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1.
Einstein (Sao Paulo) ; 18: eRC5063, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553357

RESUMO

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


Assuntos
Infecções Relacionadas a Cateter/microbiologia , Coletores de Urina/efeitos adversos , Infecções Urinárias/microbiologia , Idoso , Infecções Relacionadas a Cateter/patologia , Humanos , Masculino , Proteus mirabilis/isolamento & purificação , Fatores de Risco , Síndrome , Infecções Urinárias/patologia , Urina/microbiologia
3.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31824647

RESUMO

Cystectomy and urinary bladder substitution are rare in children but may be necessary in some cases of bladder exstrophy, in the setting of malignancy, or in other settings in which the bladder is severely dysfunctional. This article details advances in surgical techniques in creating continent urinary diversions in this specialized pediatric population.


Assuntos
Extrofia Vesical , Bexiga Urinária , Derivação Urinária , Coletores de Urina , Criança , Cistectomia , Humanos
4.
J Urol ; 202(4): 763-769, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31059666

RESUMO

PURPOSE: Current guidelines recommend confirming a negative urethral margin prior to orthotopic neobladder reconstruction. We investigated our rate of urethral positive margins and recurrence in the absence of intraoperative frozen section. MATERIALS AND METHODS: We retrospectively reviewed clinical and pathological data on 357 patients who underwent radical cystectomy and orthotopic urinary diversion without intraoperative frozen section. At a median followup of 27 months the rates of positive urethral margins and urethral recurrence were tabulated. Differences in overall and recurrence-free survival in patients with a positive urethral margin were analyzed by Cox regression to generate the HR with the 95% CI. RESULTS: We identified 6 urethral recurrences (1.6%) during followup. The urethral recurrence rate was not higher in patients with a positive urethral margin (p=0.22). In the 15 patients with positive urethral margins overall survival was unchanged (HR 0.98, 95% CI 0.24-4.04). When accounting for lymph node staging, recurrence-free survival was not significantly worse in patients with positive urethral margins (HR 2.33, 95% CI 0.95-5.73). CONCLUSIONS: Omitting intraoperative frozen section prior to orthotopic neobladder reconstruction appears safe with a rate of urethral recurrence similar to that in historical series. It may allow for increased performance of orthotopic urinary diversions.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia , Secções Congeladas , Cuidados Intraoperatórios/métodos , Uretra/patologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Uretra/cirurgia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Coletores de Urina
5.
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
6.
Scand J Urol ; 53(2-3): 145-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30958079

RESUMO

Objectives: To evaluate the long-term results after the construction of a Continent Catheterizable Urinary Conduit (CCUC) in adults. Methods: This study retrospectively reviewed the charts of 41 adults from two tertiary centers who received a CCUC. The demographics, underlying diseases, indications for a CCUC and outcomes such as the reoperation rate and the occurrence of complications were extracted. The patient reported outcome was measured with the Patient Global Impression of Improvement (PGI-I) scale and four additional questions about continence, leakage and stomal problems. Results: Twenty-nine patients were women. The median age at surgery was 32 years, with a median follow-up of 52 months. Twenty-six patients had a neurogenic bladder. The reoperation rate was 48.8%, with a median of 10.5 months after constructing the CCUC. Superficial stomal stenosis was the most common registered complication (20 times) and stoma revision was the most often performed reoperation (12 times). Twenty-four patients completed the PGI-I; the mean improvement rating was 2 (=much better). Conclusion: The construction of a CCUC in adults is associated with a high complication and reoperation rate. The high reoperation rate is in accordance with the sparse literature. Despite this, patients reported 'much better' on the PGI-I.


Assuntos
Cistostomia/métodos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Bexiga Urinaria Neurogênica/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Transtornos Urinários/cirurgia , Adulto , Apêndice , Feminino , Humanos , Cateterismo Uretral Intermitente , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Reoperação/estatística & dados numéricos , Estomas Cirúrgicos , Estreitamento Uretral/cirurgia , Retenção Urinária/cirurgia , Adulto Jovem
7.
Scand J Urol ; 53(2-3): 81-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990110

RESUMO

Robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) can be recognized to be the supreme discipline in urological pelvic surgery. The utilization of RARC with intracorporeal urinary diversion (ICUD) has increased during the last 15 years. This increase is primarily noted for ICUD with ileal conduits, but with a lesser extent also for IC neobladders, with an increase from 7% in 2005 to 17% in 2016. However, these observations are limited to a few centers of excellence reflecting the fact that IC ONB formation is regarded as technically challenging and time-consuming with a steep learning curve. The objective of this review is to summarize the current data about RARC with IC ileal ONB in terms of patient selection, preoperative preparation, functional outcomes, complications and oncological outcomes. Careful patient selection considering absolute and relative contraindications for RARC and/or ONB as well as the implementation of an enhanced recovery after surgery protocol is an integral part of successful oncological, functional and complication outcomes. Nerve sparing procedures in males and gynaecological organ sparing in females should be attempted in order to maximize functional outcomes. Different techniques of ICUD with ONB after RARC are described; however, all of them adhere to the principles for the functioning of an ONB. Both functional outcomes and complication rates have been improved significantly during the last few years. The current evidence for long-term outcomes following RARC shows acceptable oncological outcomes comparable to an open series including recurrence-free survival data, positive surgical margin rates and median pelvic lymph node yields.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Intervalo Livre de Doença , Humanos , Excisão de Linfonodo , Tratamentos com Preservação do Órgão , Seleção de Pacientes , Pelve , Nervos Periféricos
8.
J Cancer Res Ther ; 15(Supplement): S51-S55, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30900621

RESUMO

Background/Objective: To report the initial experience and the early outcomes of a modified U-shaped ileal neobladder, which was developed to facilitate the neobladder-urethral anastomosis by minimizing the anastomotic tension. Patients and Methods: Between June 2015 and December 2016, two male and two female patients (median age: 65.5 years, range: 43-72 years) underwent the modified U-shaped ileal neobladder after robotic-assisted radical cystectomy (RARC). The most mobile and dependent ileal segment was first selected intracorporeally as the site for later neobladder-urethral anastomosis. The neobladder was formed extracorporeally, and the previously selected ileal segment formed the most dependent portion of the neobladder. The neobladder-urethral anastomosis was completed after robotic redocking. Results: The median follow-up was 8 months (3-21 months). The median operative time, console time, and extracorporeal reconstruction time were 620 min (534-674 min), 372 min (314-420 min), and 151 min (128-215 min), respectively. In all patients, the neobladder-urethral anastomosis was completed intracorporeally with minimal tension. The median hospital time after the surgery was 14.5 days (14-19 days). Postoperatively, the median peak flow rate and void volume were 10 ml/s (4-35 ml/s) and 258 ml (88-775 ml). The median postvoid residual was 20 ml (10-53 ml). At daytime, two were completely continent; the other two reported mild (1-2 pads) and moderate (>2 pads) incontinence at the postoperative 3 and 4 months, respectively. Three reported nocturnal enuresis. Conclusions: Our initial experience demonstrated that the modified U-shaped neobladder designed for minimizing the anastomotic tension is safe and feasible with its satisfactory functional outcomes.


Assuntos
Íleo/cirurgia , Ureter/cirurgia , Uretra/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Cistectomia/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Coletores de Urina/efeitos adversos , Urodinâmica
10.
J Urol ; 201(5): 909-915, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30694935

RESUMO

PURPOSE: We investigated the influence of positive pre-cystectomy biopsies of the prostatic urethra in males and the bladder neck in females on urethral recurrence, cancer specific and overall survival, and functional outcomes after orthotopic bladder substitution. MATERIALS AND METHODS: We retrospectively analyzed the records of 803 consecutive patients, including 703 males and 100 females, who underwent orthotopic bladder substitution as well as pre-cystectomy biopsy of the prostatic urethra in males and the bladder neck in females, at our institution between April 1986 and December 2017. RESULTS: Pre-cystectomy biopsies were negative in 755 of the 803 patients (94%) (group 1) and positive in 48 (6%) (group 2). Biopsies in group 2 revealed carcinoma in situ in 35 of the 48 cases (73%), pTaG1/G2 in 5 (10%) and pTaG3/pT1G3 in 8 (17%). Median followup was 64 months (IQR 21-128). At a median followup of 56 months (IQR 18-127) urethral recurrence developed in 45 of the 803 patients (5.6%), including 30 of the 755 (4%) in group 1 and 15 of the 48 (31.3%) in group 2 (p <0.001). Only 10 of the 45 patients (22%) with urethral recurrence required salvage urethrectomy while locally conservative treatment was successful in 27 (60%). Of the remaining 8 patients 6 of 45 (13%) underwent synchronous palliative chemotherapy and 2 of 45 (4%) refused treatment. Multivariate regression analysis revealed a higher risk of urethral recurrence if patients had positive pre-cystectomy biopsies (group 2 HR 6.49, 95% CI 3.33-12.62, p <0.001) or received neoadjuvant or adjuvant chemotherapy (HR 3.05, 95% CI 1.66-5.59, p <0.001). Cancer specific and overall survival as well as functional outcomes were similar in the 2 groups. CONCLUSIONS: Positive pre-cystectomy biopsies prior to orthotopic bladder substitution increased the urethral recurrence rate but did not lower cancer specific or overall survival. Most urethral recurrences were managed successfully by local treatment. Orthotopic bladder substitution is an option in highly selected patients with positive, noninvasive pre-cystectomy biopsies, provided that they undergo regular followup including urethral cytology.


Assuntos
Cistectomia/métodos , Recidiva Local de Neoplasia/epidemiologia , Seleção de Pacientes , Neoplasias Uretrais/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Biópsia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Próstata/patologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Uretra/patologia , Neoplasias Uretrais/patologia , Neoplasias Uretrais/prevenção & controle , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
11.
Urology ; 127: 127-132, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30664894

RESUMO

OBJECTIVES: To determine the impact of radical cystectomy and orthotopic neobladder (NB) diversion on device-related outcomes in patients who undergo subsequent placement of both, an artificial urinary sphincter (AUS) and 3-piece inflatable penile prosthesis. MATERIALS AND METHODS: Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n = 48, non-neobladder group). RESULTS: No intraoperative complications were observed. After median follow-up of 94 months (12-177 months), 1 patient developed an infection of their penile prosthesis and 4 patients developed an erosion of their AUS. In each case, the infection did not involve the other device. Two patients required revision surgery of their penile prosthesis due to mechanical failure (reservoir leak, n = 1; cylinder aneurysm, n = 1). Twenty-one patients underwent elective revision surgery to improve continence (cuff downsizing, n = 18; pressure-regulating balloon exchange, n = 3). There were 6 cases of AUS mechanical failure. No reservoir-related complications such as herniation or erosion were observed. Compared to the control group of non-neobladder patients, there were no significant differences in prosthetic infection, mechanical failure, and revision surgery. CONCLUSION: The AUS and 3-piece inflatable penile prosthesis can coexist safely in patients with NB without an increased risk of device-related complications.


Assuntos
Cistectomia/efeitos adversos , Implante Peniano/métodos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Sobreviventes de Câncer , Estudos de Coortes , Terapia Combinada , Cistectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia , Coletores de Urina , Esfíncter Urinário Artificial/efeitos adversos
13.
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
14.
World J Urol ; 37(1): 85-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30238399

RESUMO

PURPOSE: To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d'Urologie on Bladder Cancer Urinary Diversion (UD). METHODS: A detailed analysis of the literature was conducted reporting on the different modalities of UD. For this updated publication, an exhaustive search was conducted in PubMed for recent relevant papers published between October 2013 and August 2018. Via this search, a total of 438 references were identified and 52 of them were finally eligible for analysis. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine. RESULTS: The incidence of early complications has been reported retrospectively in the range of 20-57%. Unfortunately, only a few randomized controlled studies exist within the field of UD. Consequently, almost all studies used in this report are of level 3-4 evidence including expert opinion based on "first principles" research. CONCLUSIONS: Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for lifelong follow-up. Progress has been made to prevent complications implementing robotic surgery and fast track protocols. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good results.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Carcinoma de Células de Transição/patologia , Humanos , Músculo Liso/patologia , Invasividade Neoplásica , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/patologia , Coletores de Urina
15.
Eur J Surg Oncol ; 45(3): 477-481, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30385155

RESUMO

INTRODUCTION: Women undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women. MATERIALS AND METHODS: We retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL. RESULTS: Patients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0-100: 33.3 ±â€¯29.5 vs 18.4 ±â€¯19.3, respectively; p = 0.05). CONCLUSION: Financial difficulties was the only HRQOL item to differ between the two UD groups.


Assuntos
Íleo/cirurgia , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Adulto , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer , Estudos Transversais , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Taxa de Sobrevida/tendências , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade
16.
Urol Int ; 102(1): 122-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29554647

RESUMO

Eosinophilic cystitis is a rare disease that presents with either urinary frequency, hematuria, suprapubic pain or urinary retention. Although benign, this entity may progress to diffuse bladder involvement with the need for surgical treatment. We report on 2 cases of advanced disease that required cystectomy with very complex lower urinary tract reconstruction, and review the literature of surgically treated cases.


Assuntos
Cistectomia/efeitos adversos , Cistectomia/métodos , Cistite/cirurgia , Bexiga Urinária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Coletores de Urina , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
17.
Eur Urol ; 75(2): 294-299, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30091420

RESUMO

BACKGROUND: Ureteroileal anastomotic stricture (UAS) after ileal conduit diversion occurs in a non-negligible proportion of patients undergoing radical cystectomy (RC). Surgical techniques aimed at preventing this potential complication are sought. OBJECTIVE: To describe our surgical technique of retrosigmoid ileal conduit, and to assess perioperative outcomes and postoperative complications with a focus on UAS rate. DESIGN, SETTING, AND PARTICIPANTS: A prospective single-centre, single-surgeon cohort of 67 consecutive patients undergoing open RC with ileal conduit urinary diversion between July 2013 and April 2017 was analysed. A study group of 30 patients receiving retrosigmoid ileal conduit was compared with a control group of 37 patients receiving standard Wallace ileal conduit. SURGICAL PROCEDURE: Retrosigmoid versus Wallace ileal conduit diversion after open RC. MEASUREMENTS: Operative room (OR) time, estimated blood loss (EBL), transfusion rate, and 90-d postoperative complications were recorded and compared between the two groups. In particular, rate of UAS, defined as upper collecting system dilatation requiring endourological or surgical management, was assessed and compared. RESULTS AND LIMITATIONS: The two groups were comparable with regard to all demographic, clinical, and pathological variables. No differences were observed in terms of OR time (p=0.35), EBL (p=0.12), and transfusion rate (p=0.81). Ninety-day postoperative complications were observed in 11 (36.7%) patients who underwent a retrosigmoid ileal conduit and 20 (54.1%) patients who received a traditional ileal conduit (p=0.32). Major complications (grade 3-4) were observed in three (10%) cases in the former group and in 12 (32.4%) cases in the latter group (p=0.08). Mean (standard deviation) follow-up time was 10.8±4.0 mo in the study group and 27.5±9.5 mo in the control group (p<0.001). No single case of UAS was observed in the study group, whereas six (16.2%) cases of UAS occurred in the control group (p=0.02). The main limitation is a nonrandomised comparison of a relatively small cohort with short-term follow-up. CONCLUSIONS: In our study, we observed a significantly reduced rate of UAS and no increase in postoperative complications with the retrosigmoid ileal conduit diversion compared with standard Wallace ileal conduit diversion after open RC. PATIENT SUMMARY: We describe our surgical technique of retrosigmoid ileal conduit as urinary diversion after open radical cystectomy. Compared with traditional techniques, our technique for ileal conduit was found to be safe and reduce the risk of ureteric strictures.


Assuntos
Cistectomia/métodos , Íleo/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Estudos de Casos e Controles , Constrição Patológica , Bases de Dados Factuais , Feminino , Humanos , Masculino , Duração da Cirurgia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/patologia , Derivação Urinária/efeitos adversos , Coletores de Urina/efeitos adversos
18.
Int Braz J Urol ; 44(6): 1156-1165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325614

RESUMO

PURPOSE: To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction. MATERIALS AND METHODS: From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic afferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported. RESULTS: ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively. CONCLUSIONS: We described our experience of 3D LRC with a novel intracorporeal orthotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracorporeal neobladder with bilateral isoperistaltic afferent limbs.


Assuntos
Laparoscopia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
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