[Ipsilateral ureteroureterostomy. A safe alternative in complete duplicated collecting system with associated pathology]. / Uretero-ureteroanastomosis distal ipsilateral. Una alternativa segura en doble sistema renal completo con patología asociada.

In patients with complete double renal system with the involvement of only one system, there are several surgical alternatives for its resolution. Uretero-ureteral anastomosis has been presented as a good alternative, even in cases with atrophy of the affected system. OBJECTIVE: To report our experience in patients with complete double renal system with only one system affected, with the surgical technique of uretero-ureteral anastomosis. PATIENTS AND METHOD: Retrospective study of patients with double renal system with involvement of one of the systems, treated with uretero-ureteral anastomosis technique between January 2015 and May 2022. The variables of age, specific pathology of the affected system, preoperative study, days of hospitalization, postoperative complications (leakage, obstruction, infection), and follow-up time were evaluated. RESULTS: We analyzed 26 procedures in 25 patients, mean age 36.8 months (range: 8-80); 53.8% had ectopic ureter, 23% ureterocele, 11.5% sphincteric ureterocele, and 11.5% VUR of the lower system. All were studied preoperatively with urethrocystography and 65% with scintigraphy. 50% of the operated systems showed signs of renal atrophy. The average hospital stay was 2.2 days (range: 1-7). In an average follow-up of 26.5 months (range: 3-77), one patient presented leakage, no patient presented signs suggestive of obstruction, and one patient presented febrile urinary tract infection with persistent lower-grade reflux. CONCLUSION: In our experience, the uretero-ureteral anastomosis technique proved to be an easy and safe alternative to reproduce, with a success rate of 96%, 11% of grade I complications, and 4% of grade II complications according to the Clavien-Dindo classification.

Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review

ABSTRACT Purpose: A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. Materials and Methods: A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. Results: The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. Conclusions: CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review.

PURPOSE: A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. MATERIALS AND METHODS: A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. RESULTS: The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. CONCLUSIONS: CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

Hydronephrosis and Hydroureter Improvement Rates in Robotic-Assisted Laparoscopic Uretero-Ureterostomies: Does Anastomotic Site Matter?

OBJECTIVE: To compare improvement/change of hydronephrosis and hydroureter in patients with complete ureteral duplications that underwent upper and lower robotic-assisted laparoscopic uretero-ureterostomies. The hypothesis being that improvement of hydronephrosis and hydroureter between the two groups was similar. METHODS: 35 subjects met inclusion criteria and were reviewed retrospectively. 'Upper' anastomoses were defined as those being done below the lower pole of the kidney (Group 1), while 'lower' anastomoses were those done below the iliac vessels (Group 2). Primary variables analyzed were antero-posterior and diameter measurements of the renal pelvis and ureter, respectively, before and after surgery. Secondary variables included operative time, length of hospital stay, and complication rates. RESULTS: Group 1 consisted of 20 subjects while Group 2 consisted of 15 subjects. Presenting diagnoses were hydronephrosis in 31 subjects and incontinence in 4 subjects. Group 1 mean AP renal diameters decreased by 62.9% (P<.05), while Group 2 decreased by 65.4% (P<.05). Group 1 mean hydroureter diameter measurements decreased by 80.3% (P<.05), while Group 2 decreased by 83% (P<.05). The improvement in hydronephrosis and hydroureter between the two groups was not statistically different. Group 1 median operative time (271 minutes) was longer than Group 2 (201 minutes) (P<.05). There was no significant difference in hospital stay between the groups and there were no significant complications within the cohort. CONCLUSION: The improvement rate of hydronephrosis and hydroureter is similar in upper versus lower RAL UU. Operative time was significantly shorter in the lower anastomosis group.

How I do it open distal ureteroureterostomy for ectopic ureters in infants with duplex systems and no vesicoureteral reflux under 6 months of age

ABSTRACT We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

Ultrasonographic and radiographic diagnosis of ectopic ureter in a dog

Background: Ureteral ectopia (or ectopic ureter) is a congenital anomaly of the urinary system in which the ureter insertsanywhere other than the vesical trigone. This anatomical change may have unilateral or bilateral involvement. The mostevident clinical sign, occurring mostly in females, is urinary incontinence, however in some cases the condition may progressto nephritis and dilation of the renal pelvis. The diagnosis is established through imaging, and definitive treatment requiressurgical approach. The present study reports a case of ureteral ectopia in a dog which was diagnosed by ultrasound andcontrast radiography (excretory urography) and successfully treated by neoureterostomy.Case: A 10-month-old female American Pit Bull Terrier was attended at the Veterinary Hospital of the Federal Rural University of the Semi-Arid (UFERSA), in Mossoró, RN. Her owner reported incontinence of dark, malodorous urine sincebirth as the chief complaint. After clinical examination, cystitis was suspected, and a complete blood count, urinalysis,and abdominal ultrasound was requested. The blood count and creatinine were within the reference values. The presenceof struvite crystals were found on urinalysis. Ultrasound examination revealed a tortuous, dilated right ureter from therenal pelvis to the urinary bladder; no uroliths were identified as a cause of potential obstruction, but the ipsilateral kidneyshowed increased cortical echogenicity, loss of corticomedullary definition, and moderate pelvic dilation. These findingssupported a presumptive diagnosis of ectopic ureter. For the purpose of confirming this suspicion, excretory urography wasperformed, revealing unilateral ureteral dilation and radiopaque contrast uptake following the path of the urethra. Once thediagnosis was confirmed, surgery was performed to correct the ureteral ectopia using the standard...(AU)

Ultrasonographic and radiographic diagnosis of ectopic ureter in a dog

Background: Ureteral ectopia (or ectopic ureter) is a congenital anomaly of the urinary system in which the ureter insertsanywhere other than the vesical trigone. This anatomical change may have unilateral or bilateral involvement. The mostevident clinical sign, occurring mostly in females, is urinary incontinence, however in some cases the condition may progressto nephritis and dilation of the renal pelvis. The diagnosis is established through imaging, and definitive treatment requiressurgical approach. The present study reports a case of ureteral ectopia in a dog which was diagnosed by ultrasound andcontrast radiography (excretory urography) and successfully treated by neoureterostomy.Case: A 10-month-old female American Pit Bull Terrier was attended at the Veterinary Hospital of the Federal Rural University of the Semi-Arid (UFERSA), in Mossoró, RN. Her owner reported incontinence of dark, malodorous urine sincebirth as the chief complaint. After clinical examination, cystitis was suspected, and a complete blood count, urinalysis,and abdominal ultrasound was requested. The blood count and creatinine were within the reference values. The presenceof struvite crystals were found on urinalysis. Ultrasound examination revealed a tortuous, dilated right ureter from therenal pelvis to the urinary bladder; no uroliths were identified as a cause of potential obstruction, but the ipsilateral kidneyshowed increased cortical echogenicity, loss of corticomedullary definition, and moderate pelvic dilation. These findingssupported a presumptive diagnosis of ectopic ureter. For the purpose of confirming this suspicion, excretory urography wasperformed, revealing unilateral ureteral dilation and radiopaque contrast uptake following the path of the urethra. Once thediagnosis was confirmed, surgery was performed to correct the ureteral ectopia using the standard...

How I do it open distal ureteroureterostomy for ectopic ureters in infants with duplex systems and no vesicoureteral reflux under 6 months of age.

We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

Ureterostomía cutánea como derivación urinaria definitiva en trasplante renal / Cutaneous ureterostomy as definitive urinary diversion in kidney transplant

Introducción. Cerca del 15 % de los pacientes con insuficiencia renal crónica terminal tienen alteraciones de las vías urinarias inferiores. Estas anomalías eran consideradas una contraindicación para el trasplante renal. Por lo anterior, el objetivo del presente trabajo es describir el comportamiento sociodemográfico y clínico de los pacientes trasplantados renales con ureterostomía cutánea como técnica de derivación definitiva de las vías urinarias. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes trasplantados renales con vejiga anormal y ureterostomía cutánea, entre enero de 1973 y octubre de 2012.Resultados. En 4.294 trasplantes renales, se practicaron 24 (0,55 %) ureterostomías, 19 (79,1 %) como técnica inicial y 5 por falla de la ureteroneocistostomía. Diez (41,7 %) ureterostomías fallaron, la mayoría (8 casos) por estenosis. Se presentó infección urinaria en 20 pacientes y la mortalidad fue del 8,3 % (2/24). El 50 % (12/24) de los pacientes con trasplante de riñón estuvieron libres de infección urinaria durante el primer año. La supervivencia del riñón trasplantado fue de 93,8 % (23/24) a los 18 meses, de 85,9 % (20/24) a los 36 meses y de 66,7 % (16/24) a los 50 meses de seguimiento. La supervivencia de los injertos con ureterostomía sin infección fue del 100 % durante el periodo de seguimiento, mientras que la supervivencia de los riñones con infección urinaria fue de 93 % (23/24) a los 18 meses, de 76 % (18/24) a los 36 meses y de 54 % (13/24) a los 50 meses (p=0,235). Conclusiones. La ureterostomía cutánea es una alternativa segura para la derivación urinaria en pacientes tras-plantados renales con alteraciones de la vejiga que no permite su uso o preparación antes del trasplante

Introduction. About 15% of patients with end-stage chronic renal failure have lower urinary tract abnormalities. These abnormalities were considered a contraindication for kidney transplantation. Therefore, the objective of the present work is to describe the sociodemographic and clinical behavior of renal transplant patients with skin ureterostomy as a definitive urinary tract bypass technique.Methods. A descriptive, longitudinal and retrospective study of renal transplant patients with abnormal bladder and skin ureterostomy was conducted between January 1973 and October 2012.Results. We performed 24 (0.55%) ureterostomies in 4.294 kidney transplants. Nineteen (79.1%) were used as first and definitive urinary diversion, and five were ureteroneocystostomies that failed and required ureterostomy as alternative diversion. Ten (41.7%) ureterostomies failed, most (eight cases) from stenosis. Urinary tract infection (UTI) were present in 20 patients and mortality was 8.3% (2/24); 50% (12/24) of kidney transplants were free of urinary tract infection during the first year. The survival of the transplanted kidney was 93.8% (23/24) at 18 months, 85.9% (20/24) at 36 months, and 66.8% (16/24) at 50 months of follow up. The survival of grafts with ureterostomy without urinary tract infection were 100% during the follow-up period, while the survival of the kidneys with UTI was 93% (23/24) at 18 months, 76% (18/24) at 36 months, and 54% (13/24) at 50 months (p=0.235).Conclusions. Cutaneous ureterostomy is a safe alternative for urinary diversion in transplanted renal patients with bladder abnormalities that cannot be prepared or used for a routine diversion before transplantation

Ureterostomias cutânea e colônica em suínos: avaliação da exequibilidade das técnicas / Cutaneous ureterostomies in pigs: technical feasibility assessment

O aumento da expectativa de vida dos animais de companhia favorece a ocorrência de casos de câncer, como o de bexiga. O objetivo da presente pesquisa foi avaliar a exequibilidade da técnica de ureterostomia cutânea em suínos após a realização da cistectomia total, quando comparada à técnica de ureterostomia colônica, assim como detectar e caracterizar possíveis complicações transoperatórias. Foram utilizados 20 animais, distribuídos em dois grupos. Todos foram submetidos à cistectomia radical e, em seguida, à ureterostomia cutânea ou colônica. A exequibilidade das técnicas foi avaliada. Observou-se o tamanho da incisão, o tempo de diérese, de realização da derivação urinária e o tempo de síntese, estimou-se a perda sanguínea e o grau de dificuldade na realização dos procedimentos de preparo dos ureteres, o preparo do sítio de ureteroanastomose e a realização da ureteroanastomose em si. Os resultados indicam que a ureterostomia cutânea apresentou maior eficiência quando comparada à colônica nos quesitos perda de sangue, tamanho da incisão realizada e facilidade de realização da anastomose. Já a ureterocolostomia apresentou melhor resultado referente à execução do preparo ureteral. Assim, concluiu-se que ambas as técnicas podem ser indicadas como derivações urinárias viáveis e que a escolha dependerá de fatores intrínsecos ao cirurgião e ao paciente.(AU)

Increased life expectancy of pets favors the occurrence of cancer, such as the urinary bladder ones. The aim of this study was to evaluate the feasibility of cutaneous ureterostomy technique in pigs after the total cystectomy compared to the technique of colonic ureterostomy, as well as detect and characterize possible intraoperative complications. For that, 20 pigs were used, divided into two groups. All patients underwent radical cystectomy and then the cutaneous or colonic ureterostomies. The technical feasibility was assessed during the procedures. The procedures compared were: the incision size, dieresis time, realization of urinary diversion and the synthesis time. Also, the estimated blood loss and the degree of difficulty in performing the preparation procedures of the ureters, ureteroanastomose site preparation and ureteroanastomose itself were compared. The results indicate that performing cutaneous ureterostomy was better than the colonic ureterostomy in relation to blood loss, incision size, and anastomosis performance. In contrast, ureterocolonostomy showed better results on the implementation of ureteral preparation. Thus, it was concluded that both techniques can be indicated as viable urinary diversions and the choice will depend on factors intrinsic to the surgeon and the patient.(AU)

Ureterostomias cutânea e colônica em suínos: avaliação da exequibilidade das técnicas / Cutaneous ureterostomies in pigs: technical feasibility assessment

O aumento da expectativa de vida dos animais de companhia favorece a ocorrência de casos de câncer, como o de bexiga. O objetivo da presente pesquisa foi avaliar a exequibilidade da técnica de ureterostomia cutânea em suínos após a realização da cistectomia total, quando comparada à técnica de ureterostomia colônica, assim como detectar e caracterizar possíveis complicações transoperatórias. Foram utilizados 20 animais, distribuídos em dois grupos. Todos foram submetidos à cistectomia radical e, em seguida, à ureterostomia cutânea ou colônica. A exequibilidade das técnicas foi avaliada. Observou-se o tamanho da incisão, o tempo de diérese, de realização da derivação urinária e o tempo de síntese, estimou-se a perda sanguínea e o grau de dificuldade na realização dos procedimentos de preparo dos ureteres, o preparo do sítio de ureteroanastomose e a realização da ureteroanastomose em si. Os resultados indicam que a ureterostomia cutânea apresentou maior eficiência quando comparada à colônica nos quesitos perda de sangue, tamanho da incisão realizada e facilidade de realização da anastomose. Já a ureterocolostomia apresentou melhor resultado referente à execução do preparo ureteral. Assim, concluiu-se que ambas as técnicas podem ser indicadas como derivações urinárias viáveis e que a escolha dependerá de fatores intrínsecos ao cirurgião e ao paciente.(AU)

Increased life expectancy of pets favors the occurrence of cancer, such as the urinary bladder ones. The aim of this study was to evaluate the feasibility of cutaneous ureterostomy technique in pigs after the total cystectomy compared to the technique of colonic ureterostomy, as well as detect and characterize possible intraoperative complications. For that, 20 pigs were used, divided into two groups. All patients underwent radical cystectomy and then the cutaneous or colonic ureterostomies. The technical feasibility was assessed during the procedures. The procedures compared were: the incision size, dieresis time, realization of urinary diversion and the synthesis time. Also, the estimated blood loss and the degree of difficulty in performing the preparation procedures of the ureters, ureteroanastomose site preparation and ureteroanastomose itself were compared. The results indicate that performing cutaneous ureterostomy was better than the colonic ureterostomy in relation to blood loss, incision size, and anastomosis performance. In contrast, ureterocolonostomy showed better results on the implementation of ureteral preparation. Thus, it was concluded that both techniques can be indicated as viable urinary diversions and the choice will depend on factors intrinsic to the surgeon and the patient.(AU)

Complicaciones de las derivaciones urinarias heterópicas no continentes: Ureterostomías cutáneas vs conducto ileal / Complications of Non-continent Heteropic Urinary Derivations: Skin Ureterostomies vs Ileal Duct

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.

Estenose ureteral após cistectomia radical associada à ureterostomia cutânea abdominal: relato de caso / Ureteral stricture after radical cystectomy and cutaneous abdominal ureterostomy: case report

O presente trabalho tem como objetivo relatar a realização de cistectomia total associada à ureterostomia abdominal, uma técnica ainda pouco descrita na veterinária, bem como descrever as complicações pós-operatórias observadas. Um canino da raça Akita, macho, 11 anos, castrado, foi atendido com histórico de prostração, hiporexia, disúria, hematúria e incontinência urinária havia aproximadamente 10 dias. No exame clínico, foi observada leve algia abdominal; demais parâmetros estavam dentro da normalidade. Os exames complementares de imagem revelaram presença de massa envolvendo grande parte da vesícula urinária. O paciente foi submetido à cirurgia de cistectomia total associada à implantação cutânea abdominal dos ureteres, e o exame histopatológico chegou ao diagnóstico de carcinoma de células de transicionais (CCT) infiltrativo não papilar. No pós-operatório, o paciente desenvolveu dermatite urêmica leve no local de inserção dos ureteres e estenose ureteral em região distal, de maneira que reintervenções cirúrgicas foram necessárias para a correção. Além disso, observaram-se pielonefrite e hidronefrose secundárias ao quadro obstrutivo. Devido às complicações pós-operatórias, a tutora optou pela eutanásia do cão. Dessa maneira, conclui-se que a estenose ureteral e a pielonefrite são possíveis complicações da técnica de cistectomia associada à implantação abdominal dos ureteres.(AU)

This study aims to report the technique of total cystectomy associated with abdominal ureterostomy, a technique -little described in veterinary medicine, as well as to describe the postoperative complications observed. A male Akita canine, 11 years old, castrated, was attended with a history of prostration, hyporexia, dysuria, hematuria, and urinary incontinence for approximately ten days. The clinical examination revealed mild abdominal pain and other parameters within the normal range. Complementary imaging studies revealed the presence of mass involving a large part of the urinary bladder. The patient underwent total cystectomy surgery associated with abdominal cutaneous implantation of the ureters and histopathological examination led to a diagnosis of non-papillary infiltrative transitional cell carcinoma. In the postoperative period, the patient developed mild uremic dermatitis at the insertion site of the ureters and ureteral stenosis in the distal region, so that surgical reinterventions were necessary for correction. In addition, pyelonephritis and hydronephrosis secondary to the obstructive condition were observed. Due to the postoperative complications, the tutor chose to euthanize the dog. Thus, it is concluded that ureteral stenosis and pyelonephritis are possible complications of the cystectomy technique associated with abdominal implantation of the ureters.(AU)

Tipo de derivación urinaria en el paciente llevado a cistectomía radical, participación del urólogo y tasa de filtración de la anastomosis intestinal / Type of urinary diversion in the patient led to a radical cystectomy, participation of the urologist, and filtration rate of intestinal anastomosis

Objetivo Conocer la prevalencia de cistectomías radicales que se realizan en centros especializados en Colombia, definiendo tipo de derivación intestinal, participantes en su creación, segmento intestinal utilizado y tasa de filtración. Materiales y métodos Se realizó una encuesta a instituciones de salud colombianas que realizan cistectomías radicales de manera rutinaria, se analizaron variables como número de procedimientos por año, segmento intestinal utilizado, tipo de especialidad participante en la anastomosis intestinal y la tasa de filtración de esta. Resultados Quince instituciones colombianas respondieron la encuesta, el número de cistectomías realizadas por año fue: 5/15 (33,3%) más de 15 cirugías al año, 4/15(26,6%) entre 11 y 15 procedimientos al año, 3/15 (20%) entre 5 y 10 y otro 3/15 (20%) entre 1 y 5 cistectomías al año. El 93,3% de las instituciones realizan Bricker como derivación más común; solo una institución (6,7%) lleva a cabo ureterostomías cutáneas. Con respecto a los participantes en la creación de la anastomosis de las 14 instituciones, en 9 (64,2%) es realizada por cirujano general, en 4 (28,5%) la lleva a cabo un urólogo y en una (7,4%) la derivación es realizada por coloproctólogo. La gran mayoría de los centros tiene una incidencia baja de filtración intestinal. Conclusiones En la gran mayoría de las instituciones colombianas el cirujano general y en menor medida el urólogo participan en la creación de la anastomosis intestinal como parte del protocolo de la institución. La filtración es una complicación poco frecuente pero con alta morbimortalidad. Se requiere de entrenamiento por parte del urólogo en formación para lograr mejores resultados.

Objective To determine the prevalence of radical cystectomies that are performed in specialist centres in Colombia, defining the type of intestinal derivation, participants in its creation, intestinal segment used, and filtration rate. Materials and methods A survey was conducted in Colombian health institutions that routinely perform radical cystectomies. An analysis was made of the variables, such as number of procedures per year, intestinal segment used, specialty participating in the intestinal anastomosis, and the rate of filtration. Results A total of 15 health institutions responded to the survey. The number of cystectomies performed per year was; 5/15 (33.3%) with greater than 15 surgeries per year, 4/15 (26.6%) with between 11 and 15 procedures per year, 3/15 (20%) between 5­10/year, and another 3/15 (20%) between 1­5 cystectomies per year. Most (93.3%) of the institutions performed a Bricker as the most common derivation, with only one institution (6.7%) performing cutaneous ureterostomies. As regards the participants in the creation of the anastomosis of the 14 institutions, 9 (64.2%) were performed by a general surgeon, by a urologist in 4 (28.5%), and a coloproctologist performed the shunt in one (7.4%). The vast majority of centres have a low incidence of intestinal filtration. Conclusions In the great majority of Colombian institutions, the general surgeon, and to a lesser extent the urologist, participate in the creation of intestinal anastomosis as part of the protocol of the institution. Filtration is a rare complication, but with a high morbidity and mortality. Training by the urologist during training is required to achieve better results.

Estenose ureteral após cistectomia radical associada à ureterostomia cutânea abdominal: relato de caso / Ureteral stricture after radical cystectomy and cutaneous abdominal ureterostomy: case report

O presente trabalho tem como objetivo relatar a realização de cistectomia total associada à ureterostomia abdominal, uma técnica ainda pouco descrita na veterinária, bem como descrever as complicações pós-operatórias observadas. Um canino da raça Akita, macho, 11 anos, castrado, foi atendido com histórico de prostração, hiporexia, disúria, hematúria e incontinência urinária havia aproximadamente 10 dias. No exame clínico, foi observada leve algia abdominal; demais parâmetros estavam dentro da normalidade. Os exames complementares de imagem revelaram presença de massa envolvendo grande parte da vesícula urinária. O paciente foi submetido à cirurgia de cistectomia total associada à implantação cutânea abdominal dos ureteres, e o exame histopatológico chegou ao diagnóstico de carcinoma de células de transicionais (CCT) infiltrativo não papilar. No pós-operatório, o paciente desenvolveu dermatite urêmica leve no local de inserção dos ureteres e estenose ureteral em região distal, de maneira que reintervenções cirúrgicas foram necessárias para a correção. Além disso, observaram-se pielonefrite e hidronefrose secundárias ao quadro obstrutivo. Devido às complicações pós-operatórias, a tutora optou pela eutanásia do cão. Dessa maneira, conclui-se que a estenose ureteral e a pielonefrite são possíveis complicações da técnica de cistectomia associada à implantação abdominal dos ureteres.(AU)

This study aims to report the technique of total cystectomy associated with abdominal ureterostomy, a technique -little described in veterinary medicine, as well as to describe the postoperative complications observed. A male Akita canine, 11 years old, castrated, was attended with a history of prostration, hyporexia, dysuria, hematuria, and urinary incontinence for approximately ten days. The clinical examination revealed mild abdominal pain and other parameters within the normal range. Complementary imaging studies revealed the presence of mass involving a large part of the urinary bladder. The patient underwent total cystectomy surgery associated with abdominal cutaneous implantation of the ureters and histopathological examination led to a diagnosis of non-papillary infiltrative transitional cell carcinoma. In the postoperative period, the patient developed mild uremic dermatitis at the insertion site of the ureters and ureteral stenosis in the distal region, so that surgical reinterventions were necessary for correction. In addition, pyelonephritis and hydronephrosis secondary to the obstructive condition were observed. Due to the postoperative complications, the tutor chose to euthanize the dog. Thus, it is concluded that ureteral stenosis and pyelonephritis are possible complications of the cystectomy technique associated with abdominal implantation of the ureters.(AU)

Radical Cystectomy and Cutaneous Ureterostomy in 4 Dogs with Trigonal Transitional Cell Carcinoma: Description of Technique and Case Series.

OBJECTIVE: To describe radical cystectomy followed by cutaneous ureterostomy as a treatment of invasive bladder neoplasia in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs with transitional cell carcinoma of the bladder trigone (n=4). METHODS: Perioperative complications and long-term outcomes of dogs that underwent cutaneous ureterostomy following radical cystectomy and lymphadenectomy for transitional cell carcinoma of the urinary bladder trigone were reviewed. Both ureters were transected and anastomosed to the ventral abdominal skin. Polyvinyl chloride catheters were placed in the ureteral stomas and maintained for 5 days. After catheter removal, dogs were managed with an absorbent diaper over the stomas. Long-term outcome and survival were documented by follow-up visits or phone contact. RESULTS: Median age at the time of surgery was 10.3 years (range, 8-12). Average procedural time was ∼4.7 hours (range, 3.8-6.1). Minor complications occurred in all dogs, including bleeding and edema of the ureterostomy site during the first 2-3 days after surgery. One dog developed urine scald that resolved with improved stoma care and hygiene. Median survival time after surgery was 278.6 days (range, 47-498). Distant metastases were documented in 2 dogs at 47 days (bone) and 369 days (lung) after surgery. CONCLUSION: Radical cystectomy with cutaneous ureterostomy is a viable salvage procedure for urinary diversion after cystectomy in dogs with invasive bladder neoplasia. Postoperative management and quality of life were considered acceptable by most owners. Future studies are warranted to evaluate survival time in a larger number of animals.

Carcinogenesis in rats subjected to a new model ureterosigmoidostomy and treated with L-lysine

ABSTRACT PURPOSE: To evaluate the effects of L-lysine on the intestinal and urothelial epithelium of rats subjected to ureterosigmoidostomy (new model for surgical carcinogenesis). METHODS: Forty-two rats, 9 weeks of age, were divided into 6 groups. Animals in groups A, B, C were subjected to ureterosigmoidostomy (US) and treated with L-lysine, celecoxib and H2O, respectively. Groups D, E and F (non-operated controls) received L-lysine, celecoxib and H2O, respectively. The L-lysine dose was 150 mg/kg and that of celecoxib was 20 mg/kg. The colon was analyzed for the presence of aberrant crypt foci (ACF) under a stereomicroscope.The tissue was stained with hematoxylin and eosin and PAS alcian blue. RESULTS: There were rare ACF, and there was no statistically significant difference between the groups. Histopathologic study of the ureteral epithelium identified moderate to severe urothelial hyperplasia in rats with ureterosigmoidostomy. Transitional hyperplasia in the ureters of animals receiving L-lysine (A) showed an apparent difference compared to the control (C) (P=0.2424). There was no dysplasia or atypia CONCLUSION: L-lysine does not promote carcinogenesis of the intestinal and urethelial epithelium of rats subjected to ureterosigmoidostomy at the doses and times studied.