observed compared to the controls (p=0.007, p=0.030). CONCLUSIONS: Our study indicated that ileal conduit urinary diversion causes increased excretion of urinary oxalate, leading to a decreased calcium to oxalate ratio and excretion of citrate as major metabolic alterations due to urolithiasis, although the excretions of urinary calcium and magnesium may play some role.
Subject(s)
Female , Humans , Male , Anti-Bacterial Agents , Calcium , Citric Acid , Creatinine , Magnesium , Outpatients , Phosphorus , Risk Factors , Sodium , Uric Acid , Urinary Diversion , Urinary Tract Infections , UrolithiasisABSTRACT
Continent urinary diversion or neobladder has been attempted more and more recently. However, ileal conduit urinary diversion is still the most common diversion technique applied after cystectomy, because it is much simpler than other techniques and also because it has reportedly produced less postoperative complications. But there have not been enough long term follow-up reports on this procedure in Korea. Therefore, the authors followed 90 ileal conduit urinary diversion cases which were performed at the Korea Cancer Center Hospital(KCCH) between 1985 and 1994. Upon these 90 cases, the authors analyzed the occurrence of early complications and late complications in percentage. For the early complications, wound complications comprised 16%, early intestinal obstruction 2%, necrosis of ileal segment .1%, leakage of ureteroileal anastomosis 2% and acute pyelonephritis comprised 4%. These statistics show similar result with other reports. For the late complications, stromal stenosis comprised 1% and the formation of calculi 3%. These number are lower occurrence compared to other reports. Also, the late postoperative ileus comprised 10% and renal deterioration 12%. These reflect similar occurrences with other reports. In conclusion, reviewing long term follow-up on ileal conduit urinary diversion by means of analyzing the early and late complications, the ileal conduit urinary diversion is still considered good diversion technique which has acceptable ratio of renal deterioration and postoperative complications.
Subject(s)
Calculi , Constriction, Pathologic , Cystectomy , Follow-Up Studies , Ileus , Intestinal Obstruction , Korea , Necrosis , Postoperative Complications , Pyelonephritis , Urinary Diversion , Wounds and InjuriesABSTRACT
Mucosal biopsies were obtained for histological and electron microscopical studies from 7 patients with ileal urinary conduit. Shortly after construction of the reservoir there was a reduction in villous height and an increase in crypt depth. After 2 to 3 years of observation, avillous areas were noted in the reservoir mucosa. Electron microscopy shows a loss of microvilli and a reduction of cell construction. The number of mucus-storing goblet cells increased already with in 1 month after construction. No sign of foreign body reaction, dysplasia or metaplasia was encountered. The constant exposure to urine leads to adaptive changes of the reservoir mucosa, resulting in true atropy of villi, crypts, and individual epithelial cells.