Rectosigmoidal bladder utilizing intussuscepted ileal segment: A surgical technique for urinary diversion and experiences in 30 patients

Purpose: This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. Methods: A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). Results: The surgical technique was significantly related to the number of complications (p < 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (p < 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (p < 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. Conclusions: The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

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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

Urologia Internationalis ◽

10.1159/000518561 ◽

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

Objective: 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. Patients and Methods: 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. Results: 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. Conclusions: 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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Method of Urinary Diversion Which Preserves Continence: Description of Surgical Technique and Postoperative Electrolyte Study

The Journal of Urology ◽

10.1016/s0022-5347(17)63881-3 ◽

1964 ◽

Vol 92 (1) ◽

pp. 37-41 ◽

Cited By ~ 6

Author(s):

Elliot Leiter ◽

Herbert Brendler

Keyword(s):

Surgical Technique ◽

Urinary Diversion

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Modified orthotopic ileal neobladder - surgical technique and initial results

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh170407152s ◽

2018 ◽

Vol 146 (3-4) ◽

pp. 183-186

Author(s):

Vuk Sekulic ◽

Jovo Bogdanovic ◽

Jasenko Djozic ◽

Ranko Herin ◽

Dimitrije Jeremic

Keyword(s):

Surgical Technique ◽

Radical Cystectomy ◽

Postoperative Mortality ◽

Percutaneous Nephrostomy ◽

Modified Technique ◽

Ileal Neobladder ◽

Ileal Segment ◽

Ureteral Implantation ◽

Initial Results ◽

Orthotopic Ileal Neobladder

Introduction/Objective. Vesica ileale Padovana is the surgical technique for reconstruction of lower urinary tract following radical cystectomy using isolated ileal segment. This operative technique requires dissection of both ureters in full length, that can?t be possible in some cases. The paper is aimed to present our experience with modified surgical technique of vesica ileale Padovana using 40 cm of an isolated ileal segment and initial results. Methods. 10 male patients received modified ileal neobladder following radical cystectomy at our institution during the period 2008 to 2011. The mean age of patients was 59 years (45-70). Median follow-up was 76 months (62-93). Patients were monitored cautiously for functional outcome, local recurrence, and distant progression. Results. Perioperative, early and late postoperative mortality have not been noticed. There were only 2 major complications: prolonged postoperative ileus and prolonged urinary leakage requiring percutaneous nephrostomy and subsequent ureteral reimplantation due to stenosis of ureterovesical anastomosis in 1 patient (10 %), respectively. Average ileal neobladder capacity was 450 ml. Daytime and night continence were achieved in 9 (90%) and 7 (70%) of patients, respectively. Conclusion. This modification of orthotopic ileal neobladder has not been difficult to perform in our hands. Modified technique provides a clear advantage in easier ureteral implantation more proximally than in the original technique, requiring less length of ureters. Initial encouraging results should be confirmed in further clinical practice.

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