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
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
Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progr...Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progressive ileal conduit stomal variceal bleeding which was successfully managed by endovascular embolization via the transjugular transhepatic approach.In conclusion,transjugular transhepatic endovascular embolization is a good choice in patients with ileal conduit stomal variceal bleeding who have failed conservative therapy.展开更多
Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—on...Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.展开更多
Background： Robot-assisted/laparoscopic intracorporeal ileal conduit （ICIC） has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit （ECIC） and whether ...Background： Robot-assisted/laparoscopic intracorporeal ileal conduit （ICIC） has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit （ECIC） and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy （LRC） with ICIC and ECIC. Methods： From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient＇s characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed. Results： LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients＇ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group （3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002）. The complications rates did not show significant difference between the two groups within the first 90 days postoperatively （P = 0.538）. Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1＋. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months （60% vs. 62%, P = 0.857） between the ECIC and ICIC groups. Conclusions： ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.展开更多
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
We report a unique case of a patient who underwent cystectomy with ileal conduit for nonmalignant bladder disease.Pa postoperatively developed stomal necrosis which was managed conservatively but after few months ther...We report a unique case of a patient who underwent cystectomy with ileal conduit for nonmalignant bladder disease.Pa postoperatively developed stomal necrosis which was managed conservatively but after few months there was severe stomal stenosis and retraction and patient ended up with bilateral nephrostomies.On planned open abdominal exploration with intention to refashion stoma,after resection of distal stenosed segment we found that it was impossible to mobilize proximal portion of conduit due to severe small bowel adhesions.We used a unique approach of creating one more ileal conduit,bringing it as a new stoma on one side and anastomosing its other side with proximal one(ileal conduit over conduit)to augment deficient portion.This technique is not mentioned in the literature and as such we are reporting same as it can help many urologists who may encounter such problems.展开更多
目的:探讨造瘘口切口辅助技术(通过造瘘口切口取标本,行肠吻合及输尿管吻合)在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法:将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组(试验组)及传统下...目的:探讨造瘘口切口辅助技术(通过造瘘口切口取标本,行肠吻合及输尿管吻合)在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法:将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组(试验组)及传统下腹正中切口辅助技术组(对照组),比较2组患者尿流改道手术时间、术中出血量、并发症发生率、术后住院日、术后疼痛评分的差异。结果:试验组尿流改道手术时间少于对照组[(105.0±18.9) min vs.(117.0±17.7) min,P<0.05];术后疼痛评分低于对照组(4.03±1.50 vs. 5.40±1.69,P<0.05);术后住院时间少于对照组[(8.27±1.86) d vs.(9.70±1.87) d,P<0.05];术中出血量2组间差异无统计学意义[试验组:(260±155) mL,对照组:(271±154) mL,P=0.784]。试验组并发症发生4例,其中2例为肠梗阻,1例造瘘口旁疝,1例尿路感染;对照组并发症发生6例,其中肠梗阻3例,切口感染2例,尿路感染1例。组间总体并发症发生率无明显统计学差异。结论:造瘘口切口辅助技术应用于腹腔镜膀胱根治性切除及回肠通道术安全可行,在术后快速康复中有良好的应用前景。展开更多
文摘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.
文摘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.
基金Supported by The National Natural Science Foundation of China,No.81171444 and No.30770984
文摘Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progressive ileal conduit stomal variceal bleeding which was successfully managed by endovascular embolization via the transjugular transhepatic approach.In conclusion,transjugular transhepatic endovascular embolization is a good choice in patients with ileal conduit stomal variceal bleeding who have failed conservative therapy.
文摘Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.
文摘Background： Robot-assisted/laparoscopic intracorporeal ileal conduit （ICIC） has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit （ECIC） and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy （LRC） with ICIC and ECIC. Methods： From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient＇s characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed. Results： LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients＇ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group （3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002）. The complications rates did not show significant difference between the two groups within the first 90 days postoperatively （P = 0.538）. Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1＋. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months （60% vs. 62%, P = 0.857） between the ECIC and ICIC groups. Conclusions： ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.
文摘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.
文摘We report a unique case of a patient who underwent cystectomy with ileal conduit for nonmalignant bladder disease.Pa postoperatively developed stomal necrosis which was managed conservatively but after few months there was severe stomal stenosis and retraction and patient ended up with bilateral nephrostomies.On planned open abdominal exploration with intention to refashion stoma,after resection of distal stenosed segment we found that it was impossible to mobilize proximal portion of conduit due to severe small bowel adhesions.We used a unique approach of creating one more ileal conduit,bringing it as a new stoma on one side and anastomosing its other side with proximal one(ileal conduit over conduit)to augment deficient portion.This technique is not mentioned in the literature and as such we are reporting same as it can help many urologists who may encounter such problems.
文摘目的:探讨造瘘口切口辅助技术(通过造瘘口切口取标本,行肠吻合及输尿管吻合)在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法:将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组(试验组)及传统下腹正中切口辅助技术组(对照组),比较2组患者尿流改道手术时间、术中出血量、并发症发生率、术后住院日、术后疼痛评分的差异。结果:试验组尿流改道手术时间少于对照组[(105.0±18.9) min vs.(117.0±17.7) min,P<0.05];术后疼痛评分低于对照组(4.03±1.50 vs. 5.40±1.69,P<0.05);术后住院时间少于对照组[(8.27±1.86) d vs.(9.70±1.87) d,P<0.05];术中出血量2组间差异无统计学意义[试验组:(260±155) mL,对照组:(271±154) mL,P=0.784]。试验组并发症发生4例,其中2例为肠梗阻,1例造瘘口旁疝,1例尿路感染;对照组并发症发生6例,其中肠梗阻3例,切口感染2例,尿路感染1例。组间总体并发症发生率无明显统计学差异。结论:造瘘口切口辅助技术应用于腹腔镜膀胱根治性切除及回肠通道术安全可行,在术后快速康复中有良好的应用前景。
