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1.
Zhonghua Wai Ke Za Zhi ; 57(11): 853-859, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694135

RESUMO

Objective: To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum. Methods: This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition. Conclusion: In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.


Assuntos
Íleo/transplante , Peritônio/transplante , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Cistectomia , Feminino , Modelos Animais , Distribuição Aleatória , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Suínos , Transplante Autólogo
2.
J Urol ; 202(4): 757-762, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31120374

RESUMO

PURPOSE: We report long-term data on a large cohort of adults who underwent formation of a continent catheterizable channel for various indications. We examined outcomes according to the tissue used for channel formation. MATERIALS AND METHODS: We retrospectively reviewed the case notes of 176 consecutive adult patients in whom a continent catheterizable channel was created using the Mitrofanoff principle for a broad range of indications a median of 142 months (range 54 to 386) previously. We evaluated outcomes in terms of continued use and continence for each type of material used for channel formation. RESULTS: At the time of this review 165 of the 173 patients (95.4%) included in this study were alive. We included 114 women (65.9%) and 59 men (34.1%) who underwent surgery at a median age of 42 years (range 18 to 73) with a mean followup of 78.6 months (median 60, range 2 to 365). The rate of revision for all causes was higher in the ileal group than in the group with an appendiceal channel (channel stenosis rate 22.7% vs 17.2%, p = 0.39, and channel incontinence rate 36.0% vs 19.5%, p = 0.03). Although 38.7% of patients underwent major surgical revision of the channel at some point, 75.9% of channels continued to be used, of which 90.2% were continent. CONCLUSIONS: This study provides a pragmatic overview of the outcome of these challenging cases. Mitrofanoff channel formation represents a durable technique. Appendix and ileum are each a viable choice for tissue use. Tissue selection depends on availability and individual patient factors.


Assuntos
Apêndice/transplante , Íleo/transplante , Cateterismo Urinário/métodos , Coletores de Urina , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Transtornos Urinários/etiologia , Transtornos Urinários/cirurgia , Adulto Jovem
3.
Urology ; 129: e2-e3, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009745

RESUMO

Malignant neoplasm arising from ileal ureter used for ureteral reconstructive surgery is an exceedingly rare event. Ureteroileoplasty was being performed since the beginning of the last century, but it was described more extensively in literature during the 1950s.1,2 Recurrent urinary infections, chronic renal failure, urolithiasis, anastomotic stricture, metabolic acidosis, and chronic dilation of the graft had been described as late complications of ureteroileoplasty.3,4 Herein, we describe history, imaging and pathologic findings of a small bowel adenocarcinoma arising from ileal ureter in a woman of 78-year-old, subjected to ureteroileoplasty about 40 years earlier.


Assuntos
Adenocarcinoma , Neoplasias do Íleo , Íleo/transplante , Ureter/cirurgia , Adenocarcinoma/diagnóstico , Idoso , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Complicações Pós-Operatórias , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos/métodos
4.
Urology ; 124: 286-291, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30468754

RESUMO

OBJECTIVE: To illustrate our technique to construct the Institute of Urology Peking University (IUPU) orthotopic ileal bladder and present our initial experience. METHODS: From August 2017 to April 2018, 12 patients with bladder cancer underwent radical cystectomy (RC), pelvic lymph node dissection and extracorporeal construction of an IUPU neobladder (IUPUB) by an experienced surgeon. We present the demographic, clinicopathologic, perioperative, and follow-up data. We also describe our step-by-step surgical technique for the IUPUB in this article. RESULTS: Laparoscopic RC with an extracorporeal IUPUB was successfully accomplished in 11 patients, and 1 patient was converted to open RC with an IUPUB. The median total operative time and median time spent suturing the pouch were 248 minutes and 23 minutes, respectively. The median estimated blood loss was 150 mL. The median time to recovery of bowel function (tolerance of a liquid diet) was 3½ days. The urinary catheter was removed on post-operative day 21 in 10 patients. The ureteral stents and stoma catheter were removed on day 7 after cystography. At a median followup of 7½ months, 2 patients had early complications (<30 days), and no major complications (grade ≥ 3) occurred. The follow-up outcomes were satisfactory. The limitations included the small sample size and short-term outcomes. CONCLUSION: Our technique of constructing the IUPUB is feasible and safe. The operative time and early complication rates are acceptable.


Assuntos
Cistectomia/métodos , Laparoscopia , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Feminino , Seguimentos , Humanos , Íleo/transplante , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos
5.
BMC Urol ; 18(1): 73, 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30170590

RESUMO

BACKGROUND: To explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution. METHODS: A retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed. RESULTS: A total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened. CONCLUSIONS: A total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.


Assuntos
Íleo/transplante , Ureter/cirurgia , Neoplasias Ureterais/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Ureterais/mortalidade , Neoplasias da Bexiga Urinária , Procedimentos Cirúrgicos Urológicos/métodos
6.
J Crohns Colitis ; 12(11): 1348-1358, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30165600

RESUMO

Background and Aims: pH-sensing ovarian cancer G-protein coupled receptor-1 [OGR1/GPR68] is regulated by key inflammatory cytokines. Patients suffering from inflammatory bowel diseases [IBDs] express increased mucosal levels of OGR1 compared with non-IBD controls. pH-sensing may be relevant for progression of fibrosis, as extracellular acidification leads to fibroblast activation and extracellular matrix remodelling. We aimed to determine OGR1 expression in fibrotic lesions in the intestine of Crohn's disease [CD] patients, and the effect of Ogr1 deficiency in fibrogenesis. Methods: Human fibrotic and non-fibrotic terminal ileum was obtained from CD patients undergoing ileocaecal resection due to stenosis. Gene expression of fibrosis markers and pH-sensing receptors was analysed. For the initiation of fibrosis in vivo, spontaneous colitis by Il10-/-, dextran sodium sulfate [DSS]-induced chronic colitis and the heterotopic intestinal transplantation model were used. Results: Increased expression of fibrosis markers was accompanied by an increase in OGR1 [2.71 ± 0.69 vs 1.18 ± 0.03, p = 0.016] in fibrosis-affected human terminal ileum, compared with the non-fibrotic resection margin. Positive correlation between OGR1 expression and pro-fibrotic cytokines [TGFB1 and CTGF] and pro-collagens was observed. The heterotopic animal model for intestinal fibrosis transplanted with terminal ileum from Ogr1-/- mice showed a decrease in mRNA expression of fibrosis markers as well as a decrease in collagen layer thickness and hydroxyproline compared with grafts from wild-type mice. Conclusions: OGR1 expression was correlated with increased expression levels of pro-fibrotic genes and collagen deposition. Ogr1 deficiency was associated with a decrease in fibrosis formation. Targeting OGR1 may be a potential new treatment option for IBD-associated fibrosis.


Assuntos
Colite/genética , Colágeno/genética , Doença de Crohn/genética , Doença de Crohn/patologia , Mucosa Intestinal/patologia , RNA Mensageiro/metabolismo , Receptores Acoplados a Proteínas-G/genética , Actinas/genética , Animais , Biomarcadores , Colite/induzido quimicamente , Colágeno/metabolismo , Colágeno Tipo I/genética , Colágeno Tipo III/genética , Fator de Crescimento do Tecido Conjuntivo/genética , Sulfato de Dextrana , Feminino , Fibrose , Expressão Gênica , Humanos , Íleo/metabolismo , Íleo/patologia , Íleo/transplante , Mucosa Intestinal/metabolismo , Masculino , Camundongos , Camundongos Knockout , Fator de Crescimento Transformador beta1/genética , Transplante Heterotópico , Vimentina/genética
7.
Urologiia ; (3): 129-133, 2018 Jul.
Artigo em Russo | MEDLINE | ID: mdl-30035433

RESUMO

Ureteral resection for the mid-ureter urothelial carcinoma is the operation of choice in patients with low-grade tumors. However, extensive excision within normal tissues may lead to difficulty in appropriate apposition of the ends of the ureter, while incomplete resection increases the risk of oncological progression. This article describes the first experience with laparoscopic segmental ureteral resection with the ileal - ureter substitution for mid-ureter urothelial carcinoma. In this case, a short non-reconfigurated segment of the ileum was interposed between the distal and proximal ends of the resected ureter. Operative time was 230 min, and blood loss was less than 100 ml. No complications were observed. The patients postoperative hospital stay was seven days. Follow-up examination 12 months after surgery showed no evidence of the disease progression and preserved normal renal function. The proposed method may be considered as an alternative treatment for carefully selected patients.


Assuntos
Carcinoma de Células de Transição/cirurgia , Íleo/transplante , Ureter/cirurgia , Neoplasias Ureterais/cirurgia , Carcinoma de Células de Transição/diagnóstico por imagem , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento , Neoplasias Ureterais/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos/métodos
8.
Can J Urol ; 25(3): 9334-9339, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29900822

RESUMO

INTRODUCTION: Classic surgical teaching advocates for closure of the mesenteric defect (MD) after bowel anastomosis but the necessity is controversial. We sought to evaluate the necessity of MD closure at the time of harvest of ileum for genitourinary reconstructive surgery (GURS) by analyzing the incidence of early and late gastrointestinal adverse events (GIAE) in patients with and without MD closure. MATERIALS AND METHODS: A retrospective review was conducted on patients undergoing urologic reconstruction with ileum to identify incidence of ileus, small bowel obstruction (SBO), gastrointestinal (GI) fistula and stoma complications. Patient and procedure variables were analyzed to identify risk factors for GIAE. RESULTS: A total of 288 patients met inclusion criteria and 93% of GURS was for urinary diversion following cystectomy. MD was closed in 194 cases (67%). Median follow up was 19 months. Early (< 30 day) GIAE rates were 16.5% (n = 32) and 21.3% (n = 20) in the closure and non-closure groups, respectively (p = 0.22). The rate of early ileus/SBO requiring nasogastric tube decompression or laparotomy were similar after closure (15.0%) and non-closure (21.3%) (p = .18). The late GIAE rates were 5.7% (n = 11) and 6.4% (n = 6) in the closure and non-closure cohorts, respectively (p = 0.56). The rate of late SBO were similar and no cases of early or late SBO in either cohort were due to internal herniation. On multivariate analysis, increasing BMI was associated with both early and late GIAE. CONCLUSIONS: After harvesting ileum for urologic reconstruction, the MD can safely be left open as we found no association between non-closure and early or late GIAE..


Assuntos
Cistectomia/métodos , Íleo/transplante , Mesentério/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Derivação Urinária/métodos , Idoso , Anastomose Cirúrgica/métodos , Estudos de Coortes , Cistectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Íleo/cirurgia , Obstrução Intestinal/prevenção & controle , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Mesentério/lesões , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Coleta de Tecidos e Órgãos , Resultado do Tratamento , Derivação Urinária/efeitos adversos
9.
J Thorac Cardiovasc Surg ; 156(2): 859-866, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29753503

RESUMO

BACKGROUND: The incidence of metachronous esophageal squamous cell cancer (ESCC) after head and neck cancer (HNC) and in elderly patients has increased. Both elderly ESCC patients and ESCC patients after HNC surgery are at potential risk for dysphagia, and for the latter, surgery in the neck is difficult. An intrathoracic anastomosis that bypasses the cervical procedure is preferable to preserve swallowing function and reduce surgical risk. In gastrectomized patients, because the stomach cannot be used as a substitute, securing graft blood supply is critical, but microvascular anastomosis cannot be easily added in procedures for intrathoracic posterior mediastinal reconstruction. Thus, we have developed a novel technique for esophageal reconstruction in gastrectomized patients who are elderly or who had undergone HNC surgery, enabling concomitant intrathoracic anastomosis and microvascular anastomosis. The purpose of this study was to evaluate the usefulness and safety of this technique. METHODS: The jejunal or ileocolic graft is first pulled up through the anterior mediastinum and is then passed into the right thoracic cavity via a small hole made in the anterior mediastinal pleura. The graft is finally anastomosed with the remnant esophagus in the upper posterior mediastinum. Thereafter, microvascular anastomosis is performed in the retrosternal space. RESULTS: Four patients underwent this new reconstruction procedure with no significant postoperative complications, good swallowing function postoperatively, and no retention of food in the graft. CONCLUSIONS: This novel transmediastinal reconstruction technique is a possible option for highly selected patients to enable intrathoracic anastomosis and the addition of microvascular anastomosis.


Assuntos
Anastomose Cirúrgica/métodos , Esôfago/cirurgia , Mediastino/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Esofagectomia , Feminino , Humanos , Íleo/transplante , Jejuno/transplante , Masculino , Pessoa de Meia-Idade
10.
J Pediatr Urol ; 14(4): 346-347, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29778698

RESUMO

This video provides a case report of a 16-year-old male patient who underwent bladder enlargement with a catheterized conduit under Macedo's technique. This technique involves the use of a segment of the distal ileum with a flap that is used for confection of the conduit. Key points include: 1) skin incision planning; 2) bladder release to allow a tension-free anastomosis; 3) reservoir and a conduit creation with a distal ileum; and 4) creation of a continence mechanism.


Assuntos
Íleo/transplante , Cateterismo Urinário , Coletores de Urina , Adolescente , Humanos , Masculino , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Urológicos/métodos
11.
BJU Int ; 121(6): 952-958, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29388351

RESUMO

OBJECTIVE: To describe the surgical outcomes of ileal vaginoplasty in transgender women and patients with disorders of sex development (DSD). PATIENTS AND METHODS: Transgender women and patients with DSD, who underwent ileal vaginoplasty at the VU University Medical Center Amsterdam, University Hospital Trieste, University Hospital Essen, and Belgrade University Hospital, were retrospectively identified. A chart review was performed, recording surgical technique, intraoperative characteristics, complications, and re-operations. RESULTS: We identified a total of 32 patients (27 transgender and five non-transgender), with a median (range) age of 35 (6-63) years. Ileal vaginoplasty was performed as the primary procedure in three and as a revision procedure in the remaining 29. The mean (sd) operative time was 288 (103) min. The procedure was performed laparoscopically (seven patients) or open (25). An ileal 'U-pouch' was created in five patients and a single lumen in 27. Intraoperative complications occurred in two patients (one iatrogenic bladder damage and one intraoperative blood loss necessitating transfusion). The median (range) hospitalisation was 12 (6-30) days. Successful neovaginal reconstruction was achieved in all. The mean (sd) achieved neovaginal depth was 13.2 (3.1) cm. The median (range) clinical follow-up was 35 (3-159) months. In one patient a recto-neovaginal fistula occurred, which lead to temporary ileostomy. Introital stenosis occurred in four patients (12.5%). CONCLUSION: Ileal vaginoplasty can be performed with few intra- and postoperative complications. It appears to have similar complication rates when compared to sigmoid vaginoplasty. It now seems to be used predominantly for revision procedures.


Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Cirurgia de Readequação Sexual/métodos , Vagina/cirurgia , Adolescente , Adulto , Órgãos Artificiais , Criança , Feminino , Humanos , Íleo/transplante , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Pessoas Transgênero , Transexualismo/cirurgia , Adulto Jovem
12.
Urology ; 115: 157-161, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29447946

RESUMO

OBJECTIVE: To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). METHODS: A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. RESULTS: A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P = .0001). CONCLUSION: Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.


Assuntos
Extrofia Vesical/cirurgia , Colo/transplante , Íleo/transplante , Reoperação , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Tamanho do Órgão , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fatores de Risco
13.
J Surg Oncol ; 117(3): 459-468, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29094356

RESUMO

BACKGROUND: Several surgical options exist for the reconstruction of total pharyngolaryngectomy defect. The purpose of this report is to present our experience with ileocolon flap for simultaneous reconstruction of both esophagus and voice. METHODS: Demographic data, clinical information, and outcomes of 205 patients who underwent the ileocolon flap procedure over the last 35 years were examined. Preoperative evaluation, intraoperative details, and postoperative management were analyzed. The types of additional procedures performed to improve outcomes were explored. RESULTS: Of the 205 patients, 191 had a free ileocolon flap and the remaining 14 a pedicled flap. Ninety-seven percent of the flaps were successful with a fistula rate of 5.4%. Seven patients required reexploration and six flaps failed. Seventy-eight percent of the patients reported their swallowing function to be very good to excellent. Speech function was rated as good in 64% of patients and moderate in 21%. Three patients develop bowel obstruction, two of which required enterolysis. Five patients had postoperative diarrhea that responded to conservative measures. CONCLUSION: Reconstruction of pharyngoesophageal defects with ileocolon flap permits resumption of swallowing and production of speech without the need for voice prosthesis and with minimal complications.


Assuntos
Esôfago/cirurgia , Retalhos de Tecido Biológico/transplante , Íleo/transplante , Neoplasias Laríngeas/cirurgia , Neoplasias Faríngeas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Voz/fisiologia , Adulto , Feminino , Humanos , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Faringectomia/métodos , Neoplasias da Glândula Tireoide/cirurgia
14.
Urology ; 113: 235-240, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29197522

RESUMO

OBJECTIVE: To evaluate the mechanical properties of gastrointestinal (GI) tissue segments and to compare them with the urinary bladder for urinary tract reconstruction. METHODS: Urinary bladders and GI tissue segments were sourced from porcine models (n = 6, 7 months old [5 male; 1 female]). Uniaxial planar tension tests were performed on bladder tissue, and Cauchy stress-stretch ratio responses were compared with stomach, jejunum, ileum, and colonic GI tissue. RESULTS: The biomechanical properties of the bladder differed significantly from jejunum, ileum, and colonic GI tissue. Young modulus (kPa-measure of stiffness) of the GI tissue segments was on average 3.07-fold (±0.21 standard error) higher than bladder tissue (P < .01), and the strain at Cauchy stress of 50 kPa for bladder tissues was on average 2.27-fold (±0.20) higher than GI tissues. There were no significant differences between the averaged stretch ratio and Young modulus of the horizontal and vertical directions of bladder tissue (315.05 ± 49.64 kPa and 283.62 ± 57.04, respectively, P = .42). However, stomach tissues were 1.09- (±0.17) and 0.85- (±0.03) fold greater than bladder tissues for Young modulus and strain at 50 kPa, respectively. CONCLUSION: An ideal urinary bladder replacement biomaterial should demonstrate mechanical equivalence to native tissue. Our findings demonstrate that GI tissue does not meet these mechanical requirements. Knowledge on the biomechanical properties of bladder and GI tissue may improve development opportunities for more suitable urologic reconstructive biomaterials.


Assuntos
Íleo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Engenharia Tecidual/métodos , Sistema Urinário/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Materiais Biocompatíveis , Fenômenos Biomecânicos , Feminino , Íleo/transplante , Masculino , Teste de Materiais , Modelos Animais , Sensibilidade e Especificidade , Estresse Mecânico , Retalhos Cirúrgicos/transplante , Suínos , Bexiga Urinária
15.
Urology ; 114: 193-197, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29180072

RESUMO

OBJECTIVE: To assess perioperative, clinical, and functional outcomes following completely robotic ileal ureter. METHODS: We retrospectively reviewed 7 consecutive patients undergoing completely intracorporeal ileal ureteric replacement between November 2015 and May 2017. One patient had a solitary kidney. A 4-arm technique was used. In 5 patients, additional psoas hitch procedure was performed. Patients had retrograde filling and removal of the ileal stent and transurethral catheter at an average of 14 days postoperatively. Renal ultrasonography, serum analysis, and diuretic renography were performed at follow-up 3 months postoperatively. RESULTS: Mean operative time was 328 ± 66.3 minutes and median estimated blood loss was 100 mL (range 50-200); mean length of the ileal substitute was 20.4 cm (range 18-24). No case was converted to open surgery. In 1 patient, there was a prolonged insufficiency of the pyeloileal anastomosis, requiring prolonged stenting. Apart from that, there were no major complications and no open surgical or endoscopic reinterventions. On 3-month follow-up, all patients presented symptom-free, with no signs of obstruction on ultrasound and significantly improved glomerular filtration rate, creatinine levels, and differential renal function (P = .02, 0.03, and 0.046, respectively). Five patients had a diuretic halftime <10 minutes, 2 had a halftime between 10 and 20 minutes. CONCLUSION: Completely intracorporeal robotic ileal ureteric replacement results in full functional restoration of the upper tract in cases of long defects of the mid and upper ureter.


Assuntos
Íleo/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Stents , Procedimentos Cirúrgicos Urológicos/métodos
16.
Eur Urol ; 73(6): 934-940, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-27780643

RESUMO

BACKGROUND: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction is a challenging procedure. The need for surgical skills and the long operative times have led to concern about its reproducibility. OBJECTIVE: To illustrate our technique for RARC and totally intracorporeal orthotopic Padua ileal bladder. DESIGN, SETTING, AND PARTICIPANTS: From August 2012 to February 2014, 45 patients underwent this technique at a single tertiary referral centre. SURGICAL PROCEDURE: RARC, extended pelvic lymph node dissection, and intracorporeal partly stapled neobladder. Surgical steps are demonstrated in the accompanying video. MEASUREMENTS: Demographics, clinical, and pathological data were collected. Perioperative, 2-yr oncologic and 2-yr functional outcomes were reported. RESULTS AND LIMITATIONS: Intraoperative transfusion or conversion to open surgery was not necessary in any case and intracorporeal neobladder was successfully performed in all 45 patients. Median operative time was 305min (interquartile range [IQR]: 282-345). Median estimated blood loss was 210ml (IQR: 50-250). Median hospital stay was 9 d (IQR: 7-12). The overall incidence of perioperative, 30-d and 180-d complications were 44.4%, 57.8%, and 77.8%, respectively, while severe complications occurred in17.8%, 17.8%, and 35.5%, respectively. Two-yr daytime and night-time continence rates were 73.3% and 55.5%, respectively. Two-yr disease free survival, cancer specific survival, and overall survival rates were 72.5%, 82.3%, and 82.4%, respectively. The small sample size and high caseload of the centre might affect the reproducibility of these results. CONCLUSIONS: Our experience supports the feasibility of totally intracorporeal neobladder following RARC. Operative times and perioperative complication rates are likely to be reduced with increasing experience. PATIENT SUMMARY: We report the outcomes of our first 45 consecutive patients who underwent robot-assisted radical cystectomy with intracorporeal neobladders. Perioperative, oncologic, and functional outcomes support this technique as a feasible and safe surgical option in tertiary referral centres.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Íleo/transplante , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Idoso , Perda Sanguínea Cirúrgica , Cistectomia/efeitos adversos , Intervalo Livre de Doença , Enurese Diurna/etiologia , Feminino , Humanos , Tempo de Internação , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Enurese Noturna/etiologia , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Taxa de Sobrevida , Incontinência Urinária/etiologia , Coletores de Urina/efeitos adversos , Coletores de Urina/fisiologia
17.
Urology ; 111: 203-207, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28818535

RESUMO

OBJECTIVE: To investigate the functional outcomes of ileal ureter replacement for complex ureteral loss, including bilateral and single ureter stricture, as a result of various etiologies. METHODS: In 2013-2016, 31 patients underwent ileal ureter replacement surgery. The data for their assessments included etiology, combined surgical procedures, ureteral replacement type, postoperative complications, and changes in renal function. RESULTS: The 31 study patients had a median age of 56.0 (range 18-65) years and were followed for a median of 23.6 (range 6.5-43.2) months. There were 14 bilateral, 12 unilateral, and 5 single-kidney cases. The main indication for surgery was ureteral defects after gynecological surgery and radiation in 24 patients (77.4%). The mean operation time was 370.6 minutes and the median hospital stay was 25.2 (range 6-79) days. Various types of ileal arrangement were performed to cover bilateral ureter loss. After 30 days past surgery, 24 patients (77.4%) were in a stable state and 5 (16.1%) had decreased serum levels of creatinine. Short-term complications greater than grade 3 on the Clavien scale occurred in 10 patients (33.3%), and long-term complications occurred in 27 (87.1%). However, all cases were well relieved by conservative care, and surgical intervention was needed in only 1 case. Apart from 2 patients who died because of the progression of cervical cancer, all patients had stent-free status at 22.4 months. CONCLUSION: Ileal ureter replacement is a useful reconstructive surgery for complex ureteral loss, such as bilateral and single-kidney cases resulting from various etiologies.


Assuntos
Íleo/transplante , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rim Único/complicações , Resultado do Tratamento , Obstrução Ureteral/complicações , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
18.
Georgian Med News ; (284): 120-123, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30618402

RESUMO

The gold standard for the treatment of invasive bladder cancer recognized throughout the world is radical cystectomy with orthotopic ileocystoplasty using the ileal intestinal tract. The study of the effect of urine on the adaptation of the mucosa of the artificial bladder continues for the last twenty years. According to the researchers, the results are quite contradictory, as some scientists note the hypersecretion of sulphomucins, sialomucins, progressive atrophy of microvilli, adenomatous hyperplasia and dysplasia. The aim of investigation to study the features of the histochemically revealed activity of succinate dehydrogenase in the wall of the artificial bladder and ileum in experimental animals. The material of the present study were the results obtained from the study of 18 female mini-pigs aged 4-5 months and weighing 8-10 kg. The modeling of the artificial bladder was performed in experimental animals, by cystectomy and subsequent ileo-cystoplasty. Experimental animals with a bladder model in groups of 6 animals were withdrawn from the experiment 3, 6 and 12 months after operational modeling. As for the wall of the official bladder, the changes in the activity of the studied enzymes were significant and showed not only possible changes in the activity of the Krebs cycle, but also about periodic displacements of the accents of substrate maintenance. These changes, in our view, are related to the transformation processes in the structural elements of the ileum wall, from which an unproblem has been formed to fulfill new functional duties. Signs of a violation of energy metabolism indicate the processes of hypoxia in the tissue of the artificial bladder and require further study and observation.


Assuntos
Íleo/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Succinato Desidrogenase/metabolismo , Bexiga Urinária/cirurgia , Urodinâmica/fisiologia , Animais , Cistectomia/métodos , Feminino , Íleo/enzimologia , Mucosa Intestinal/enzimologia , Músculo Liso/enzimologia , Suínos , Porco Miniatura , Bexiga Urinária/enzimologia , Bexiga Urinária/fisiopatologia , Neoplasias da Bexiga Urinária/fisiopatologia , Neoplasias da Bexiga Urinária/cirurgia
19.
Urol Nurs ; 37(2): 90-3, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29240374

RESUMO

The diagnosis and treatment of patients with rare inherited metabolic disorders associated with recurrent and often obstructive kidney stones are important to the prevention of chronic kidney disease or end stage renal disease. Two case studies in this article describe the diagnosis and management of cystinuria, the most common rare kidney stone disorder.


Assuntos
Cistinúria/diagnóstico , Íleo/transplante , Cálculos Renais/cirurgia , Ureter/cirurgia , Adolescente , Adulto , Cistinúria/complicações , Cistinúria/terapia , Dietoterapia , Diuréticos/uso terapêutico , Feminino , Hidratação , Humanos , Cálculos Renais/etiologia , Masculino , Adesão à Medicação , Citrato de Potássio/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos , Insuficiência Renal Crônica/etiologia , Bicarbonato de Sódio , Tiopronina/uso terapêutico , Tomografia Computadorizada por Raios X , Ureteroscopia
20.
Dis Esophagus ; 30(9): 1-7, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28859368

RESUMO

Aortoesophageal fistula is a critical and life-threatening disease. The cardiovascular strategy for graft replacement has been widely discussed. However, the surgical strategy of esophageal resection and reconstruction for aortoesophageal fistula has rarely been discussed. The objective of this study is to establish a surgical strategy and procedure of esophageal resection and reconstruction for aortoesophageal fistula. Eleven patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2008 and 2015 at Kobe University Hospital were enrolled in this study. Patient characteristics, operative methods, and clinical outcomes were obtained by retrospective chart review. All 11 patients underwent graft replacement, esophagectomy, and omental wrapping. Ten esophagectomies were simultaneously accomplished in the same operative field as aortic graft replacement. Seven patients underwent subtotal esophagectomy from a left thoracotomy, and three patients underwent upper hemiesophagectomy from a median sternotomy. The other patient underwent staged esophagectomy from a right thoracotomy. Seven of 11 patients (63.6%) successfully underwent staged esophageal reconstruction. Pedicled jejunal transfer with supercharge and superdrainage were performed in six patients, and ileocecal reconstruction was performed in one patient. Median survival time in the patients with esophageal reconstruction was 21 months while that in the patients without esophageal reconstruction was 10 months. Six of 7 patients (85.7%) who underwent esophageal reconstructions were alive. Our surgical strategy for aortoesophageal fistula, which includes simultaneous graft replacement and esophagectomy in the same operative field and staged reconstruction by pedicled jejunal transfer to ensure omental wrapping, is feasible and promising.


Assuntos
Doenças da Aorta/cirurgia , Fístula Esofágica/cirurgia , Esofagectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Vascular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ceco/transplante , Feminino , Humanos , Íleo/transplante , Jejuno/transplante , Masculino , Pessoa de Meia-Idade , Omento/transplante , Estudos Retrospectivos , Esternotomia , Taxa de Sobrevida , Toracotomia , Enxerto Vascular , Procedimentos Cirúrgicos Vasculares/métodos
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