The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy

2015 ◽  
Vol 33 (2) ◽  
pp. 65.e1-65.e8 ◽  
Author(s):  
Kyle A. Richards ◽  
Joshua A. Cohn ◽  
Michael C. Large ◽  
Gregory T. Bales ◽  
Norm D. Smith ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Ileal Neobladder ◽  
Stricture Rate

scholarly journals Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2236 ◽  
Author(s):  
Jihion Yu ◽  
Bumsik Hong ◽  
Jun-Young Park ◽  
Yongsoo Lee ◽  
Jai-Hyun Hwang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Filtration Rate ◽  
Ileal Conduit ◽  
Significant Decline ◽  
Ileal Neobladder ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Gfr Decline

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

scholarly journals Morbidity and Quality of Life in Bladder Cancer Patients following Cystectomy and Urinary Diversion: A Single-Institution Comparison of Ileal Conduit versus Orthotopic Neobladder

ISRN Urology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Barbara Erber ◽  
Mark Schrader ◽  
Kurt Miller ◽  
Martin Schostak ◽  
Daniel Baumunk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Oncological Outcome ◽  
University Hospital ◽  
Ileal Neobladder ◽  
Eortc Qlq

Objective. To evaluate and compare noncontinent and continent urinary diversion after radical cystectomy in patients with bladder cancer. Methods. A total of 301 patients submitted to radical cystectomy at the Charité-University Hospital Berlin from 1993 to 2007 including 146 with an ileal conduit and 115 with an ileal neobladder. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. Quality of life was analyzed using the EORTC QLQ-C30 and BLM30 questionnaires. Results. 69.1% and 69.6% of all patients who received an ileal conduit and ileal neobladder, respectively, developed early complications. The two groups differed significantly concerning the occurrence of postoperative ileus (P=0.02) favoring patients who received an ileal conduit but not with regard to any other early-onset complication evaluated. Patients with ileal neobladder had a significantly better global health status and quality of life (P=0.02), better physical functioning (P=0.02), but also a higher rate of diarrhoea (P=0.004). Conclusion. Cystectomy with any type of diversion remains a complication-prone surgery. Even if the patient groups are not homogeneous in all respects, there are many arguments in favor of the ileal neobladder as the urinary diversion of choice.

scholarly journals Outcome of Radical Cystectomy With Urinary Diversion at Nicrh, Bangladesh

2020 ◽  
Vol 21 (2) ◽  
pp. 62-65
Author(s):  
Md Shawkat Alam ◽  
Howlader Fazlul Karim ◽  
Md Monowarul Islam ◽  
Md Siddiqur Rahman ◽  
SK Amirul Islam ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Disease Free Survival ◽  
Oncological Outcome ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Ileal Neobladder ◽  
Muscle Invasive ◽  
Si Joint

Introduction: Radical Cystectomy (RC) is an effective surgical procedure for muscle invasive bladder cancer ( MIBC). 5 years disease free survival after RCs are PT2 - 81%, PT3a – 68%, PT3b – 47%, PT4a – 44% respectively, Stein et al, 2001[1]. In this study early surgical & oncological outcome have been assessed. Patients & methods: A total of 24(N) patients underwent radical cystectomy with urinary diversion between December 2013 to June 2016. Age ranges from 41-69 years. Indications were T2HG for twenty cases and T1HG for four cases. Among the T1 tumours, one had early recurrence, one had numerous tumours and two had multiple tumours with concomitant CIS. Urinary diversion methods were: Orthotopic Ileal neobladder-1, Ileal conduit-20, Cuteneous Ureterostomy -3 (2 due to unhealthy mesentry with gut, 1 single kidney with poor general condition), For uretero-Ileal anaestomosis we used Bricker method in all cases. Result: Mean OR time was 3:45 hours, blood loss average 350 ml, hospital stay after operation 9 days, enlarged pelvic lymph nodes were found in two cases. In follow up we found,stomal stenosis of cutaneous ureterostomy in 1 out of 3 cases, Ileal conduit prolapse with para-stomal hernia in 1 out of 20 cases, stenosis at uretero-Ileal anastomosis in 1 pt. .Distant recurrence occurred in two cases, one in Lt. Supraclavicular LN and another in sacrum near SI joint. No local recurrence was found in any case. Conclusion: Our experience on RC and all the three types of UD are safe and effective for patient and encouraging for us. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.62-65

scholarly journals Bricker versus Wallace anastomosis: A meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion

2015 ◽  
Vol 9 (5-6) ◽  
pp. 284 ◽  
Author(s):  
Niall F. Davis ◽  
John P. Burke ◽  
TED McDermott ◽  
Robert Flynn ◽  
Rustom P. Manecksha ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Primary Outcome Measure ◽  
Stricture Rate ◽  
Significant Difference ◽  
Meta Analyses ◽  
Ureteroenteric Stricture

Introduction: Data comparing the incidence of ureteroenteric strictures for Bricker and Wallace anastomoses are limited. This study compares both anastomotic techniques in terms of ureteroenteric stricture rates after radical cystectomy and ileal conduit urinary diversion.Methods: Electronic databases (Medline, EMBASE, and Cochrane database) were searched for studies comparing Bricker and Wallace ureteroeneteric anastomoses for ileal conduit urinary diversion after radical cystectomy. Meta-analyses were performed using the random effects method. The primary outcome measure was to determine differences in postoperative ureteroenteric stricture rates for both surgical techniques. Four studies describing 658 patients met the inclusion criteria. The total number of ureters used for ureteroeneteric anastomoses was 1217 (545 in the Bricker group and 672 in the Wallace group).Results: There were no significant differences in age (p = 0.472), gender (p = 0.897), duration of follow-up (p = 0.168), and duration to stricture development between groups (p = 0.439). The overall stricture rate was 29 of 1217 (2.4%); 16 of 545 ureters (2.9%) in the Bricker group and 13 of 672 ureters (1.9%) in the Wallace group. The Bricker anastomosis was not associated with a significantly higher overall stricture rate compared to the Wallace ureteroenteric anastomosis (odds ratio: 1.393, 95% confidence interval: 0.441–4.394, p = 0.572).Conclusion: Accepting limitations in the available data, we found no significant difference in the incidence of ureteroenteric stricture for Bricker and Wallace anastomoses.

Modification of the Indiana Pouch Ileo-Caecal Cutaneous Continent Urinary Diversion: Tubular Ileal Afferent Limb for Ureteral Anastomosis Has Low Stricture Rate and Allows Ileal Ureter Replacement

2021 ◽  
pp. 1-6
Author(s):  
Rolf von Knobloch ◽  
Marc Seybold ◽  
Hans Peter Fischer ◽  
Monika Kibele ◽  
Wasim Abdul Samad
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Locally Advanced ◽  
Continent Urinary Diversion ◽  
Ileal Segment ◽  
Stricture Rate ◽  
Indiana Pouch ◽  
Anastomotic Strictures ◽  
Ureter Replacement ◽  
Muscle Invasive

<b><i>Objective:</i></b> The aim of the study was to introduce our new modification of the Indiana pouch with a refluxing ureteral anastomosis in a tubular afferent ileal segment of the ileo-caecal urinary reservoir. <b><i>Patients and Methods:</i></b> Between February 2008 and December 2020, we performed a total of 37 modified continent ileo-caecal pouches for urinary diversion when orthotopic bladder substitution was not possible. Hereby, we modified the Indiana pouch procedure with a new refluxing end-to-end ureteral anastomosis into an 8-cm afferent tubular ileal segment. <b><i>Results:</i></b> We performed the modified Indiana pouch in 27 women (73%) and 10 men (27%). The median age of the patients at time of operation was 64 years (43–80 years). To date, the average follow-up is 69 months (3–156 months). In 32/37 cases, we performed the new pouch procedure after radical cystectomy for muscle-invasive bladder cancer and in 1/37 cases after radical cystectomy for locally advanced prostate cancer. In 4 cases, the procedure was performed after total exenteration of the pelvis due to locally advanced bladder, colorectal, or gynaecological cancers. Ureteral anastomotic strictures were seen in 2/37 patients (5.4%) or 2/72 (2.8%) of renal units. <b><i>Conclusions:</i></b> Our modification of the Indiana pouch cutaneous continent urinary diversion with the ureteral anastomosis to a tubular segment of the pouch is easy to perform and effective in reducing the rate of ureteral anastomotic strictures. By lengthening, the afferent tubular ileal segment, it additionally allows easy ureteral replacement.

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