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1.
Urologiia ; (5): 54-60, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185348

RESUMO

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. AIM: To describe the main stages of RARC and to analyze its short-term results. MATERIALS AND METHODS: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. RESULTS: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. CONCLUSION: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Estruturas Criadas Cirurgicamente , Neoplasias da Bexiga Urinária , Derivação Urinária , Cistectomia/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos
2.
Medicine (Baltimore) ; 99(42): e22135, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080671

RESUMO

PURPOSE: We present a new approach for urine drainage in pediatric patients following laparoscopic pyeloplasty, the trans-uretero-cystic external urethral stent (TEUS). METHODS: We retrospectively identified 85 children who underwent laparoscopic pyeloplasty from July 2015 to June 2017. The included children were assigned to group A (double-J stent) or group B (TEUS). In group A, the double-J stent was removed by a cystoscopy under anesthesia after 1 month, while in group B, the external stent was removed after 5 to 7 days. We examined the durations of operation, hospital stay and the frequency of stent-related complications including urinary leakage, stent dislocation, stent occlusion, and urinary tract infection. RESULTS: The operation time was significantly longer for patients in group B than for those in group A. No significant difference was observed between the groups regarding stent-related complications. In group A, 4 patients need auxiliary stent re-insertion for the management of complications, 2 developed urinary tract infection, and 2 had stent occlusion. In group B, none needed auxiliary stent re-insertion for complications and avoided re-operation. CONCLUSIONS: In children, the outcome of external stent implantation was similar to that using double-J stent, and the use of the former approach may be beneficial for younger children.


Assuntos
Laparoscopia/métodos , Stents , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Pré-Escolar , Cistoscopia , Remoção de Dispositivo , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Derivação Urinária/métodos
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 637-641, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773792

RESUMO

OBJECTIVE: To summarize the initial clinical experience and follow-up results of the treatment for ureteroileal anastomotic stricture after radical cystectomy with Allium coated metal ureteral stent. METHODS: From September 2018 to September 2019, 8 patients with ureteroileal anastomotic stricture after radical cystectomy underwent Allium ureteral stent insertion in Peking University People's Hospital and People's Hospital of Daxing District. The preoperative renal pelvis width under ultrasound was collected to evaluate the postoperative hydronephrosis, creatinine and urea nitrogen (BUN) before and after surgery, perioperative infection, and stent-related complications. The serum creatinine and BUN, renal pelvis width under ultrasound, urography and abdominal plain film (KUB) were reviewed at the end of 1, 3, and 6 months and annually postoperatively to observe the stent position and morphology. The long-term stent patency rate, complication rate, renal function and hydronephrosis were followed up and analyzed. The t-test or rank-sum test was used to compare the measurement data of the matched sample from the preoperative to the last follow-up. RESULTS: In the study, 6 cases (7 sides) were ureteral ileal conduit stricture, and 2 cases (3 sides) ureteral orthotopic neobladder stricture. Before surgery, 5 patients underwent long-term indwelling of a single J ureteral stent, with an average indwelling time of (20.6±8.8) months and an average replacement frequency of (3.6±1.3) months/time. The mean width of renal pelvis was (26.5±9.1) mm on preoperative renal ultrasonography. Among them, 6 patients were successfully indwelled with Allium coated metal ureteral stent by retrograde approach, and 2 patients by combination of double-endoscopy and ante-retrograde approach. No surgery-related complications during perioperative period were observed. The mean follow-up period was 9.8 months and Allium stent and ureter remained unobstructed in all the patients at the last follow-up without replacement or removal. Compared with preoperative data, the mean width of renal pelvis and mean blood urea nitrogen (BUN) in the last follow-up period were significantly reduced [(26.5±9.1) mm vs. (13.4±2.5) mm, P=0.008; (11.6±2.3) mmol/L vs. (10.2±2.2) mmol/L, P=0.017], however, there were no significant differences in the average serum creatinine or hemoglobin (P>0.05). Ureteroileal anastomotic re-stricture and other stent-related complications were not observed in all the patients by antegrade urography. CONCLUSION: Allium coated metal ureteral stent could be used for the treatment for ureteroileal anastomotic stricture, which could maintain relatively long-term patency rate and protect renal function. The indwelling time was longer and it could improve quality of life of patients.


Assuntos
Ureter , Obstrução Ureteral , Derivação Urinária , Allium , Anastomose Cirúrgica , Constrição Patológica , Cistectomia , Seguimentos , Humanos , Metais , Qualidade de Vida , Stents , Resultado do Tratamento , Obstrução Ureteral/cirurgia
6.
Medicine (Baltimore) ; 99(27): e20902, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629682

RESUMO

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols were introduced in clinical practice to reduce complication rates and hospital stay. We performed a randomized controlled single center study to evaluate perioperative benefits of an adapted ERAS protocol in patients with bladder cancer who underwent radical cystectomy (RC) and ileal urinary diversions (IUD). MATERIALS AND METHODS: Forty five from 90 consecutive randomized patients were enrolled in an adapted ERAS protocol. Length of stay, diet issues, return of bowel function, readmission rates and complications were examined. RESULTS: Among patients following ERAS protocol, we found a significant reduction in time to first flatus (1 vs 5 days, P < .001), time to first stool (2 vs 5 days, P < .001), time to normal diet (5 vs 6 days, P < .001) and length of stay (16 vs 18 days, P < .001). Also, postoperative ileus at less than 4 days was lower than in non-ERAS patients (15.6% vs 24.4%), but with a marginal trend toward significance (P = .05). Readmission rate was lower in the ERAS group, but the difference did not reach statistical significance. We also found a lower readmission and complication rate in patients with ERAS protocol (6.6% vs 11.1%, P = .23 and 46.6% vs 57.5%, P = .29, respectively). CONCLUSIONS: Implementation of ERAS protocol for patients undergoing RC in our center was associated with a significant reduction in the time to the first flatus, time to the first stool, time to a normal diet, length of hospital stay.


Assuntos
Protocolos Clínicos , Cistectomia/reabilitação , Recuperação Pós-Cirúrgica Melhorada , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/reabilitação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
11.
Arch Esp Urol ; 73(4): 316-319, 2020 May.
Artigo em Espanhol | MEDLINE | ID: mdl-32379067

RESUMO

OBJECTIVE: Despite the high frequency of complications after a radical cystoprostatectomy, the presence of a fistula that communicates the external iliac artery and the ureteroileostomy has not been described in the medical literature. We present the diagnosis and medical management of a massive hemorrhage through the Bricker´s ostomy due to an external iliac artery´s mycotic aneurysm  fistulized to the ureteroileostomy. METHOD: A 78 years old patient under went laparoscopic radical cystoprostatectomy with Bricker-type urinary diversion due to muscle-invasive bladder cancer. During the immediate pos toperative period he presented different complications including sepsis caused by a pelvic collection. Due to a massive hemorrhage through Bricker´s ostomy he went to the emergency department where was diagnosed by CT of active bleeding from right external iliac artery to the interior of the ureteroileostomy. We decided to perform exploratory laparotomy showing an aneurysm with fistulous orifice communicating the medial external iliac artery to Bricker ureteroileostomy. A femoro-femoral bypass, ligation of two centimeters of the external iliac artery, closure of the Bricker´s orifice and right cutaneous ureterostomy was needed. RESULTS: After the surgery, the patient required renal replacement therapy and vasoactive drugs. Discharge from the hospital was 11 days after the intervention. CONCLUSIONS: The presence of an uncontrolled arterial fistula implies urgent care in a pathology such as the mycotic aneurysm that already constitutes a challenge. Fast diagnosis and surgical skills are essential to increase patient's survival chances.


Assuntos
Aneurisma Infectado , Laparoscopia , Derivação Urinária , Idoso , Cistectomia/efeitos adversos , Humanos , Artéria Ilíaca/cirurgia , Masculino
12.
Arch. esp. urol. (Ed. impr.) ; 73(4): 257-267, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192985

RESUMO

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG


INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS


Assuntos
Humanos , Sepse/complicações , Obstrução Ureteral , Biomarcadores , Diagnóstico Precoce , Estudos Prospectivos , Gasometria , Fatores de Risco , Modelos Logísticos , Derivação Urinária , Imunossupressão
14.
Am J Trop Med Hyg ; 102(6): 1396-1398, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228779

RESUMO

Strongyloidiasis is a disease caused by the parasite Strongyloides stercoralis in humans. We present a case of incidentally discovered Strongyloides urinary tract infection in a patient in whom there was a urologic surgery consisting of urinary diversion created by self-bowel transplantation and conduit creation. Historical review demonstrated eosinophilia before surgery and detection of the parasite. Social review demonstrated endemic exposure. Our patient's case was differentiated from hyperinfection by the presence of rhabditiform larvae, and not filariform larvae, in the urine, suggesting localized small bowel infection was transferred to the urinary tract secondary to the creation of the ileal loop conduit. This patient's clinical course improved with antibiotic treatment of the bacterial infectious complications of surgery and resolution of Strongyloides infection with ivermectin. To our knowledge, this is the first case of Strongyloides infection of the urinary tract secondary to ileal loop conduit creation and not as a result of hyperinfection.


Assuntos
Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Derivação Urinária , Idoso , Animais , Cistectomia , Humanos , Ivermectina/uso terapêutico , Masculino , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/urina
15.
16.
Int J Clin Oncol ; 25(7): 1377-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32318904

RESUMO

BACKGROUND: Radical cystectomy (RC) is the primary treatment strategy for muscle invasive bladder cancer (MIBC). However, it carries a high risk of urethral recurrence (UR) in male patients. The risk factors and oncological outcomes of UR remain unclear. We aimed to identify the risk factors and oncological outcomes of UR in male patients with MIBC after RC combined with urinary diversion. METHODS: After propensity score matching, we evaluated 137 male patients with MIBC who underwent RC combined with urinary diversion at our center between January 1, 2007 and December 31, 2015. Patient demographics, comorbidity, and perioperative data were recorded. Univariate and multivariate Cox proportional hazards regression were used to estimate the hazard ratio and 95% confidence intervals. Cancer-specific survival (CSS) and overall survival (OS) were measured using the Kaplan-Meier curve with log-rank test. P < 0.05 was considered statistically significant. RESULTS: Of the 310 patients, 30 (9.7%) patients underwent UR. In the matched group, the independent risk factors of UR were history of TURB (HR = 3.069, P = 0.018), tumor stage (T3 vs. T2, HR = 3.997, P = 0.014; T4 vs. T2, HR = 2.962, P = 0.015), and tumor multifocality (HR = 2.854, P = 0.011). The CSS and OS of patients with UR were equivalent to the patients without UR (P = 0.295, P = 0.616). CONCLUSION: This propensity score-matched case-control study showed that UR is not rare in male patients with MIBC after RC combined with urinary diversion. We identified three independent risk factors of UR: history of TURB, tumor stage, and tumor mutifocality. The oncological outcomes were equivalent between patients with and without UR. These findings could help improve treatment strategies and follow-up schedules.


Assuntos
Cistectomia/métodos , Neoplasias Uretrais/patologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Idoso , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do Tratamento , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/secundário , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
17.
Vet Surg ; 49(5): 1052-1057, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32324904

RESUMO

OBJECTIVE: To report the occurrence and describe the management of pubic fractures after the use of an extended transpelvic urethrostomy (TPU) to treat postprostatic intrapelvic urethral obstruction and laceration in a cat. ANIMAL: One 6-year-old domestic short-haired cat. STUDY DESIGN: Case report. METHODS: A cat was presented with urethral obstruction and laceration confirmed by positive contrast retrograde urethrography. Temporary urinary diversion was performed. An attempt was made to perform perineal urethrostomy, but the cranial location of the laceration precluded this technique. An extended TPU was performed, which required removal of 30% to 60% greater length of pelvic bone than has been previously described. RESULTS: Bilateral pubic ramus fractures occurred 1 week after surgery, from which the cat clinically improved with cage rest, and exhibited evidence of healing according to computed tomography after 8 weeks. CONCLUSION: Extended TPU used to treat postprostatic intrapelvic urethral laceration may lead to pubic fractures postoperatively. CLINICAL SIGNIFICANCE: It may be prudent to rest any cat that has had a TPU or extended TPU to reduce fracture risk.


Assuntos
Fraturas Ósseas/veterinária , Complicações Pós-Operatórias/veterinária , Osso Púbico/lesões , Uretra/cirurgia , Obstrução Uretral/veterinária , Animais , Gatos , Fraturas Ósseas/cirurgia , Masculino , Ossos Pélvicos , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Obstrução Uretral/cirurgia , Derivação Urinária/métodos
18.
Urologe A ; 59(4): 416-425, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32130447

RESUMO

As useful and necessary as radiotherapy may be, it is associated with irreversible long-term adverse effects including loss of bladder function. In the majority of cases the small bowel, sigmoid rectum and ureter are also affected. The extent of injury depends on the irradiated area, the applied dose and the quality of application. Three factors are essential when choosing a urinary diversion: the length of functional ureter, the position of the bowel outside of the irradiated area and the type of diversion. A continent diversion is best performed through a ascending-transverse or transverse-descending colon pouch. The efferent segment is diverted through the umbilicus. The simplest technique for an incontinent diversion is a conduit using the ascending colon or the right colon flexure. If the length of the ureter does not suffice for such a conduit, the ideal solution is a transverse conduit, as this conduit can be attached to both renal pelves, while simultaneously allowing free choice of the lateral location of the stoma. In case of an exenteration, a double stoma on one side of the body should be avoided in order to prevent maintenance issues.


Assuntos
Pelve Menor/efeitos da radiação , Pelve/efeitos da radiação , Lesões por Radiação , Derivação Urinária , Colo , Humanos , Ureter
19.
Int Braz J Urol ; 46(3): 446-455, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32167712

RESUMO

PURPOSE: To compare perioperative outcomes, complications and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy (RC) with modified Wallace anastomotic technique versus traditional ileal conduit. MATERIALS AND METHODS: Study enrolled 180 patients, of whom 140 were randomized and underwent RC; seventy were randomized to group I and the seventy to the group II. For the primary objective, we hypothesized that the rate of ureteroenteric strictures would be at least 20 % lower in the second group. Secondary end points included rate of anastomotic leak, surgical time, deterioration of the upper tract, intraoperative blood loss and patient-reported quality of life (HRQOL). The modified Wallace 1 technique involved eversion of the ureteral plate and bowel mucosa edges, which were anastomosed together in running fashion, while the outher anastomotic wall was augmented with sero-serosal interrupted sutures. RESULTS: The mean (SD) follow-up time was 26.1 (5.7) months in group I and 25.2 (4.8) months in group II, during which, anastomotic stricture was observed in 8 patients (12%) from the first and 2 patients (3%) from the second group (p < 0.05). The anastomotic leakage rate was significantly higher in first group (17% vs. 8.5%, p < 0.05), while patient-reported HRQOL outcomes were similar between groups after the 12 month follow-up period. CONCLUSIONS: By using a modified Wallace technique, we were able to significantly lower anastomotic stricture and anastomotic leakage rates, which are major issues in minimizing both short- and long-term postoperative complications.


Assuntos
Neoplasias da Bexiga Urinária , Derivação Urinária , Anastomose Cirúrgica , Constrição Patológica , Cistectomia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos
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