scholarly journals Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Frank Christoph ◽  
Franziska Herrmann ◽  
Peter Werthemann ◽  
Thomas Janik ◽  
Martin Schostak ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Ileal Conduit ◽  
Anastomotic Stricture ◽  
The Body ◽  
Stricture Formation ◽  
Obese Patients ◽  
Single Institution ◽  
Single Center Experience ◽  
Stricture Rate

Abstract Background To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis. Methods A total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up. Results Seventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m2 Bricker and 26.4 kg/m2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant (p = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m2, p = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group (p = 0.6) to develop stricture. Conclusions The stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.

A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

2021 ◽  
pp. 205141582110414
Author(s):  
Francesco Chiancone ◽  
Francesco Persico ◽  
Marco Fabiano ◽  
Maurizio Fedelini ◽  
Clemente Meccariello ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Multivariate Logistic Regression Model ◽  
Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

scholarly journals Prognostic Value of Normal Stress Echocardiography in Obese Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Michele Murphy ◽  
Siva Krothapalli ◽  
Jose Cuellar ◽  
Somsupha Kanjanauthai ◽  
Brian Heeke ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Normal Weight ◽  
Emergency Department Visits ◽  
The Body ◽  
Noninvasive Evaluation ◽  
Obese Patients ◽  
Cardiac Events ◽  
Obese Subjects ◽  
Lost To Follow Up

Background.Chest pain is a common problem in obese patients. Because of the body habitus, the results of noninvasive evaluation for CAD may be limited in this group.Methods.We reviewed the records of 1446 consecutive patients who had undergone clinically indicated stress echocardiography (SE). We compared major adverse cardiac events (MACE; myocardial infarction, cardiac intervention, cardiac death, subsequent hospitalization for cardiac events, and emergency department visits) at 1 year in normal weight, overweight, and obese subjects with normal SE.Results.Excluding patients with an abnormal and indeterminate SE and those who were lost to follow-up, a retrospective analysis of 704 patients was performed. There were 366 obese patients (BMI ≥ 30), 196 overweight patients (BMI 25–29.9), and 142 patients with normal BMI (18.5–24.9). There was no MACE in the groups at 1-year follow-up after a normal SE.Conclusions.In obese patients including those with multiple risk factors and symptoms concerning for cardiac ischemia, stress echocardiography is an effective and reliable noninvasive tool for identifying those with a low 1-year risk of cardiac events.

Buttressing hepaticojejunostomy's with hepatic round ligament flap may be beneficial

2017 ◽  
Vol 89 (4) ◽  
pp. 5-10 ◽  
Author(s):  
Jayant Kumar Banerjee ◽  
Ramanathan Saranga Bharathi ◽  
Pankaj Purushotam Rao
Keyword(s):  
Anastomotic Stricture ◽  
Bile Leak ◽  
Technical Difficulty ◽  
Round Ligament ◽  
Pancreas Carcinoma ◽  
Operative Outcomes ◽  
Stricture Rate ◽  
Anastomotic Strictures ◽  
Head Of The Pancreas

Background: Bile leaks and anastomotic strictures are important complications of hepaticojejunostomy (HJ). Evidence suggests that the use of hepatic round ligament (HRL) to buttress HJ may be beneficial. This study evaluates the feasibility of this approach. Methods: HJs performed over 2 years (Jun 2014- May 2016), with HRL reinforcement, were analyzed. Operative outcomes measured included technical difficulty, blood loss, time necessary for flap harvest, and reinforcement of HJ. The postoperative outcomes measured were the presence of bile leak and anastomotic stricture. Results: Forty-one patients (27 M: 14 F), aged 2-79 years, median age of61 years, underwent HJ with HRL buttress; 27 for periampullary/ head of the pancreas carcinoma; 4 for choledochal cysts; 4 for chronic pancreatitis; 3 for gallbladder carcinoma; 3 for benign biliary stricture. The time for harvesting HRL flaps and buttressing HJ was <10 minutes. No blood was lost during harvesting the flaps. One patient (2.5 %) had grade A leak following radical cholecystectomy, and structures were not observed during a median follow-up of 18 months (6 months to 2years). Conclusion: HRL-based buttressing of HJ can reduce the bile leak and/or stricture rate.

scholarly journals Persistent, long-term risk for ureteroenteric anastomotic stricture formation: the case for long term follow-up

2020 ◽  
Vol 9 (1) ◽  
pp. 142-150 ◽  
Author(s):  
David Y. Yang ◽  
Stephen A. Boorjian ◽  
Mary Beth Westerman ◽  
Robert F. Tarrell ◽  
Prabin Thapa ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Stricture Formation ◽  
Long Term Follow Up

scholarly journals Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qi Wang ◽  
Liang Tang ◽  
Liangkuan Bi ◽  
Jie Min ◽  
Lu Fang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Anastomotic Leak ◽  
Ileal Conduit ◽  
Anastomotic Stricture ◽  
Major Complication ◽  
Clinical Effectiveness ◽  
Ileal Loop ◽  
Novel Method ◽  
The Mean

Abstract Background This study aimed to introduce a novel method for ureteroileal anastomosis, explore its clinical effectiveness, observe the incidence of postoperative anastomotic stricture, and compare the postoperative complications with those of other types of ureteroileal anastomosis reported in the literature. Methods Both ureters were first anastomosed at their distal ends and then inserted into the proximal end of the ileal loop. A postoperative follow-up analysis was performed to evaluate major complication indicators, including anastomotic stricture, anastomotic leak, and hydroureteronephrosis. Results We successfully performed ureteral distal ends anastomosis combined with end-to-end insertion into the ileum for 143 patients. The mean postoperative follow-up lasted 37 months (range: 10–68 months). There was no occurrence of an anastomotic leak. The incidence of anastomotic stricture combined with hydronephrosis, ileal conduit stones, urinary tract infection, and renal dysfunction were 2.1%, 0.7%, 2.1%, and 4.2%, respectively. Conclusion Ureteral distal ends combined and inserted into the ileum were simple to perform and helped achieve precise anastomosis with fewer postoperative complications.

scholarly journals Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

2017 ◽  
Vol 11 (3-4) ◽  
pp. 88 ◽  
Author(s):  
Nathan Hoag ◽  
Nathan Papa ◽  
Bhawanie Koonj Beharry ◽  
Nathan Lawrentschuk ◽  
Danny Chiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Anastomotic Stricture ◽  
Elevated Serum ◽  
Stricture Formation ◽  
Serum Urea ◽  
Urea Level ◽  
Ileal Stricture ◽  
Increased Risk

Introduction: Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk.Methods: A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression.Results: Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing ureteroileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each).Conclusions: In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required.

scholarly journals Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016

2018 ◽  
Vol 6 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Yudiana Wayan ◽  
Pratiwi Dinar Ayu ◽  
Oka A. A. Gde ◽  
Niryana Wayan ◽  
I Putu Eka Widyadharma
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Ileal Conduit ◽  
Wound Dehiscence ◽  
Oncological Outcome ◽  
Pathological Result ◽  
Muscle Invasive

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.

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