Self-esteem and quality of life in patients with neurogenic dysfunction and continent urinary diversion and/or procedures for anterograde enemas.

INTRODUCTION AND OBJECTIVE: The importance of evaluating the self-esteem and quality of life of patients with a chronic disease has become increasingly relevant. The study describes self-esteem and quality of life outcomes in patients with neurogenic dysfunction and continent urinary diversions and/or antegrade enema procedures. MATERIALS AND METHODS: Cross-sectional observational study, including patients with neurogenic dysfunction who required a continent urinary diversion and/or an antegrade enema conduit during their treatment. The self-esteem evaluation was done with the Rosenberg scale and the quality of life with the KIDSCREEN-27 questionnaire. VARIABLES MEASURED: socio-demographic, clinical and economic characteristics. Descriptive statistics were applied. RESULTS: The mean age of the 9 patients was 15.6 years, the mean time elapsed from surgery to application of the questionnaires was 60.9 ±â€¯37.1 months. With a perception of improvement in 8 of the 9 patients and a normal or higher self-esteem score in all cases. In the description of physical activity and health, it was found that 7 of the 9 young people presented a perception of good health in general. A considerable reduction in the use of diapers was achieved after the intervention, going from consuming 6.2 ±â€¯1.4 diapers per day to only 1.7 ±â€¯1.3 diapers per day. CONCLUSIONS: Despite the sequelae, comorbidities and procedures, the results of self-esteem and quality of life in patients with neurogenic dysfunction are high.

A New Technique for Continent Urinary Diversion: Initial Experience and Description of the Technique.

PURPOSE: Orthotopic neobladder is a well-established surgical solution for continent urinary diversion after radical cystectomy. Nevertheless, it still represents a challenging surgery. Some critical issues of orthotopic bladder substitution include relevant complication rates, renal function impairment, urinary incontinence and patient quality of life. We present a new ileal neobladder technique, Vesuvian Orthotopic Neobladder (VON), performed for the first time at our institution in 2020. The main purpose of this new surgical procedure is to simplify and speed up the reservoir reconstruction through a ten standardized technical steps and obtain an appropriate bladder capacity at the same time.   METHODS: Inclusion criteria were muscle-invasive bladder carcinoma or non muscle-invasive high risk bladder cancer patients fit for bladder substitution. The exclusion criteria were locally advanced cancer, presence of hydronephrosis, renal or hepatic impairment. A chest-abdominal CT scan and urinary cytology were performed before the procedure. Patients received neoadjuvant chemotherapy, as required. Overall, operative time, bladder reconfiguration time, hospitalization time, catheterization time were recorded. All complications associated with the procedure were classified according to the Clavien Dindo score. The bladder volume was evaluated by ultrasound three months after the surgery.   RESULTS: A total of six male patients diagnosed with non-metastatic muscle-invasive or high-risk non-muscle invasive bladder cancer who underwent radical cystectomy followed by VON reconfiguration were included in the study. Mean age was 62.8 (±4.9) years; all selected patients enjoyed good health conditions (Charlson Comorbidity Index 4-6). One patient presented with high-risk non-muscle invasive bladder cancer. Four patients received neoadjuvant chemotherapy. Mean overall operative time was 273.3 (±18.6) minutes. Average time for neobladder reconstruction was 63.7 (±16.1) minutes. There were no intraoperative complications. A single case of urethral anastomosis leakage occurred and was treated conservatively. Bladder volume on ultrasound evaluation ranged between 250 and 290 ml.  Day time and nocturnal continence were observed in four and three patients, respectively.   CONCLUSION: The new VON technique is a good alternative to traditional orthotopic bladder procedures. VON reconstruction seems to offer the advantage of speeding up the procedure, reducing intestinal compromise with good storage capacity. The ten surgical steps can be considered a good starting point for further improvements in surgical technique. More robust data regarding the number of procedures and the duration of follow-up is required.

Hypokalaemic quadriparesis in a patient with urinary diversion through Indiana pouch.

A man in his 20s, a patient with chronic kidney disease with a baseline estimated glomerular filtration rate of 33 mL/min/1.73 m2, who had an Indiana pouch continent urinary diversion procedure done at 6 years of age for bladder exstrophy, presented to the emergency room with sudden-onset progressive quadriparesis over 6 hours with power 1/5 in all the limbs with preserved reflexes. He was fully conscious and oriented, with stable vital signs. On evaluation, he had severe hypokalaemia and severe metabolic acidosis (both high anion gap and non-anion gap acidosis). Imaging studies showed bilateral gross hydroureteronephrosis, and renal and pouch calculi. Hypokalaemia was promptly treated with intravenous potassium chloride and acidosis with emergency haemodialysis. The patient had a complete motor recovery following intravenous potassium correction and was discharged with oral potassium and bicarbonate supplements. Here, the Indiana pouch, its metabolic and electrolyte complications, and its treatment are discussed.

Laparoscopic Cystectomy with Totally Intracorporeal Versus Extracorporeal Orthotopic Neobladder for Bladder Cancer: A Single Center Experience.

Objective: The objective of this study was to compare the perioperative, oncological, and functional results and complications of extracorporeal orthotopic neobladder (EON) and totally intracorporeal orthotopic neobladder (ION) after laparoscopic radical cystectomy (LRC) in patients with muscle-invasive bladder cancer and high-risk nonmuscle-invasive bladder cancer. Methods: From January 2013 to October 2019, 152 patients underwent LRC and U-shape neobladder urinary diversion at a single tertiary referral hospital. We then compared the extracorporeal (n = 62) and intracorporeal (n = 90) orthotopic neobladder after laparoscopic cystectomy groups. Results: Of all patients, 90 with ION and 62 with EON were included in the study. Concerning perioperative outcomes, the ION group had lower estimated blood loss (455.7 versus 371.7 mL, P = .019), a shorter interval to solid food (6.9 versus 8.7 days, P = .006), and a shorter length of hospital stay (14.6 versus 16.0 days, P = .009). No statistically significant differences were identified in overall (P = .649), early (P = .509), and late (P = .367) complications. However, in terms of gastrointestinal complications, the ION group had a lower complication rate than the EON group (11.1% versus 27.4%, P = .018). There were no statistically significant differences in cancer-specific or noncancer-specific mortality. Daytime and nocturnal continence rates for the ION versus EON groups were 86.7% and 87.1% (P = 1) and 70.0% versus 66.1% (P = .614), respectively. Patients who underwent intracorporeal urinary diversion had a higher health-related quality of life within 3 months postoperative than the extracorporeal urinary diversion group. Conclusion: LRC with ION could be an alternative to EON with similar oncological and functional outcomes at tertiary referral centers. ION had advantages of faster bowel recovery, fewer gastrointestinal complications, and higher quality of life within 3 months postoperative. Clinical Trial Registration No. ChiCTR2100042063.

Salvage cystectomy and ileal conduit urinary diversion as a last-line option for benign diseases-perioperative safety and postoperative health-related quality of life.

AIMS: Radical cystectomy and urinary diversion impact various dimensions of patients' health-related-quality-of-life (HRQOL). Yet, less is known about salvage cystectomy as a last-line option for treatment-refractory benign diseases. Therefore, our aim is to provide HRQOL data from a contemporary cohort of open salvage cystectomies for benign conditions. METHODS: Fifty-four consecutive patients were enrolled in one single tertiary referral center. Analysis was limited to patients undergoing urinary diversion via ileal conduit (IC). Complications were assessed via Clavien-Dindo-scale. HRQOL was measured using the validated European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BLM30 questionnaire. HRQOL QLQ-C30 domains were measured preoperatively and up to 3 years postoperatively. Longitudinal changes were analyzed using Friedman's rank test. Primary endpoint was good general HRQOL based on QLQ-C30 global health status (GHS). Multivariate analysis was performed using logistic regression models with a step-wise backward selection procedure. RESULTS: Longitudinal analysis of HRQOL subdomains revealed significantly improved pain (p = .005) and fatigue (p = .002) scores as well as improved social functioning (p = .038). Furthermore, general HRQOL (GHS scores) improved significantly during the follow-up period (28.0 vs. 50.6 [36 months], p = .045). In multivariate analysis, the indication for salvage cystectomy could not be identified as an independent predictor for good general HRQOL. We observed a total number of 10 (41.7%) high-grade (Clavien ≥III) 90 day-complications. Limitations include limited follow-up rates at respective time-points. CONCLUSION: Salvage cystectomy and IC can be safely performed as a last-line treatment for benign conditions and increases general HRQOL in the long-term follow-up. Thus, it can play a role in a holistic approach for a challenging clinical setting.

Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: A New Standard of Urinary Diversion.

Background: To summarize the current evidence on robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) and compare perioperative outcomes and postoperative complications of patients undergoing RARC with extracorporeal urinary diversion (ECUD) and ICUD. Patients and Methods: Through a systematical search of multiple scientific databases in March 2020, we performed a systematic review and cumulative meta-analysis of the primary outcomes of interest. Also, we assessed the quality of the relevant evidence according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Thirteen studies with 4696 participants were included in this review. No significant differences were found between the ECUD and ICUD in operation time (OT) (mean difference [MD]: -6.45, 95% confidence interval [CI]: -35.20 to 22.30), length of stay (MD: 0.36, 95% CI: -0.81 to 1.54), 30-day overall complications (odds ratio [OR]: 0.92, 95% CI: 0.60-1.41), 30-day minor complications (OR: 1.36, 95% CI: 0.85-2.19), 30-day major complications (OR: 0.70, 95% CI: 0.34-1.43), 90-day overall complications (OR: 1.34, 95% CI: 0.83-2.18), and major complications (OR: 1.03, 95% CI: 0.68-1.57). However, less estimate blood loss (MD: 99.28 mL, 95% CI: 62.59-135.98), lower intraoperative blood transfusion (OR: 1.80, 95% CI: 1.09-2.95), shorter oral intake time (MD: 0.78, 95% CI: 0.43-1.14), and 90-day minor complications (OR: 1.72, 95% CI: 1.08-2.73) were associated with ICUD. The subgroup analysis showed less estimated blood loss (MD: 149.73, 95% CI: 21.33-278.13) and less OT (MD: 32.45, 95% CI: 14.37-50.53) were found in ICUD. Conclusions: The ICUD is a safe and feasible alternative to ECUD, which decreases the need for blood transfusion and reduces 90-day complications. However, further quality studies are needed to evaluate effectiveness of ICUD and its oncologic outcomes, functional outcomes, cost, and the quality of life.

A New Appendicostomy Technique to Prevent Stomal Stenosis.

PURPOSE: Stomal stenosis has been reported to occur in 12% to 45% of patients following Malone antegrade continence enema and Mitrofanoff appendicostomy. The standard stoma technique entails excision of the distal appendix. We evaluated a novel technique with preservation of the appendiceal tip and vessels, and opening the lumen in a more proximal and vascular area to determine whether the incidence of stenosis would be decreased. MATERIALS AND METHODS: Medical records of patients who underwent appendicostomy for Malone antegrade continence enema or urinary diversion were retrospectively evaluated. We included cases with a minimum of 1 year of followup and those in which the distal portion of a complete appendix was oriented for use as the stomal end in the umbilicus. Variables such as age, gender, body mass index, antegrade continence enema or urinary diversion, open or laparoscopic approach, cecal and appendiceal adhesions, retrocecal position, cecal imbrication, technique and stenosis were recorded. Cox proportional hazards analyses were performed to determine association of covariates. RESULTS: A total of 123 patients met inclusion criteria. The incidence of stenosis following standard stoma technique was 13% (12 of 93 patients) with a median followup of 9.4 years. Of these cases 75% occurred within 1 year of surgery. Stomal stenosis did not occur after the new stoma technique in 30 patients with a median followup of 3.3 years. Only technique cohort (standard vs new) was associated with stenosis (p=0.04). CONCLUSIONS: Stomal stenosis of appendicostomy may be lessened by preservation of the distal appendiceal vasculature and tip, and opening the lumen in a more proximal location.

Ureterostomy as an alternative to ileal conduits in pediatric kidney transplantation.

INTRODUCTION: Urinary diversion in pediatric renal transplant candidates with bladders not amenable to primary reconstruction can be achieved by pre-transplant ileal conduit creation. We performed cutaneous ureterostomies to limit pre-transplant surgery, protect the peritoneum for dialysis, transplant patients sooner, and preserve ureter length for future surgical reconstruction. METHODS: We compared four pediatric transplant recipients with ureterostomies to four recipients with ileal conduits from 2009 to 2017. RESULTS: All patients with ileal conduits developed at least one urinary tract infection (UTI) within 1 year of transplant and three of four patients had recurrent UTIs within the first year. Two patients required ileal conduit revisions for redundant conduits and recurrent UTIs. Of the four ureterostomy patients, two patients had UTIs within one year of transplant. Two patients developed ureterostomy strictures requiring revision at the fascial level; one was associated with a UTI. CONCLUSION: In our small case series, ureterostomy allowed for a single operative intervention with preservation of ureter length for later reconstruction. Ureterostomy is safe and recurrent UTI may be lower in the ureterostomy group. Long-term evaluation of ureterostomy for urinary diversion in pediatric kidney transplant is warranted.

Treatment of Peristomal granulomatosis with a Neem and Red Hypericum Oil application: Case studies.

BACKGROUND: Peristomal granulomatosis is a chronic inflammatory disease of uncertain aetiology, and a high recurrence rate. It frequently occurs in patients with enterostomy and urostomy. The most frequent type affects the mucocutaneous junction, causing bleeding and painful nodular lesions, which complicate management of the ostomy pouching system. Currently, only invasive treatments are available, consisting in cauterisation or surgical removal of the granuloma. Our objective was to evaluate efficacy of a topic mixture oil, composed by a 1:1 of extracts of Neem and Red Hypericum; amongst its many therapeutical properties, it is proven to inhibit the over-granulation process. METHOD: Two clinical cases presenting typical peristomal granulomatosis were selected. On first access after recruitment, the patients underwent an accurate nursing anamnesis, a global assessment was carried out according to the Toven Method and an assessment of peristomal sore skin according to SACS 2.0. Granulomatosis wounds were treated with the oil mixture, applied on a hydrofiber pad, secured over the wound site by means of a transparent film. This allowed the release of active ingredients while ensuring the pouching system secure adhesion. The chosen protocol consisted in 2 dressing changes per week, while monitoring the granulomatosis wound evolution by means of a TOR Form validated data form and documenting progress by taking photographs. RESULTS: Initially a regression of the inflammatory process was observed, with significant decrease of bleeding and pain. Gradually, the proliferating lesions reduced in size (both width and extent), and eventually healed completely. The product was very well tolerated, even when in contact with the stoma mucous membrane. No recurrence signs were observed either at the follow up visit 15 days from end of treatment, and in clinical case N.2 equally none were present two months after treatment. CONCLUSIONS: Compared to conventional methods which are invasive, not resolving, and not tolerated by patients, the product was demonstrated to be an innovative therapeutical solution, easy to apply, with no side effects and well-liked by patients. The excellent results obtained require further confirmation and validation through new studies on a statistically significant number of cases.

Factors That Influence Selectionof Urinary Diversion Among Bladder Cancer Patients in 3 Community-based Integrated Health Care Systems.

OBJECTIVE: To assess the relative contributions of patient and surgeon factors for predicting selection of ileal conduit (IC), neobladder (NB), or continent pouch (CP) urinary diversions (UD) for patients diagnosed with muscle-invasive/high-risk nonmuscle invasive bladder cancer. This information is needed to enhance research comparing cancer survivors' outcomes across different surgical treatment options. METHODS: Bladder cancer patients' age ≥21 years with cystectomy/UD performed from January 2010 to June 2015 in 3 Kaiser Permanente regions were included. All patient and surgeon data were obtained from electronic health records. A mixed effects logistic regression model was used treating surgeon as a random effect and region as a fixed effect. RESULTS: Of 991 eligible patients, 794 (80%) received IC. One hundred sixty-nine surgeons performed the surgeries and accounted for a sizeable proportion of the variability in patient receipt of UD (intraclass correlation coefficient = 0.26). The multilevel model with only patient factors showed good fit (area under the curve = 0.93, Hosmer-Lemeshow test P = .44), and older age, female sex, estimated glomerular filtration rate <45, 4+ comorbidity index score, and stage III/IV tumors were associated with higher odds of receiving an IC vs neobladder/continent pouch. However, including surgeon factors (annual cystectomy volume, specialty training, clinical tenure) had no association (P = .29). CONCLUSION: In this community setting, patient factors were major predictors of UD received. Surgeons also played a substantial role, yet clinical training and experience were not major predictors. Surgeon factors such as beliefs about UD options and outcomes should be explored.

Extra-Anatomic Stents in Ureteric Obstruction: Our Experience.

OBJECTIVES: To present our experience of the Detour extra-anatomic stent (EAS; Porges-Coloplast, Denmark) to bypass ureteric obstruction. Use of the EAS is indicated in patients with complex ureteric strictures or malignant disease, where long-term nephrostomy drainage is undesirable. MATERIALS AND METHODS: Between December 2001 and October 2017, 20 Detour EAS were implanted into 13 patients. The primary indication was ureteric obstruction or injury secondary to metastatic malignancy, or from treatment for malignancy. Five patients required bilateral EAS, with two patients having bilateral EAS following initial unilateral insertion. In 11 patients, the stent was inserted into their bladder, with 2 diverted into a double-barreled stoma. The mean age at the time of implantation was 64 years (range: 50-83 years), and the median follow-up was 12 months (range: 1.5-42 months). RESULTS: Four patients required stent revision for urinary leaks, and two developed recurrent urinary tract infections in their stent requiring intravenous antibiotics. All EAS continued to drain successfully following treatment or revision. One patient died due to complications from dislodgement of the stent, leading to laparotomy and intra-abdominal sepsis. Seven patients died due to progression of metastatic malignant disease, and the Detour EAS was functioning in all seven at time of death. The remaining five patients are well with functioning Detour EAS. CONCLUSIONS: The Detour EAS system provides a suitable alternative option for urinary diversion, affording a good quality of life to carefully selected patients with multiple comorbidities and malignant disease.

Robotic conversion of cecostomy tube to catheterizable antegrade continence enema (ACE): Surgical technique.

INTRODUCTION: Antegrade continence enema (ACE) is a well described treatment for pediatric patients with neurogenic bowel refractory to medical and retrograde management. ACE can be carried out either by catheterizable channel with enteric conduit or a cecostomy tube appliance. For those patients who have issues with pain or leakage around the cecostomy appliance or wish to be appliance free, we present our initial results and description of a novel technique of laparoscopic conversion of cecostomy to catheterizable ACE which uses the existing tract and requires no enteric conduit. METHODS: A single institution, retrospective chart review was carried out for 2014-2017 to identify patients undergoing ACE conversion. Preoperative parameters included age, sex, weight, neurogenic bowel etiology and time from initial cecostomy. Perioperative data included length of surgery, length of hospitalization and postoperative complications (via Clavien-Dindo scale). Postoperative follow up, ancillary procedures pertinent to the ACE and status at time of submission are also presented. RESULTS: Six patients were identified (mean age 14.1 +/- 4.3 years) with median follow up of 36 months (range 18-65). Neurogenic bowel etiology was spina bifida in five and spinal cord injury in one; all patients had concurrent neurogenic bladder with preexisting appendicovesicostomy. Mean operative time was 168 +/- 37 min (range 122-228) and mean length of hospital stay was 2 days (range 1-4). Success rate is 83% (5/6 continue to catheterize ACE channel), with one patient opting back for appliance through same tract. One patient has required operative revision for stomal stenosis. CONCLUSION: To our knowledge, this is the first report describing robotic-assisted laparoscopic conversion of cecostomy tube to a catheterizable ACE. The surgical technique we describe is simple and safe with minimal morbidity to the patient. It does not require an enteral conduit, and may represent a valid treatment in patients without the option of using the appendix.

No Appendix is Too Short-Simultaneous Mitrofanoff Catheterizable Vesicostomy and Malone Antegrade Continence Enema (MACE) for Children with Spina Bifida.

OBJECTIVE: To present the results of simultaneous creation of both Mitrofanoff stoma and Malone antegrade continence stoma (MACE) using simple division of the appendix and a cecal extension method. MATERIALS AND METHODS: Between June 2011 and November 2016, simultaneous Mitrofanoff and MACE was performed in 16 children (12 children-simple division of the appendix, 4 children-appendicovesicostomy and cecal extension of the appendix). Extension of the appendix was achieved by tubularization of the excised cecal flap next to the short appendicular stump. The new extended channel was then wrapped by cecal wall. RESULTS: Follow-up was 40 months (10-74 months). Currently, in all children, both stomas are easily catheterizable. Obstruction of MACE occurred in 5 children (4 with split appendix, 1 with extended appendix); Mitrofanoff stomal stenosis occurred in 1 child. Endoscopic revision and prolonged catheterization of stenotic stomas were effective in all cases. Wound infection and dehiscence was noted in 2 children (both with split appendix). Drainage and intravenous antibiotics were effective. All Mitrofanoffs are continent. In 4 children there is incident minor leakage of the MACE (3 with split appendix and in 1 with extended appendix). CONCLUSION: The split appendix procedure is feasible. Cecal extension of the appendix seems to be a good option when the appendix is too short for a simple split procedure.

Comparing inpatient versus outpatient bowel preparation in children and adolescents undergoing appendicovesicostomy.

PURPOSE: The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric urology has come under scrutiny, secondary to literature demonstrating little benefit regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive procedures at our institution no longer underwent IBP. We hypothesized that outpatient bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative complications after appendicovesicostomy surgery. MATERIALS AND METHODS: An institutional database of patients undergoing lower urinary tract reconstruction between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty or continent ileovesicostomy were excluded because of insufficient numbers undergoing OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013. Cost data were obtained from the Pediatric Health Information System. RESULTS: Sixty-seven patients met the inclusion criteria, with 30 (44.8%) undergoing IBP. There were no differences with respect to gender, age, presence of ventriculoperitoneal shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified as Clavien-Dindo grade 1-2, with no statistical difference (IBP 20.0% vs. OBP 5.4%, p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel obstruction, or shunt infection. DISCUSSION: This is the first analysis of hospitalization costs and IBP, showing a higher median cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar to a previous report. Similar complication rates between the groups add to the growing body of literature that avoidance of IBP is safe in pediatric lower urinary tract reconstruction. Being a retrospective review of a practice change, differences in care that influenced cost and LOS may be missing. Also, as the surgeons do not know if a usable appendix is initially present, our data may not extrapolate to all patients. Despite these potential limitations, our data support the safety of utilizing OBP in patients with a high likelihood of a usable appendix, including those undergoing a synchronous Malone antegrade continence enema via a split-appendix technique. CONCLUSION: In patients undergoing an appendicovesicostomy, preoperative IBP led to longer LOS and higher costs of hospitalization. OBP was not associated with increased risks of postoperative complications.

Serous-lined, stapled pouch wall plication: initial results of a simple and quick novel continence mechanism in troubleshooting secondary to continent cutaneous urinary diversion.

OBJECTIVES: To report a novel and straightforward technique of a secondary continent outlet for continent cutaneous urinary diversion (CCUD) reservoirs without the need for further bowel resection, reducing operating time and length of hospitalization. PATIENTS AND METHODS: From 2015 to 2017, six patients with unreconstructable, incontinent outlets (out of a total pool of 595 patients with CCUD) have undergone the technique described in the present paper at our department. The technique relies on the Mitrofanoff principle, using a stapled full-thickness pouch wall plication, which creates a flap-valve continence mechanism. RESULTS: All patients enjoyed full continence with ease of clean intermittent catheterization (CIC) in the postoperative period and on follow-up to a mean (range) of 12.4 (7-18) months. No major complications were encountered in any patient and the average capacity of the reservoirs was not compromised by the procedure (540 mL preoperatively vs 500 mL in further follow-up). CONCLUSION: In revisional surgery for secondary CCUD incontinence, especially if the patient has already lost a significant amount of bowel or has previously undergone radiation therapy, the technique described here represents a safe and effective alternative to restore continence.

Cuidados de enfermería en un paciente intervenido de neovejiga ileal ortotópica tipo Hautmann. Caso clínico / No disponible

Entre las derivaciones urinarias en pacientes sometidos a una cistectomía radical por cáncer vesical infiltrante, la neovejiga ileal ortotópica, tipo Hautmann, es una excelente alternativa. Como objetivos nos planteamos: 1) exponer los cuidados de enfermería en pacientes intervenidos de cistectomía radical por cáncer vesical infiltrante a los que se les ha construido una neovejiga ileal tipo Hautmann, y 2) señalar el importante papel que juega enfermería, tanto hospitalaria como de atención primaria, en este tipo de intervención quirúrgica. Se expone un caso clínico de un paciente diagnosticado de cáncer urotelial papilar de alto grado con infiltración perineural al que se le ha construido una neovejiga. Se muestra el procedimiento seguido en el servicio, así como los protocolos empleados y actuaciones de enfermería. Como complicación presentó un íleo paralítico. La bibliografía especializada señala que el íleo paralítico es una de las complicaciones inmediatas que se da con más frecuencia en la cistectomía radical por cáncer vesical infiltrante, junto con la fístula urinaria, retención urinaria por mucus y urosepsis. Estudios de seguimientos de casos de neovejiga ileal tipo Hautmann muestran buenos resultados funcionales, una baja tasa de complicaciones, tanto inmediatas como tardías, y, sobre todo, una buena calidad de vida de estos pacientes

Orthopic ileal neobladder, type Hautmann, is currently the preferred method for urinary derivation in patients undergoing radical cystectomy for muscle-infiltrating bladder cancer. We set goals such as: 1) to supply useful information to patients with neobladder, specifically Hautmann neobladder about patients who underwent radical cystectomy due to infiltrating bladder cancer. 2) to highlight the important role that nursing staff plays by promoting quality in nursing care in this type of surgical intervention. It is described the case of a patient diagnosed with high-grade papillary urothelial carcinoma with evidence of perineural invasion. This patient underwent a radical cystectomy with neobladder reconstruction. The patient presented paralytic ileus. Paralytic ileus is a severe complication resulting from a variety of disorders, which is most commonly associated with radical cystectomy due to infiltrating bladder cancer. Other complications are urinary fistula, urinary retention due to mucus and urosepsis. Surveys aimed at monitoring the Hautmann neobladder show good functional outcomes, a low rate of complications of both immediate and late responses, and therefore, the quality of life for these patients was good

Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies.

PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications.