scholarly journals Bladder Replacement and Urinary Diversion after Radical Cystectomy

1996 ◽  
Vol 3 (6) ◽  
pp. 512-518 ◽  
Author(s):  
Julio M. Pow-Sang ◽  
Evangelos Spyropoulos ◽  
Mohammed Helal ◽  
Jorge Lockhart
Keyword(s):  
Urinary Tract ◽  
Urinary Diversion ◽  
Stone Formation ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Continent Urinary Diversion ◽  
Operative Care ◽  
Bladder Replacement ◽  
Urinary Tract Reconstruction ◽  
Bowel Segments

Background The optimal mode of urinary tract reconstruction following cystectomy continues to challenge the urologic surgeon. Disadvantages with bowel conduits have prompted the search for better techniques to improve patient outcomes. Methods The development of urinary tract reconstruction is reviewed, and results from several forms of continent urinary diversion and bladder replacement construction are presented. The authors report on their experience in creating continent reservoirs or neobladders in over 400 patients. Results Several surgical approaches are now available for continent urinary diversion. Metabolic and nutritional abnormalities, stone formation, infection, and cancer formation are potential complications. Conclusions Advances in surgical techniques, an understanding of the physiology of isolated bowel segments, and improvements in pre- and post-operative care have altered the field of urinary reconstruction after cystectomy for bladder cancer. Most patients can expect minimal morbidity and mortality.

Pregnancy following urinary tract reconstruction using bowel segments: a review of published literature

2019 ◽  
Vol 38 (2) ◽  
pp. 335-342
Author(s):  
Nina Huck ◽  
Stefanie Schweizerhof ◽  
Raimund Stein ◽  
Patrick Honeck
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Reconstruction ◽  
Bowel Segments

scholarly journals Use of Bowel in Reconstructive Urology: What a Colorectal Surgeon Should Know

2017 ◽  
Vol 30 (03) ◽  
pp. 207-214
Author(s):  
Christopher Morrison ◽  
Stephanie Kielb
Keyword(s):  
Urinary Tract ◽  
Abdominal Surgery ◽  
Review Article ◽  
Reconstructive Urology ◽  
Basic Understanding ◽  
Colorectal Surgeon ◽  
Urinary Tract Reconstruction ◽  
Bowel Segments

AbstractUrologists routinely use bowel in the reconstruction of the urinary tract. With an increasing prevalence of urinary diversions, it is important for surgeons to have a basic understanding of varied use and configuration of bowel segments in urinary tract reconstruction that may be encountered during abdominal surgery. The aim of this review article is to provide an overview of the various reconstructive urological surgeries requiring bowel and to guide physicians on how to manage these patients with urinary diversions.

scholarly journals Comparison of Three Types of Continent Urinary Diversions in a Single Center

2004 ◽  
Vol 4 ◽  
pp. 135-141 ◽  
Author(s):  
Cengiz Girgin ◽  
Akif Sezer ◽  
Kutan Ozer ◽  
Huseyin Tarhan ◽  
Ahmet Bolukbasi ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Stone Formation ◽  
Late Complication ◽  
Transitional Cell ◽  
Complication Rates ◽  
Continent Urinary Diversion ◽  
Kock Pouch ◽  
Ileal Loop ◽  
Mainz Pouch Ii

The results including the complication and continence rates for 3 types of continent urinary diversion were evaluated. From 1992 to 1998 we performed 58 continent urinary diversions after radical cystectomy for invasive transitional cell carcinoma (TCC) of the urinary bladder. All three types of continent diversions and ileal loop procedures were discussed and patient preferences were determined. The patient preference rate for continent urinary diversion was 96.6%, and half of these patients wanted to be completely dry. Mean age of the patients was 58.2 years. Of the 58 patients, 9 (15.5%) had a Kock pouch, 15 (25.8%) had a Kock neobladder and 34 (58.6%) had sigmoidorectal pouch (Mainz-II pouch). Early and late complication rates of the three different continent diversions were evaluated. The number of complications, such as urine leakage, pyelonephritis, hydronephrosis, reflux and stone formation, were similar in all three types of diversions. Two (5.9%) Mainz pouch II patients who had stopped oral alkalinization demonstrated severe hyperchloremic acidosis. Spontaneous pouch rupture occurred in 1 of the Kock pouches. Reoperation rates were higher with the Kock pouch and Kock neobladder cases. Daytime continence rates for the Kock pouch, Kock neobladder and Mainz II pouch were 77.7%, 86.7% and 100% respectively. Even though complete dryness may not be achieved in every patient, orthotopic bladder substitution appears to be the best choice after radical cystectomy. Although it carries the risk of life-long oral alkalinization therapy, the Mainz pouch II is associated with an excellent continence rate and may be a good alternative for patients who desire to be dry.

scholarly journals The history of urinary diversion

2007 ◽  
Vol 54 (4) ◽  
pp. 9-17 ◽  
Author(s):  
Dragoslav Basic ◽  
Jovan Hadzi-Djokic ◽  
I. Ignjatovic
Keyword(s):  
Metabolic Acidosis ◽  
Urinary Diversion ◽  
High Rate ◽  
Clean Intermittent Catheterization ◽  
Continent Urinary Diversion ◽  
Ileal Loop ◽  
Metabolic Complications ◽  
Replacement Surgery ◽  
Bladder Replacement ◽  
Hyperchloremic Metabolic Acidosis

The earliest attempt to divert urine flow from the ureters to the intestine, was performed in 1851 by John Simon. In the absence of antibiotics, ureterosigmoidostomy and its modifications during the 19th and early 20th century have been associated with high rate of surgical and metabolic complications. In 1910, Robert Coffey demonstrated a new method for ureterointestinal anastomosis, which renovated primary enthusiasm in ureterosigmoidostomy and it gained broad popularity during the next forty years. In 1950, Ferris and Odel reported 80% incidence of hyperchloremic metabolic acidosis following ureterosigmoidostomy. Based on further investigations by Lapides in 1951, Parsons, Powel and Pyrah in 1952, and Stamey in 1956, which clearly demonstrated that hyperchloremic metabolic acidosis is inevitable complication of ureterosigmoidostomy, this urinary diversion lost its popularity. In 1950?s ileal conduit, popularized by Bricker, became the gold standard for the subsequent 35 years. Early attempts for continent urinary diversion occurred form 1888, by Guido Tizzoni and Alfonso Poggi, while the first reservoir-type ileal loop urinary diversion was performed by Cuneo in 1911. By better understanding of principles of detubularization, based on works of Kock and principles of clean intermittent catheterization, established by Lapides, interest in continent urinary diversion has increased. Up to date, various continent cutaneous stomal reservoirs, sigmoidorectal pouches and orthotopic bladder substitutes have been described. Regarding encouraging improvements in biocompatible materials, alloplastic bladder replacement could be the next step for the future in bladder replacement surgery.

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