جستجوی مقالات مرتبط با کلیدواژه « urinary diversion » در نشریات گروه « پزشکی »

It is unclear if robotic radical cystectomy with extracorporeal urinary diversion (eRARC) provides additional benefit when performed along with enhanced recovery after surgery (ERAS). We assessed the additional efficacy of eRARC in terms of perioperative outcomes.

We retrospectively assessed 143 patients undergoing radical cystectomy with urinary diversion between June 2010 and December 2021 at a single center. The patients were assigned to three groups: open radical cystectomy (ORC) with conventional recovery after surgery (CRAS) [Group A], ORC with ERAS [Group B], and eRARC with ERAS [Group C]. A propensity score-matched analysis was performed to evaluate how ERAS and eRARC affected outcomes respectively. Meanwhile, multivariable analysis was used to detect the predictors of prolonged length of hospital stay (LOS).

The median LOS was shorter after ERAS and eRARC. In the propensity score-matched analysis, ERAS was linked to a significantly shorter median LOS (28.0 vs. 20.0 days, P < .001), but eRARC was not associated with a shorter LOS (19.0 vs. 17.5 days, P = .21). Neither ERAS nor eRARC were connected with a reduce in complication rate. Following multivariable analysis, ERAS was found to be independently associated with shorter LOS (OR=0.23, P < .001), but eRARC demonstrated no such correlation (OR=0.29, P = .096).

ERAS had strong association with shorter LOS, although eRARC did not contribute to additional efficacy. Neither ERAS nor eRARC decreased the complication rate.

Orthotopic neobladder is a well-established surgical solution for continent urinary diversion after radical cystectomy. Nevertheless, it still represents a challenging surgery. Some critical issues of orthotopic bladder substitution include relevant complication rates, renal function impairment, urinary incontinence and patient quality of life. We present a new ileal neobladder technique, Vesuvian Orthotopic Neobladder (VON), performed for the first time at our institution in 2020. The main purpose of this new surgical procedure is to simplify and speed up the reservoir reconstruction through a ten standardized technical steps and obtain an appropriate bladder capacity at the same time.

Inclusion criteria were muscle-invasive bladder carcinoma or non muscle-invasive high risk bladder cancer patients fit for bladder substitution. The exclusion criteria were locally advanced cancer, presence of hydronephrosis, renal or hepatic impairment. A chest-abdominal CT scan and urinary cytology were performed before the procedure. Patients received neoadjuvant chemotherapy, as required. Overall, operative time, bladder reconfiguration time, hospitalization time, catheterization time were recorded. All complications associated with the procedure were classified according to the Clavien Dindo score. The bladder volume was evaluated by ultrasound three months after the surgery.

A total of six male patients diagnosed with non-metastatic muscle-invasive or high-risk non-muscle invasive bladder cancer who underwent radical cystectomy followed by VON reconfiguration were included in the study. Mean age was 62.8 (±4.9) years; all selected patients enjoyed good health conditions (Charlson Comorbidity Index 4-6). One patient presented with high-risk non-muscle invasive bladder cancer. Four patients received neoadjuvant chemotherapy. Mean overall operative time was 273.3 (±18.6) minutes. Average time for neobladder reconstruction was 63.7 (±16.1) minutes. There were no intraoperative complications. A single case of urethral anastomosis leakage occurred and was treated conservatively. Bladder volume on ultrasound evaluation ranged between 250 and 290 ml.  Day time and nocturnal continence were observed in four and three patients, respectively.

The new VON technique is a good alternative to traditional orthotopic bladder procedures. VON reconstruction seems to offer the advantage of speeding up the procedure, reducing intestinal compromise with good storage capacity. The ten surgical steps can be considered a good starting point for further improvements in surgical technique. More robust data regarding the number of procedures and the duration of follow-up is required.

The conventional Trans-Peritoneal Radical Cystectomy (TPRC) harbors numerous postoperative com - plications, the most prevalent of which are Gastrointestinal (GI) problems. To reduce these morbidities we intro - duced our own version of extra-peritoneal approach and compared it with the conventional method.

In a cross-sectional observational retrospective design, eligible bladder cancer patients whom underwent Extra-Peritoneal Radical Cystectomy (EPRC) or TPRC in our center, were considered for this study and were compared for early post-operative complications.

Ninety-nine patients in TPRC and 81 in EPRC were compared. The two techniques differed in their mean operation time (298.2 ± 37.8 min TPRC vs. 262.8 ± 37.2 min EPRC , P : 0.001). Early GI complications were lower in EPRC groups, including oral intake intolerance ( 21 vs. 8, P: 0.04), ileus (19 vs. 8, P : 0.04), intestinal obstruction (3 vs. 0, P : 0.04), and anastomosis leakage (8 vs. 1, P : 0.01). Urine leak (14 vs.7 , P : 0.02) and wound related complications (19 vs. 6 , P : 0.02) also favored EPRC group.

The extra-peritoneal technique is beneficial in reducing postoperative morbidity, especially the more prevalent GI complications. This approach is functionally safe and allows preservation of the peritoneal integrity

Surgical repair of post-traumatic complex urethral stricture poses a major challenge to urologists. Here, we report six patients with irreparable urethral strictures who were successfully treated by using the appendix as conduit for urinary diversion.

Six patients who had underwent urinary diversion using an appendix during 2015 to 2019 were included in our study. All patients had a history of one or more failed attempts of urethral reconstruction in the past. Mean follow-up for patients was 29 months. Continency was defined as being completely dry for at least 3 hours.

Mean age of patients was 40.1 years old (range: 20-70 years). Intermittent catheterization through the conduit was easily performed for every patient without any stomal stenosis. Mild stomal incontinence only oc - curred in one case which was resolved after a few months. All patients were continent during day and night.

Based on the results of our study, Mitrofanoff’s technique is a valuable procedure for managing pa - tients with serious complicated urethral strictures who cannot be treated with common standard approaches

  To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy (RC) and multimodal treatment (MMT). We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer (MIBC) at our institution, between January 1995 and December 2010. After ex cluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th month. The mean age and mean baseline GFR were 66.5±5.7 years and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd month. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more reg ularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 mL/min at the end of five years. Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term fol low-up. Renal function deterioration is more prominent within the first year after MMT.

We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS. The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration. All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period. Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively). PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.

To assess the long-term changes in renal function, blood electrolyte levels, and nutritional indices after radical cystectomy and ileal conduit in patients with bladder cancer. Patients and In 129 patients who underwent radical cystectomy and ileal conduit, we evaluated clinicopathologic features, complications, and the change in the estimated glomerular filtration rate (eGFR) from baseline to 1, 2, 3, 4, 5, and 10 years postoperatively. Two nutritional indices, the geriatric nutritional risk index (GNRI) and prognostic nutrition index (PNI), were calculated with laboratory tests. In the ileal conduit group, a parastromal hernia was observed in 10% of patients, whereas 13% had an ureteroenteric anastomotic stricture, which was associated with greater decline in the eGFR postoperatively. The first 5 year-decline in the eGFR was 1.74 mL/min/1.73 m2/year. The levels of only potassium showed a significant increase at 1 year postoperatively (mean: 4.34 mEq/L) and remained high compared with the baseline (4.14 mEq/L). Evaluation of the nutritional indices demonstrated that the GNRI, and not PNI, showed a significant, transient increase from 1 to 4 years (range: 108−110) postoperatively compared with the baseline (105). The first 5 year-decline was much higher than that among Japanese individuals who participated in an annual health examination program. Further research should be performed to identify an appropriate strategy for selecting the suitable type of urinary diversion and postoperative nutritional interventions to improve the clinical outcome of patients with bladder cancer.

To assess early and late-term outcomes of patients who had undergone pelvic exenteration and simultaneous fecal and urinary diversion with plain wet colostomy (PWC) or double-barrelled wet colostomy (DBWC). The medical records of all patients who had undergone pelvic exenteration and urinary diversion between 2006 and 2017 at our hospital were reviewed retrospectively. In total, 15 patients with a mean age of 56 ± 13 years were included in the study. Simultaneous urinary and fecal diversions were carried out as PWC (n = 8), or DBWC (n = 7). No significant differences were found between PWC and DBWC groups in terms of operation time (373.7 ± 66.5 versus 394.2 ± 133.2 min, P = .955), estimated blood loss (862.8 ± 462.4 versus 726.2 ± 489.4 mL, P = .613), length of hospital stay (13.2 ± 9.1 versus 14.1 ±6.9 days), early complications (25% versus 28.6%, P = 1.0) and late term complications (37.5% versus 42.9%, P = 1.0). The rate of recurrent pyelonephritis in PWC group was higher than DBWC group but not statistically significant (37.5% versus 14.3%, P = .569). Overall survival (OS) of the patients was 385 ± 91 days. There was no difference between OS of patients with PWC and DBWC (414 ± 165 versus 352 ± 70 days, P = .618). PWC and DBWC are valid options for creating simultaneous urinary and fecal diversion after extensive pelvic surgery in patients with short life expectancy. DBWC might be superior to PWC in terms of decreased risk of recurrent pyelonephritis.

Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented.
Patients and During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomy tube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management.
Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines.
Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.

While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage.. We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures.. We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management..

In 1981, Mitrofanoff described a procedure to create a continent urinary stoma for clean intermittent catheterization. Since then several procedures have been described including Yang-Monti ileovesicostomy for effective catheterization.. We report on our experience from the use of Monti’s procedure in children at our center..Patients and Children < 18 years of age undergoing urinary diversion/reconstruction with Yang-Monti’s procedure for congenital conditions or neuropathic bladder formed the study group. All these children, post-operatively were taught clean intermittent catheterization (CIC) and put on a regime using a 14/16 Fr catheter every 3 hours. The children were followed regularly at 3, 6, 12, 18 and 24months post-operatively, with special attention paid to any problems with catheterization and incontinence.. During the period from Jan 2000 to Dec 2011, at our center, 19 children less than eighteen years of age underwent urinary diversion with Yang-Monti’s catheterizable stoma. The indications for urinary diversion was neuropathic bladder in eight, exstrophy bladder in seven, valve bladder syndrome in three and persistent urethral stricture in one. None of the children found CIC difficult during the post-operative period and there was no hindrance to the passage of the catheter.. Although the appendix remains the tissue of choice for creation of catherterizable stoma, the Yang-Monti ileovesicostomy is effective, convenient conduit for children. Long-term complications are minimal and children find this comfortable to do CIC..