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Contemporary outcomes of patients undergoing robotic-assisted radical cystectomy:A comparative analysis between intracorporeal ileal conduit and neobladder urinary diversions
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作者 Jordan M.Rich Shivaram Cumarasamy +6 位作者 Daniel Ranti Etienne Lavallee Kyrollis Attalla John P.Sfakianos Nikhil Waingankar Peter N.Wiklund Reza Mehrazin 《Asian Journal of Urology》 CSCD 2023年第4期446-452,共7页
Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Pati... Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion. 展开更多
关键词 ROBOTIC Radical cystectomy INTRACORPOREAL Ileal conduit Neobladder urinary diversion Oncologic outcome
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Totally intracorporeal robot-assisted urinary diversion for bladder cancer(part 2).Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder 被引量:5
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作者 Hugo Otaola-Arca Kulthe Ramesh Seetharam Bhat +2 位作者 Vipul R.Patel Marcio Covas Moschovas Marcelo Orvieto 《Asian Journal of Urology》 CSCD 2021年第1期63-80,共18页
Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent ima... Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique. 展开更多
关键词 Bladder cancer Ileal orthotopic neobladder Intracorporeal urinary diversion Robot-assisted radical cystectomy Surgical technique
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Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch 被引量:3
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作者 Hugo Otaola-Arca Rafael Coelho +1 位作者 Vipul R.Patel Marcelo Orvieto 《Asian Journal of Urology》 CSCD 2021年第1期50-62,共13页
Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent image... Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was performed.Results:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the analysis.Regarding ICIC,the patients’age ranged from 60 to 76 years.The operative time to perform a urinary diversion ranged from 60 to 133 min.The total estimated blood loss ranged from 200 to 1117 mL.The rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,respectively.Late minor and major complication rates ranged from 0%to 66%and from 0%to 32%,respectively.Totally ICIP data are limited to one case report and one clinical series.Conclusion:The most frequent type of CUD is ICIC.Randomized studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature.To this day,there are not enough quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique. 展开更多
关键词 Bladder cancer Ileal conduit Indiana pouch Intracorporeal urinary diversion Robot-assisted radical cystectomy Surgical technique
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Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion 被引量:3
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作者 Jason M.Sandberg Ashok K.Hemal 《Asian Journal of Urology》 2016年第3期156-166,共11页
Robot-assisted radical cystectomy with intracorporeal urinary diversion(RARCICUD)has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncolo... Robot-assisted radical cystectomy with intracorporeal urinary diversion(RARCICUD)has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques.Inspired by earlier open and laparoscopic work,initial descriptions of RARC-ICUD were published in 2003,and have since been followed by multiple larger case series which have suggested promising outcomes for our patients.However,the rate of adoption has remained relatively slow when compared to other robotassisted procedures such as the radical prostatectomy,likely owing to longer operative times,operative complexity,costs,and uncertainty regarding oncologic efficacy.The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists.Though there are still questions regarding economic costs,effectiveness,and generalizability of outcomes reported in published data,a growing dataset has brought us ever closer to the answers.Here,we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients. 展开更多
关键词 CYSTECTOMY ROBOTICS urinary bladder neoplasms urinary diversion
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Serum cystatin C can be used as a marker of renal function even in patients with intestinal urinary diversion
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作者 Masahiro Matsuki Toshiaki Tanaka +6 位作者 Takeshi Maehana Koji Ichihara Masahiro Yanase Masanori Matsukawa Hideki Adachi Satoshi Takahashi Naoya Masumori 《Asian Journal of Urology》 2015年第3期167-169,共3页
Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in... Objective:Recently,serum cystatin C(CysC)has been used as a novel marker of renal function.However,there is a lack of data on CysC levels in patients with intestinal urinary diversion(UD).Here we report CysC levels in such patients.Methods:We prospectively observed 38 patients who were diagnosed with bladder cancer and subsequently treated with radical cystectomy and UD at our institution in 2012 and 2013.Serum creatinine(sCr)and CysC were obtained optionally at the same time at least 1 month after radical cystectomy and UD.Results:The median CysC and sCr concentrations were 1.12 mg/L(range 0.75-2.47 mg/L)and 0.99 mg/dL(range 0.61-2.22 mg/dL),respectively.The median estimated concentrations of glomerular filtration rate(GFR)based on CysC(eGFRcys)and GFR based on creatinine(eGFRcreat)were 61.08 mL/min/1.73 m^2(range 22.64e99.89 mL/min/1.73 m^2)and 58.01 mL/min/1.73 m^2(range 23.48e91.82 mL/min/1.73 m2),respectively.CysC had a significant correlation with sCr(r=0.8607,p<0.0001)and eGFRcreat(r=-0.8993,p<0.0001).eGFRcys also had a significant correlation with eGFRcreat(r=0.8104,p<0.0001).Conclusion:The correlation between CysC and sCr was strong and the correlation coefficient was equivalent to that in patients without UD.The results suggest that CysC is not affected by UD and can be used as a marker of renal function similarly to sCr in patients with UD. 展开更多
关键词 Renal function Cystatin C urinary diversion
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Laparoscopic continent cutaneous urinary diversion using a modified Yang-Monti technique in an adult:A case report including 5-year follow-up
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作者 Silu Chen Yuye Wu +5 位作者 Peng Zhang Zhihua Li Xinfei Li Zhenyu Li Kunlin Yang Xuesong Li 《Current Urology》 2024年第1期71-74,共4页
Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable.The Yang-Monti channel is an alternative to the tunneled appendix for urinary diversion.We present a case involving a 4... Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable.The Yang-Monti channel is an alternative to the tunneled appendix for urinary diversion.We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously.No tumor recurrence was observed;however,the patient experienced severe catheter-related bladder irritation after the procedure.The patient was readmitted to the authors'hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang-Monti channel.The operation lasted 232 minutes,with an estimated blood loss of 10 mL.The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube.After this,clean intermittent catheterization was performed every 3 hours for 4 weeks.Five years after the procedure,the modified Yang-Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed.The patient was satisfied with his postoperative quality of life. 展开更多
关键词 Cutaneous urinary diversion Yang-Monti channel LAPAROSCOPY
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Tissue-engineered conduit using bladder acellular matrix and bladder epithelial cells for urinary diversion in rabbits 被引量:1
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作者 LIAO Wen-biao SONG Chao LI Yong-wei YANG Si-xing MENG Lin-chao LI Xin-hui 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第2期335-339,共5页
Background For muscle invasive bladder cancer, radical cystectomy is the most effective treatment now and urinary diversion is often necessary. The use of intestinal tissue for urinary diversion is frequently associat... Background For muscle invasive bladder cancer, radical cystectomy is the most effective treatment now and urinary diversion is often necessary. The use of intestinal tissue for urinary diversion is frequently associated with complications. In this study, we aimed to make a tissue-engineered conduit (TEC) using bladder epithelial cells and bladder acellular matrix (BAM) for urinary diversion in rabbits. Methods Bladder epithelial cells of rabbit were cultivated and expanded in vitro, then seeded on BAM, and cultured for 7 days. Then cell-seeded graft was used to make TEC. In the experimental group, most of bladder of the rabbit was removed while bladder trigone was retained. The proximal end of TEC was anastomosed with bladder trigone and the distal end was anastomosed with the abdominal stoma. In the control group, TEC was made using unseeded BAM. Haematoxylin and eosin staining was conducted, respectively, at 1, 2, 4, and 8 weeks postoperatively. Immunohistochemistry was performed 8 weeks postoperatively. Intravenous urography, retrograde pyelography, and cystoscopy of TEC were made at 12 weeks postoperatively. Results All animals were alive in the experimental group. Haematoxylin and eosin staining showed epithelial coverage in TEC. Immunohistochemistry showed anti-cytokeratin AEI/AE3 antibody and anti-ZO1 antibody positive, confirming there were mature and functional epithelial cells on the lumen of TEC. Retrograde pyelography and intravenous urography showed that TEC developed well and that there was no obstruction. In the control group, four rabbits were dead within 2 weeks and scar formation, atresia, and severe hydronephrosis were found. Conclusions We successfully made TEC using BAM and bladder epithelial cells for urinary diversion in rabbits. The lumen of this new TEC covered mature epithelial cells and could prevent urinary extravasation. 展开更多
关键词 bladder cancer bladder acellular matrix epithelial cells urinary diversion tissue engineer
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Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury
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作者 Xabier Pérez-Aizpurua Ramiro Cabello Benavente +6 位作者 Gonzalo Bueno Serrano JoséMaría Alcázar Peral Blanca Gómez-Jordana Mañas Jaime Tufet i Jaumot Joaquín Ruiz de Castroviejo Blanco Felipe Osorio Ospina Carmen Gonzalez-Enguita 《World Journal of Nephrology》 2024年第2期5-15,共11页
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounti... Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of cases.Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.The aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and management.Recent literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were prioritized.Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney.Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related issues.Obstructive uropathy is one of the leading causes of AKI.Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management. 展开更多
关键词 Obstructive uropathy urinary tract obstruction Obstruction of the urinary tract Acute kidney injury urinary diversion Renal recovery
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High Urine Retention: Experience in a Series of Patients with Renal Failure Patients
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作者 Cyrille Ze Ondo Abdoulaye Ndiath +6 位作者 Amath Thiam Alioune Sarr Ndiaga Seck Ndour Ousmane Sow Babacar Sine Babacar Diao Alain Khassim Ndoye 《Open Journal of Urology》 2024年第1期1-10,共10页
Purpose: High urinary retention (HUR) can negatively impact renal function. Our study aimed to present the epidemiological, diagnostic, and therapeutic aspects of HUR in a Senegalese academic hospital. Patients and Me... Purpose: High urinary retention (HUR) can negatively impact renal function. Our study aimed to present the epidemiological, diagnostic, and therapeutic aspects of HUR in a Senegalese academic hospital. Patients and Methods: We conducted a retrospective study of 70 patients with HUR associated with renal failure from January 2017 to December 2020. Parameters examined included: age, sex, coexisting conditions affecting renal function, clinical symptoms, diagnostic tests, causes of HUR, urinary diversion, and patient outcomes. Results: The average age was 66, with a majority of male patients (87%). Twenty-three patients had pre-existing medical conditions. Oligo-anuria was the most common reason for detecting HUR (70%). Half of the patients had an ECOG score ≥ 2. The mean creatinine level was 50.7 mg/l. Nineteen patients exhibited hydroelectrolytic disorders. Bacterial colonization was observed in 25 patients. Ultrasound and computed tomography were the most frequently performed imaging tests (100% and 62.8%, respectively). Sixty-seven patients had ureterohydronephrosis (UHN), with bilateral UHN in 88.6% of cases. Pelvic cancers (47.1%) were the primary cause of HUR, primarily bladder cancers (27.1%). Nephrostomy was the most common urinary drainage method (50%), particularly for obstructions due to pelvic cancer (88.6%). The majority of patients (52.8%) regained normal renal function after drainage. Nineteen deaths occurred among elderly patients with compromised general health. Conclusion: Urinary drainage significantly improved renal function for most patients. Pelvic cancer emerged as the leading cause of HUR. Nephrostomy was the predominant drainage method. 展开更多
关键词 KIDNEY urinary Retention Renal Failure urinary diversions Senegal
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Modified Indiana Pouch Following Radical Cystectomy
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作者 余虓 叶章群 +7 位作者 杨为民 胡志全 王少刚 曾晓勇 章慧平 曾令启 商学军 杨奕 《The Chinese-German Journal of Clinical Oncology》 CAS 2003年第1期34-35,60,共3页
Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radi... Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization. 展开更多
关键词 bladder tumor urinary diversion Indiana pouch
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Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction 被引量:10
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作者 Linda Hsu Hanhan Li +4 位作者 Daniel Pucheril Moritz Hansen Raymond Littleton James Peabody Jesse Sammon 《World Journal of Nephrology》 2016年第2期172-181,共10页
The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no ... The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies. 展开更多
关键词 Percutaneous nephrostomy urinary diversion Ureteral obstruction Quality of life Ureteral stents Pelvic malignancy urinary drainage
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Transperitoneal Laparoscopic Cystoprostatectomy for Muscle Invasive Bladder Cancer: Results and Oncologic Outcomes in a Single Center in Douala Cameroon
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作者 Cyril Kamadjou Divine Enoru Eyongeta +4 位作者 Annie Wadeu Kameni Herve Moby Mpah Justin Kamga Bertin Njinou Ngninkeu Fru Angwafo 《Surgical Science》 2022年第11期529-540,共12页
Background and Aim: Radical cystectomy is the treatment of choice for muscle-invasive bladder cancer. Although open surgery is currently the gold standard for this procedure, it can also be done via laparoscopy. We ai... Background and Aim: Radical cystectomy is the treatment of choice for muscle-invasive bladder cancer. Although open surgery is currently the gold standard for this procedure, it can also be done via laparoscopy. We aimed to evaluate the oncologic results and the place of laparoscopic cystectomy in the management of bladder cancer in a single urology center in Douala, Cameroon. Patients and Methods: This is a prospective, single-center study carried out from 2015 to 2019. We included 12 patients (ten men and two women) with bladder cancer who underwent total radical laparoscopic transperitoneal cystectomy with ilio-obturator lymph node dissection. Data on patients’ demographic characteristics, pre-operative and postoperative clinical parameters and workup results, and surgical outcomes were collected to determine the overall survival using a Kaplan-Meier curve. Results: We recruited ten men and two women with a median age of 61.5 [52.8 - 68.5] years. The mean tumor diameter was 3.75 ± 1.06 cm. Three (25%) patients received adjuvant chemotherapy while eight did not. The mean surgery duration was 242 ± 45.85 minutes. Blood vessels and nerves were preserved in four (33.33%) patients during surgery. Transitional cell carcinoma was found in 10 (83.33%) patients while epidermoid carcinoma was found in two (16.67%) patients. Metastasis occurred in four (33.33%) patients while the tumor recurred in two (16.67%) patients who later died. Bricker’s ileal conduit urinary diversion was performed in 10 (83.33%) patients while the Studer neobladder was used in two (16.67%) patients. The mean duration of hospitalization was 6 ± 1.48 days. Only one patient (8.33%) developed a postoperative complication. Six (50%) of the patients died while six survived. The median overall survival was 486 days and the five-year overall survival rate was 46.47%. Conclusion: Laparoscopic cystectomy is a mini-invasive technique associated with good cancer control. When performed by well-trained staff using specialized equipment, it can be a safe and effective method of managing muscle-invasive bladder cancer. 展开更多
关键词 Laparoscopic Radical Cystectomy Bladder Cancer Overall Survival urinary diversion
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Modified Ureterosigmoidostomy
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作者 程双管 钱立新 +6 位作者 吴宏飞 华立新 张炜 顾民 殷长军 眭元庚 徐正铨 《Journal of Nanjing Medical University》 2000年第2期105-108,共4页
Objective To introduce an operation procedure and evaluate the continence diversion results of the modified ureterosigmoidostomy after radical cystectomy. Methods Fourteen cases of bladder cancer or prostate carcin... Objective To introduce an operation procedure and evaluate the continence diversion results of the modified ureterosigmoidostomy after radical cystectomy. Methods Fourteen cases of bladder cancer or prostate carcinoma were operated on with modified Sigma pouch from Feb, 1998 to Dec, 1999. A longitudinal incision about 25 cm on the sigmoid wall was done to form a low pressure pouch. The vertex of the new pouch was fixed to sacrum. Both ends of ureters were anastomosed side to side and to form a big nipple and inserted into the top of pouch for 2 to 3 centimeters.Results It took about sixty five minutes to create a new low pressure pouch after radical cystectomy. Early complication of was found in two cases postoperatively, and cured with temporary colonostomy. Hydronephrosis and hypokalemia in one patient were cured by percutaneous anterograde ureter dilatation with balloon and oral replacement of potassium salt. All patients displayed urinary continence. No symptomatic renal infection or hypercholoraemic acidosis occurred. Conclusion Modified ureterosigmoidostomy is a safe procedure of urinary diversion and provides a big volume, low intravesical pressure pouch. The patients are free from the troublesome urine bag, intermittert catheterization, and upper urinary tracts are protected effectively. The quality of life is satisfied. 展开更多
关键词 bladder neoplasm prostate neoplasm urinary diversion ureterosigmoidostomyere randomly allocated into two groups:ovariectomy(OVX) group and sham operation(sham) group. The rats in both groups were killed three weeks after operation. One th
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Urodynamic study of enhanced continent mechanism using tapered ileum as continent urinary reservoir
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作者 徐月敏 乔勇 +6 位作者 陈忠 张心如 陈嵘 撒应龙 张炯 李涛 吴登龙 《Chinese Medical Journal》 SCIE CAS CSCD 2002年第11期1653-1657,149-150,共5页
OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal... OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. RESULTS: One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46 - 124 cmH(2)O (91.26 +/- 15.71 cmH(2)O) and with an empty pouch was 34 - 84 cmH(2)O (67 +/- 10.60 cmH(2)O). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -11.78 and P = 0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67 +/- 78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17 +/- 1.17 cmH(2)O) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12 +/- 5.61 cmH(2)O) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89 +/- 26.34 cmH(2)O) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78 +/- 14.54 cmH(2)O) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -7.58 and P = 0.00003). CONCLUSIONS: This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls. 展开更多
关键词 urinary Reservoirs Continent URODYNAMICS ADULT Aged FEMALE Humans ILEUM Male Middle Aged Research Support Non-U.S. Gov't urinary diversion
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The challenging management of malignant ureteral obstruction:Analysis of a series of 188 cases
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作者 Alberto Artiles Medina Inés Laso García +7 位作者 Fernando González Tello Sara Álvarez Rodríguez Manuel Hevia Palacios Marina Mata Alcaraz César Mínguez Ojeda Fernando Arias Funez Victoria Gómez Dos Santos Francisco Javier Burgos Revilla 《Current Urology》 2024年第1期34-42,共9页
Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstru... Background:Malignant ureteral obstruction(MUO)is a common condition that complicates the course of advanced malignancies.The aims of this study are to analyze the causes,management,and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors.Furthermore,we studied the complications and outcomes in patients who underwent urinary diversion.Materials and methods:A retrospective study was conducted on patients with computed tomography-confirmed MUO between January 2016 and November 2020.Demographic,clinical,radiological,laboratory,and management data were collected.Survival curves were estimated using the Kaplan-Meier method,and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival.Results:A total of 188 patients were included.The mean age was 69.01 years(SD,14.95 years),and the majority(54.8%)were male.The most common mechanism leading to MUO was compression by a pelvic mass(36.9%),and the 3 most frequent tumors causing MUO were prostate(17.6%),bladder(16.5%),and rectal cancer(11.7%).Forty-seven patients(25%)underwent urinary diversion:23(48.9%)underwent double-J stenting and 21(44.7%)underwent percutaneous nephrostomy.The most common reason for urinary diversion was acute kidney injury(53.3%).Recovery of renal function was observed in 55.8%of the patients after urinary diversion.The most frequently identified complications after urinary diversion were urinary tract infection(24.4%),hematuria(17.0%),and urinary sepsis(14.9%).The median survival after hydronephrosis diagnosis was 6.43 months(interquartile range,1.91-14.81 months).In patients who underwent urinary decompression,the median survival after urinary diversion was 8.67 months(interquartile range,2.99-17.28 months).In the multivariate analysis,a lower grade of hydronephrosis and cancer cachexia negatively impacted survival.Conclusions:Cancer patients with MUO have a poor prognosis;therefore,the risk-benefit ratio of urinary diversion should be carefully considered.Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion. 展开更多
关键词 HYDRONEPHROSIS Ureteral obstruction NEOPLASMS urinary diversion SURVIVAL PROGNOSIS
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Diagnosis and Treatment of Urinary Incontinence after Orthotopic Ileal Neobladder in China 被引量:5
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作者 Yao-Guang Zhang Qi-Xiang Song +3 位作者 Bo Song Da-Lei Zhang Wei Zhang Jian-Ye Wang 《Chinese Medical Journal》 SCIE CAS CSCD 2017年第2期231-235,共5页
INTRODUCTIONRadical cystectomy for bladder and urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. Urinary diversion is... INTRODUCTIONRadical cystectomy for bladder and urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. Urinary diversion is usually classified into three types: orthotopic neobladder, ileal conduit or sigmoid conduit, and cutaneous ureterostomy Orthotopic neobladder is a better choice for urinary diversion than the other types because of its nonurinary diversion and better quality of life when this method is feasible for patients. One of the complications after creating an orthotopic neobladder is urinary incontinence. With an increasing amount of orthotopic neobladder procedures, more patients are suffering from urinary incontinence. Therefore, an article is required for diagnosis and treatment of urinary incontinence after the orthotopic ileal neobladder procedure. 展开更多
关键词 Bladder Cancer urinary diversion urinary Incontinence
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Reinforcing the continent mechanism of continent cutaneous diversions by wrapped rectus abdominis muscle flap: a preliminary experimental study
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作者 ZHANG Xin-ru XU Yue-min FENG Chao YU Jian-jun SONG Lu-jie FEI Xiao-fang 《Chinese Medical Journal》 SCIE CAS CSCD 2009年第9期1087-1091,共5页
Background Continent cutaneous diversion (CCD) has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especi... Background Continent cutaneous diversion (CCD) has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap (RAMF) and assessed the feasibility of this new technique to achieve urinary continence. Methods A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice. Results MIP in the study group was significantly higher than that in the control group at each phase (P 〈0.05). However no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased (P 〈0.05) and FPL decreased significantly (P 〈0.05) compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum. Conclusion The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF. 展开更多
关键词 urinary diversions continent urinary reservoir abdomen rectus muscles
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An improved ileal conduit surgery for bladder cancer with fewer complications 被引量:3
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作者 Zhiyong Li Zhuowei Liu +9 位作者 Kai Yao Zike Qin Hui Han Yonghong Li Pei Dong Yunlin Ye Yanjun Wang Zhiming Wu Zhiling Zhang Fangjian Zhou 《Cancer Communications》 SCIE 2019年第1期178-187,共10页
Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolong... Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolongs patient survival remarkably,there are postoperative complications associated with urinary diversion.This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma-and ureteroileal anastomo-sis-related complications,as compared with conventional ileal conduit urinary diversion.Methods:We retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1,2000 and June 30,2016.Ileal conduit was created by the conventional or a modified technique.The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test.Multivari-able logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma-and ureteroileal anastomosis-related complications in the two groups.Results:145 and 100 patients underwent the modified and conventional ileal conduit surgery,respectively.The two groups were comparable with regard to clinicopathologic features.The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(0.7%vs.17.0%,P<0.001).No late stoma-related complications were seen in the modified ileal conduit group,but were seen in 13(13.0%)patients in the conventional ileal conduit group.The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(4.8%vs.15.0%,P=0.001).In multivariable analyses,the modified ileal conduit group was significantly less likely to develop stoma-(odds ratio[OR]=0.024,95%confidence interval[CI]0.003-0.235;P=0.001)or ureteroileal anastomosis-related complications(OR=0.141,95%CI 0.042-0.476;P=0.002)than the conventional ileal conduit group.Conclusions:Our modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis.Prospective randomized clinical trials are needed to confirm our results. 展开更多
关键词 Bladder cancer CYSTECTOMY urinary diversion Ileal conduit COMPLICATION Surgical technique
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Hand-assisted-drawing-needle running suture with a curved needle: an effective technique to create a W-ileal neobladder 被引量:1
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作者 FANG Dan-bo CAI Song-liang +9 位作者 JIN Xiao-dong CHEN Jun JIN Bai-ye ZHENG Xiang-yi WANG Chao-jun TAN Fu-qing WANG Shuo SHEN Bo-hua ZHU Xuan-wen XIE Li-ping 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第12期2225-2227,共3页
Background An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) i... Background An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution (OBS). However, reconstruction of OBS by the traditional hand suture method (THSM) is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture (HADNRS). Methods Between April 1993 and December 2011, 347 patients (338 men and 9 women) aged 28-77 years (median age: 59 years) underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 (20 patients in 2003) were evaluated by urodynamic tests. Results The operative time ranged from 110 to 310 minutes (mean 148 minutes), and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was (20.2±4.3) minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients (0.8%) had neobladder abdominal fistula. No other early complications or injury to the surgeon's hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was (492.9±177.8) ml, and the maximum pressure within the reservoir at the end of filling was (32.1±8.6) cmH2O.Conclusion Reconstruction of W-ileal neobladder by HADNRS is effective and economical. 展开更多
关键词 urinary diversion urinary reservoir bladder ileum CONTINENT neobladder
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Orthotopic ileal neobladder similar to original bladder 被引量:3
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作者 黄健 许可慰 +3 位作者 姚友生 郭正辉 林天歆 江春 《Chinese Medical Journal》 SCIE CAS CSCD 2003年第12期1943-1945,共3页
Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatecto... Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection. 展开更多
关键词 bladder tumor · cystectomy ˙ urinary diversion · ileal neobladder
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