Treatment of long ureteric strictures with a free peritoneal graft: long-term results.

ZIEL DER STUDIE: Beschreibung einer neuen Technik zur Rekonstruktion von komplexen Ureterstrikturen unter Verwendung eines freien Peritoneallappens. MATERIAL UND METHODEN: Zwischen 2006 und 2021 behandelten wir 11 Patienten mit langen komplexen Harnleiterstrikturen, die in 9 Fällen den mittleren- und in 2 Fällen den proximalen Harnleiter betrafen. Die Länge der Strikturen variierte von 3 bis 12 cm (Mittelwert 7 cm). In drei Fällen handelte es sich um eine retroperitoneale Fibrose nach einem gefäßchirurgischen Eingriff, in zwei Fällen um einen Morbus Ormond, in vier Fällen um eine ausgedehnte Resektion großer Harnleitertumoren, in drei Fällen um wiederholte endoskopische Eingriffe bei Harnsteinen und in einem Fall um eine viermal fehlgeschlagene Pyeloplastik. Der Harnleiter wurde längs gespalten, ein freier Peritoneallappen aus dem nahe gelegenen gesunden Bauchfell entnommen und nach Positionierung eines Harnleiterkatheters als Onlay-Patch mit einer fortlaufenden Naht an der verbleibenden Harnleiterplatte fixiert. Der Ureter wurde zuletzt mit Omentum gedeckt. ERGEBNISSE: Die Nachbeobachtungszeit reichte von 12 bis 122 (Mittelwert 61,6) Monate. Sieben Patienten waren nach 12, 18, 60, 78, 98, 99 und 122 Monaten (Mittelwert 69,5 Monate) rezidivfrei, ohne Erweiterung des oberen Harntrakts und mit normaler Nierenfunktion. Bei vier Patienten kam es zu einem Rezidiv: Bei einem Patienten wurde das Rezidiv nach 60 Monaten ohne Symptome und mit leichter Hydronephrose festgestellt, ohne dass eine Operation erforderlich war. Bei einem Patienten mit Morbus Ormond trat das Rezidiv 6 Monate nach dem Eingriff symptomlos im distalen Teil des 10 cm langen Omlays auf. Es wurde eine Resektion des stenotischen Segments mit Psoas-Hitch durchgeführt. Bei den beiden anderen Patienten trat 3 und 6 Monate nach dem Eingriff eine Obstruktion unterhalb des rekonstruierten Segments mit Hydronephrose auf, ohne dass die Nierenfunktion beeinträchtigt war. Bei diesen Patienten wurde keine weitere Operation durchgeführt. Die Limitation dieser Studie besteht in der kleinen Studiengröße, die auf die strenge Indikationsstellung zurückzuführen ist. SCHLUSSFOLGERUNGEN: Die beschriebene Technik ermöglicht den Erhalt der verbleibenden Gefäßversorgung des Harnleiters und stellt eine praktikable und nützliche Alternative zu Nephrektomie, Ileum-Ureter, Uretero-Uretero-Stomie und Autotransplantation in hochselektierten Fällen dar.

[Bladder hernia: report of a case series and review of the literature]. / Die Blasenhernie: eine Fallserie und Review der Literatur.

Inguinal bladder hernia accounts for only 1 - 4 % of all inguinal hernias. It may be difficult to diagnose due to the atypical symptoms. In most cases, the diagnosis is only made intraoperatively. However, a preoperative diagnosis is important to avoid possible iatrogenic complications. We report a case series of five patients with the rare pathology of bladder hernia treated in our department in the past 20 years.

Efficacy and Safety of Two Fosfomycin Regimens as Antimicrobial Prophylaxis for Transrectal Prostate Biopsy: A Randomised Study.

PURPOSE: Prostate biopsy is the gold standard for prostate cancer diagnosis; unfortunately, this procedure is not free from complications. Recent studies have shown an increase in antibiotic resistance. The aim of our prospective randomized study was to evaluate the efficacy and safety of a prostate biopsy prophylaxis protocol using 2 vs. 3 fosfomycin doses. METHODS: Two hundred and ninety-seven patients undergoing transrectal systematic ultrasound (US)-guided (n = 277) or transrectal fusion prostate biopsy (n = 20) were prospectively evaluated and randomized by date of birth, to receive 2 (even years, group A) versus 3 doses of fosfomycin (odd years, group B), and prospectively evaluated. RESULTS: Two hundred and ninety-seven patients were randomized to group A (n = 162) or group B (n = 135). The 2 groups were comparable with respect to age, comorbidity, PSA value, prostate volume, operative time and urine culture results. Out of 297 patients, 44 (14.8%) developed complications after the procedure; 2.7% (8/297) of patients developed fever >38° requiring hospitalization (6 [3.7%] in group A and 2 [1.5%] in group B, p = 0.29). Patients who underwent fusion biopsy were more frequently readmitted in comparison with patients undergoing US-guided prostate biopsy (p = 0.000). CONCLUSION: The low fever and prostatitis rate suggest that fosfomycin prophylaxis is safe and efficient. There is no significant difference in clinical outcome between the 2 dosage regimens.

Use and duration of antibiotic prophylaxis and the rate of urinary tract infection after radical cystectomy for bladder cancer: Results of a multicentric series.

OBJECTIVES: To assess the rate of urinary tract infection (UTI), the characteristics of the bacterial aetiological agents involved, the type and duration of antibiotics used, and the clinical risk factors of UTI in a multi-institutional cohort of patients who had undergone radical cystectomy (RC). PATIENTS AND METHODS: The pre- and postoperative characteristics of patients who had undergone open RC at 1 of 3 institutions between 2009 and 2015 were analyzed by means of the patient charts. Patients were classified according to the presence or absence of UTI. Analysis of the severity of UTI was based on the EAU/EAU Section of Infections in Urology (ESIU) classification system. The bacterial aetiological agents and their antibiotic susceptibility were also assessed. Factors predicting postoperative UTI were identified using univariable and multivariable logistic regression analysis. RESULTS: Of 217 patients, 42 (19.4%) had developed postoperative UTI, of whom 50% had urosepsis or uroseptic shock. Multivariable analysis showed continent urinary derivation as the only significant predictor of UTI with an odds ratio of 5.03 (95% confidence interval 2.12-11.9, P < 0.001). The duration of perioperative antibiotic prophylaxis was not associated with an increased risk of UTI. Enterococcus was the most commonly isolated bacteria (25.7%), but this species is not covered by the recommended antibiotic prophylaxis. CONCLUSION: Patients with continent urinary diversion after RC have a significantly higher risk of developing UTI. Prolonged perioperative administration of antibiotics does not seem to reduce the risk of UTI. Enterococcus as the most commonly isolated bacteria is not covered by most recommended antibiotic prophylaxis regimens. Therefore different antibiotic regimens should be considered for high-risk patients.

Radical cystectomy: do we need standardization?

INTRODUCTION: The first series of radical cystectomy with a definition of surgical landmarks was published in 1949 and was characterized by a high perioperative mortality and a 5-year survival rate around 50%. Decades later, nevertheless many surgical progresses were made and the perioperative mortality dropped to 2,5%, this had not lead to an improvement of long term survival rates, also because a standardization of the procedure is still missing. Areas covered: Radical cystectomy is performed with different surgical techniques obmitting a standardization. The comparability of many studies is therefore difficult or havely compromised. A paragon with other diciplines was made emphazing that there high surgical quality is defined, measured and controlled. A systematic literature search was made selecting finally 76 article adressing this issue. Expert commentary: Surgical guidelines in uro-oncology are vague and a definition of surgical quality is missing. A view outside of the box could be very helpful. This is a plea for a change.