Soporte ventilatorio no invasivo como puente hacia el trasplante pulmonar: reporte de un caso / Bridging to lung transplant using noninvasive ventilatory support: a case report

El soporte ventilatorio no invasivo es una herramienta que ha demostrado mejorar la sobrevida de pacientes con falla muscular de la bomba respiratoria y el manejo de enfermedades pulmonares crónicas, incluso la ventilación no invasiva nocturna ha servido de puente hacia el trasplante pulmonar. Se presenta el caso de una adolescente de 14 años con enfermedad pulmonar crónica hipoxémica severa y falla ventilatoria secundaria, que requirió ventilación prolongada y traqueostomía en espera de trasplante pulmonar. Luego de reevaluar indemnidad de la vía aérea fue decanulada a soporte ventilatorio no invasivo, con uso alternado de mascarilla nasal nocturna y pieza bucal diurna, permitiendo descanso muscular respiratorio eficiente, y mejoría de flujo de tos con técnicas de apilamiento de aire. Este plan permitió una decanulación segura y realizar soporte continuo ventilatorio no invasivo con un programa de rehabilitación cardiorrespiratorio. Generalmente, el soporte ventilatorio no invasivo se utiliza en trastornos primarios de la bomba respiratoria. En este caso, se indicó para enfermedad pulmonar crónica hipoxémica, mostrando claros beneficios con oxigenación adecuada, buen rendimiento cardiovascular con mejor tolerancia al ejercicio y entrenamiento en el escenario de preparación al trasplante pulmonar.

Noninvasive Ventilatory Support has demonstrated to improve survival of patients with ventilatory pump muscle failure and nocturnal noninvasive ventilation is useful in chronic lung disease, even bridging to lung transplant. We present a 14 years old girl with severe hypoxemic chronic lung disease and secondary ventilatory failure, who required continuous long-term ventilation and underwent a tracheostomy waiting for lung transplant. After reevaluated the airway patency the patient was decannulated to Noninvasive Ventilation Support, alternating nocturnal nasal mask with diurnal mouth piece in order to provide efficient respiratory muscle rest, made air stacking and improved cough flow. This plan allows safe decannulation to continuous Noninvasive Ventilatory Support tailoring a rehabilitation cardiorespiratory program. Usually, Noninvasive Ventilation Support is prescribed for primary respiratory pump muscles failure, but in this case, it was applied for a hypoxemic chronic lung disease. Clear benefits were observed leading to appropriate oxygenation, good cardiovascular performance with better tolerance to exercise for training in the preparatory scenario of a lung transplant.

Time of catheter removal in candidemia and mortality

ABSTRACT Background: The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia). Objective: Evaluate the effect of time to CVC removal, early (within 48 h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality. Methods: Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48 h (first analysis) or at any time (second analysis). Results: A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1-28) but was six days (range 3-28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066-1.158), removal at any time (OR 0.079, 95% CI 0.021-0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133-0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071-1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103-0.590) retained significance. Conclusions: The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses.

Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms / Terapia de resgate com stent para tromboembolismo durante tratamento endovascular de aneurismas intracranianos

ABSTRACT Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.

RESUMO Tromboembolismo é a complicação mais frequente no tratamento endovascular de aneurismas cerebrais, podendo causar morte ou sequelas. Como os stent retrievers alcançaram altas taxas de recanalização arterial no tratamento do acidente vascular encefálico isquêmico, testamos esses dispositivos para tratar eventos tromboembólicos ocorridos durante a embolização de aneurismas. Foram analisados retrospectivamente 10 pacientes apresentando oclusão arterial transoperatória, tratados com trombectomia mecânica em um único centro. Obtivemos recanalização angiográfica em oito casos, mTICI 3, 2b e 2a em cinco, três e dois pacientes, respectivamente, sem complicações adicionais ou óbito. Cinco casos apresentaram recuperação completa (mRS 0) e todos os pacientes apresentaram melhora dos déficits (mRS médio 1.1) durante acompanhamento médio de 31 meses. Oito pacientes apresentaram boa recuperação clínica, enquanto dois permaneceram com déficits (mRS 3 e 4). O estudo concluiu que stents são uma ferramenta valiosa, rápida e eficaz para restaurar o fluxo sanguíneo, aumentando a segurança do tratamento endovascular.

The long-term results of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture disease

ABSTRACT Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed. Results: The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively. Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.

Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal / Incidência de flebites durante o uso e após a retirada de cateter intravenoso periférico / Incidencia de flebitis durante el uso y después de la retirada de catéter intravenoso periférico

ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC) and following their removal - (post-infusion phlebitis) in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective.

RESUMO Objetivo: investigar a incidência de flebites e a associação de fatores de risco com a sua ocorrência durante o uso e após a retirada do cateter intravenoso periférico - CIP (Flebite pós-infusão) em adultos hospitalizados. Método: estudo de coorte com 171 pacientes com CIP, totalizando 361 punções. Foram coletadas variáveis sociodemográficas e relacionadas ao cateter. Análise estatística descritiva e analítica. Resultados: dos pacientes, 51,5% eram homens e a média de idade foi de 56,96 anos. A incidência de flebites durante o uso do CIP foi de 1,25% e a pós-infusão foi de 1,38%. Associou-se à flebite durante o uso do CIP ao tempo de permanência do cateter e, com a flebite pós-infusão, a punção em antebraço. Os medicamentos Ceftriaxona, Claritromicina e Oxacilina foram associados à flebite pós-infusão. Conclusões: este estudo possibilitou investigar a associação de fatores de risco e a ocorrência de flebites durante o uso e após a retirada do cateter. A frequência da flebite pós-infusão foi maior do que o número de flebites durante a permanência do cateter, sendo as de grau III e II, respectivamente, as mais frequentes. Podem ser elucidados aspectos relacionados à flebite pós-infusão, considerando-se poucos estudos abordam o tema sob esta perspectiva.

RESUMEN Objetivo: investigar la incidencia de flebitis y la asociación de factores de riesgo con su ocurrencia durante el uso y después de la retirada del catéter intravenoso periférico (CIP) (flebitis post-infusión) en adultos hospitalizados. Método: estudio de cohorte con 171 pacientes con CIP, totalizando 361 punciones. Fueron recolectadas variables sociodemográficas y relacionadas al catéter. Análisis estadístico descriptivo y analítico. Resultados: de los pacientes, 51,5% eran hombres y el promedio de edad fue de 56,96 años. La incidencia de flebitis durante el uso del CIP fue de 1,25% y de post-infusión fue de 1,38%. Se asoció la flebitis durante el uso del CIP al tiempo de permanencia del catéter y con la post-infusión (punción en el antebrazo). Los medicamentos Ceftriaxona, Claritromicina y Oxacilina fueron asociados a la flebitis post-infusión. Conclusiones: este estudio posibilitó investigar la asociación de factores de riesgo y la ocurrencia de flebitis durante el uso y después de la retirada del catéter. La frecuencia de la flebitis post-infusión fue mayor que el número de flebitis asociada a la permanencia del catéter, siendo las de grado III y II, respectivamente, las más frecuentes. Se trato de elucidar aspectos relacionados a la flebitis post-infusión, considerando que existen pocos estudios que abordan el tema bajo esta perspectiva.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes / Remoção ou troca de lentes intraoculares: indicações, intervenções pós-operatórias e resultados

ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity. .

RESUMO Objetivo: Analisar as indicações para a remoção ou troca de lentes intraoculares (IOL), que foram originalmente implantadas para a correção de afacia após a extração da catarata. Método: Todos os casos que envolveram remoção ou troca de lentes intraoculares em uma única instituição, entre janeiro de 2008 e dezembro 2014 foram analisados retrospectivamente. Resultados: No total, foram analisados 93 olhos de 93 pacientes. O intervalo de tempo médio entre o implante e a remoção das LIOs de câmara anterior (AC IOL) e de câmara posterior (PC IOL) foi 83,40 ± 83,14 meses (variando de 1 a 276 meses) e 55,14 ± 39,25 meses (variando de 1 a 168 meses), respectivamente. Ceratopatia bolhosa pseudofácica (17 olhos, 38,6%) e irite persistente (12 olhos, 27,8%) no grupo AC IOL, e deslocamento ou descentralização (30 olhos, 61,2%) e poder incorreto da IOL (nove olhos, 18,4%), no grupo PC IOL, foram as indicações mais comuns para a remoção das IOLs. A média logMAR da melhor acuidade visual corrigida (BCVA) melhorou significativamente a partir de 1,30 no pré-operatório para 0,62 no pós-operatório no grupo PC IOL (p<0,001), mas não melhorou significativamente no grupo AC IOL (p=0,186). Conclusões: A principal indicação para remoção ou troca de lentes intraoculares foi a ceratopatia bolhosa pesudofácica no grupo AC IOL e deslocamento ou descentralização no grupo PC IOL. A remoção ou troca de PC IOLs é segura e melhora a acuidade visual. .

Estenosis subglótica: reporte de casos / Subglottic stenosis: case report

Introducción: La estenosis subglótica (ES) plantea un desafío clínico constante dado su alta morbimortalidad, diversidad de causas, localización, severidad y variedad de procedimientos terapéuticos. Objetivos: Determinar el perfil de pacientes con diagnóstico de ES, evaluar el tratamiento y sus resultados. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes con ES entre 2008 y 2011. Se describen las características demográficas, factores de riesgo, sintomatología, tipo y grado de estenosis, tratamiento, porcentaje de decanulación y complicaciones. Resultados: 17 pacientes adultos fueron incluidos. Edad promedio: 51 ± 14,37 años. Sexo: 70,6% femenino, 29,4% masculino. El principal síntoma fue la disnea (76,5%). La ES con compromiso sólo de partes blandas (88,2%) y el grado III de severidad fueron predominantes. El tratamiento incluyó procedimientos endoscópicos (47%) y quirúrgicos abiertos (41%). La cirugía abierta, como único tratamiento o segundo paso presentó un porcentaje de decanulación menor al manejo endoscópico. La dilatación con broncoscopio presentó una tasa de éxito de 63%. La tasa de decanulación general fue 58,8%. Conclusiones: La ES es una patología compleja. La baja tasa de sospecha, sintomatología inespecífica y el retraso en la consulta hace necesaria la creación de equipos de vía aérea multidisciplinarios para su pesquisa y manejo.

Introduction: Subglottic stenosis (SE) pose a constant clinical challenge because it's high morbidity and mortality, diversity of causes, location, severity and variety of treatment procedures. Aim: Determine the profile of patients with SE and evaluate the treatment and its results. Material and method: Retrospective descriptive study by reviewing medical records of patients with SE between 2008 and 2011. Demographic characteristics, risk factors, symptoms, type and degree of stenosis, treatment, decannulation percentage and complications were described. Results: 17 adult patients were included. Average age: 51 ± 14.37 years. Sex: 70.6% female and 29.4% male. The main symptom was dyspnea (76.5%). The SE with only soft tissue involvement (88.2%) and grade III severity were predominant. For treatment endoscopic procedures (47%) and open surgery were used (41%). Open surgical technique as unique treatment or as a second step, was less successful compared to endoscopic treatment. Bronchoscopic dilatation had a success rate of 63%. The overall decannulation rate was 58.8%. Conclusions: The SE is a complex pathology. The low rate of suspicion, nonspecific symptoms and delay in medical consultation requires the creation of multidisciplinary teams for diagnosis and management.

Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population

OBJECTIVE: Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke. METHODS: Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score. RESULTS: Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilarartery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%. CONCLUSIONS: Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.

Filtros de vena cava en pacientes con cáncer / Vena cava filters in cancer patients

Los pacientes con tromboembolismo venoso (TEV) y cáncer tienen más complicaciones vinculadas al tratamiento anticoagulante que la población general. Los filtros de vena cava constituyen una herramienta útil para el tratamiento del TEV y su utilización es controvertida en estadios avanzados de la enfermedad. En este trabajo se revisaron las indicaciones, complicaciones y frecuencia de retiro de los filtros de vena cava en una población de pacientes oncológicos con TEV. Se analizaron 27 pacientes a quienes se les había colocado filtros de vena cava. Veinticinco tenían tumores sólidos y dos linfomas no Hodgkin. Veinticinco estaban bajo tratamiento activo (cirugía y/o quimioterapia). Diecinueve se hallaban en estadio IV de su enfermedad. El motivo de su indicación fue profilaxis en el período perioperatorio en 14 casos (51.9%), hemorragia (n = 5), trombocitopenia (n = 4), metástasis en sistema nervioso central (n = 2), accidente cerebrovascular (n = 1) y neurocirugía previa no reciente (n = 1). Se retiraron 8 (29.6%) filtros. La mediana del tiempo de permanencia fue 21 días (6-75). No hubo diferencias estadísticamente significativas en la frecuencia de retiro entre los filtros colocados en el perioperatorio (6/14) y los colocados por otras contraindicaciones para la anticoagulación (2/13; p = 0.2087). No hubo fracasos ni complicaciones en los procedimientos de colocación y retiro.

Cancer patients with venous thromboembolism (VTE) have more complications related to the anticoagulation treatment than the general population. Vena cava filters are a useful tool in cancer patients, but their use in advanced disease is controversial. In this paper, we reviewed the indications, complications and frequency of retrieval of vena cava filters in cancer patients with VTE. Twenty seven patients with vena cava filter placements were analyzed. Twenty five had solid tumors and two non Hodgkin lymphomas. Twenty five were under active treatment (surgery and/or chemotherapy). Nineteen were classified as stage IV of disease. Indications for filter placement were perioperative prophylaxis in 14 cases (51.9%), hemorrhage (n = 5), thrombocytopenia (n = 4), central nervous system metastases (n = 2), stroke (n = 1) and previous neurosurgery (n = 1). Eight (29.6%) filters were retrieved. The median time to retrieval was 21 days (range: 6-75). There was no statistically significant difference in the frequency of retrieval between perioperative prophylaxis placement (6/14) and other contraindications for anticoagulation treatment (2/13; p = 0.2087). There were no adverse events related to the placement or retrieval procedures.

Microscopic analysis of opacification in Ioflex® hydrophilic acrylic intraocular lenses / Análise microscópica da opacificação de lentes intraoculares acrílicas hidrofílicas Ioflex®

Five cases of intraocular lens (IOL) opacification in patients implanted with the Mediphacos Ioflex® IOL are described. Clinical data in each case was obtained from the patient's medical record. The five explanted IOLs underwent gross and light microscopic analysis. Selected lenses were processed for further evaluation and multiple sagittal cuts were stained with the alizarin red and von Kossa methods. Light microscope analysis confirmed the presence of deposits on and within the lens, which stained positive for calcium. The reason why calcification has occurred in these cases remains unclear, but surgeons should be aware of this potential late postoperative complication.

Cinco casos de opacificação de lente intraocular (LIO) em pacientes implantados com a LIO Ioflex® da Mediphacos são descritos. Os dados clínicos dos pacientes foram obtidos a partir dos prontuários médicos. As cinco LIOs explantadas foram enviadas para análise macroscópica e sob microscopia óptica. Algumas lentes foram processadas para análise adicional e múltiplos cortes sagitais foram corados pelos métodos de vermelho de alizarina e von Kossa. A análise sob microscopia óptica confirmou a presença de depósitos na superfície e no corpo da lente, que coraram positivamente para cálcio. A razão pela qual a calcificação ocorreu nestes casos permanece obscura. Entretanto, cirurgiões devem estar atentos para esta potencial complicação tardia.

Periurethral constrictor: late results of the treatment of post prostatectomy urinary incontinence

OBJECTIVES: We evaluated retrospectively, the long-term outcome of patients with post-prostatectomy urinary incontinence (PPUI) after placement of the Periurethral Constrictor (PUC). MATERIALS AND METHODS: Fifty-six men with severe PPUI were studied, with a mean age of 68.5 years old. Fifty-one men had PPUI due to radical surgery having the device placed around the bulbous urethra, and five individuals with benign prostatic hypertrophy (BPH) had placement around the bladder neck. The mean follow-up was 82.2 months. RESULTS: Twenty-two patients (39.28 percent) became continent (0 to 1 pad a day) and 34 (60.72 percent) were incontinent. Complications were as follows: urethral erosion in 15 (26.78 percent); mechanical malfunction in 2 (3.5 percent); infection in 2 (3.5 percent); urinary fistula in 1 (1.7 percent); Urinary tract infection1 (1.7 percent). Twenty-three patients needed to have the device removed (41.07 percent). Success rate (continent me) was 30.35 percent. CONCLUSION: In the present series the PUC was not effective for the treatment of severe PPUI in the long-term follow-up.

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

PURPOSE: Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09 percent) from the intervention and 3 patients (14.3 percent) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.