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Continent Urinary Diversion (continent + urinary_diversion)
Selected AbstractsIn vitro determination of active bile acid absorption in small biopsy specimens obtained endoscopically or surgically from the human intestineEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2002K-A. Ung Abstract Background In the construction of a Kock reservoir for continent urinary diversion, 70 cm of the distal ileum are used. Impaired absorption of bile acids in these patients might cause diarrhoea. Data on the absorption of bile acids in different parts of the human intestine are limited. Methods Biopsies were taken during endoscopy from the duodenum, the terminal ileum or the right colon, and during surgery 10, 50, 100 and 150 cm proximally to the ileo-caecal valve using standard endoscopy biopsy forceps. The biopsy specimens were incubated in vitro with radio-labelled taurocholic acid at 37 °C for 22 or 45 min The radioactivity was determined using the liquid scintillation technique. Results A linear increase in the uptake was observed, with increased concentrations of taurocholic acid between 100 and 500 µm in all specimens tested, that represented passive uptake or unspecific binding. The active uptake could be calculated from the intercept of the line representing passive uptake with the ordinate. The active uptake in the terminal ileum was 3,4 times greater than 100 cm proximal to the valve. Conclusions The active absorption of bile acids in humans can be determined in small biopsy specimens taken using standard biopsy forceps during endoscopy or surgery. This method is suitable for clinical studies of bile acid absorption. Active uptake of bile acids not only takes place in the very distal part of the ileum but also to a considerable degree 100 cm proximally to the ileo-colonic valve. This should be taken into account when selecting the ileal segment for continent urinary diversion. [source] Bladder-sparing surgery and continent urinary diversion using the appendix (Mitrofanoff procedure) for urethral cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2005MIZUKI KOBAYASHI Abstract We performed bladder-sparing surgery and continent urinary diversion in two patients with urethral cancer. The first patient was a 58-year-old man with bulbomembranous urethral cancer (squamous cell carcinoma, cT2N0M0). The second patient was a 77-year-old woman with urethral cancer invading the vaginal wall (transitional cell carcinoma with squamous cell carcinoma, cT3N0M0). After bladder-sparing urethrectomy, continent urinary diversion with appendicovesicostomy (Mitrofanoff procedure) was performed in the both patients. More than 4 years after the surgery, both patients were continent, had no trouble with catheterization, and experienced no recurrence of cancer. Bladder-sparing surgery and urinary diversion based on the Mitrofanoff procedure can be considered for appropriately selected patients with urethral cancer. [source] Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine modelBJU INTERNATIONAL, Issue 2 2008Mitchell R. Humphreys OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51,55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four-port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6-week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model. [source] Modified ureterosigmoidostomy (Mainz Pouch II) in different age groups and with different techniques of ureteric implantationBJU INTERNATIONAL, Issue 3 2004Patrick J. Bastian In this section there are papers on three types of urinary diversion which are in common use. Authors from Germany, Greece and Turkey describe their experience with the Mainz pouch II, S-pouch neobladder and modified Hautmann bladder, respectively. OBJECTIVE To examine the outcome of Mainz Pouch II urinary diversion in different age groups and with different techniques of ureteric implantation. PATIENTS AND METHODS Between March 1995 and August 2002 a Mainz Pouch II was created in 41 patients (27 male and 14 female, median age 56.3 years, range 2,75) with 81 renal units (RU). For analysis, the patients were divided into 29 (70%) aged <65 years and 12 (30%) aged >65 years. Ureteric implantation with the Goodwin-Hohenfellner (GH) technique was used in 55 RU, with the Abol-Enein (AE) modification in 23 and Le-Duc procedure in three. The median (range) follow-up (available for 36 patients, 88%) was 19 (1,80) months. An unvalidated questionnaire was used to determine specific urinary diversion items. RESULTS Early complications occurred in 7% of patients, none requiring surgical intervention. Pyelonephritis occurred in five of 36 patients and seven of 71 RU (14% of the patients, 10% of the RU); all patients were <65 years old. In five of seven RU pyelonephritis was caused by the development of upper urinary tract dilatation; none required surgical revision. Ureteric stenosis requiring reimplantation occurred in two RU (2%, one GH, one AE). All patients were continent in the daytime; all but one patient had to wake to urinate at night, with 36% having to do so more than six times. Of the patients, 63% were able to distinguish between stool and urine. Initially, alkalinizing drugs to prevent metabolic acidosis were taken by 30% of the patients. Of previously medicated patients with a follow-up of >1 year, 8% required oral alkalinizing medication. CONCLUSION The Mainz Pouch II is a safe and reproducible urinary diversion, and serves as a satisfying alternative to other forms of continent urinary diversion in all age groups. The follow-up shows a low complication rate with good results in terms of continence. There were no significant differences in complication rates for the different ureteric implantation techniques. The long-term results remain to be evaluated. [source] A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional resultsBJU INTERNATIONAL, Issue 4 2002M. Soulié Objective ,To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. Patients and methods ,From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21,74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. Results ,The median (range) follow-up was 47.6 (10,124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively ( P = 0.13). Conclusion ,Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved. [source] Urinary diversion and morbidity after radical cystectomy for bladder cancer,CANCER, Issue 2 2010John L. Gore MD Abstract BACKGROUND: The rate of continent urinary diversion after radical cystectomy for bladder cancer varies by patient and provider characteristics. Demonstration of equivalent complication rates, independent of diversion type, may decrease provider reluctance to perform continent reconstructions. The authors sought to determine whether continent reconstructions confer increased complication rates after radical cystectomy. METHODS: From the Nationwide Inpatient Sample, the authors used International Classification of Disease (ICD-9) codes to identify subjects who underwent radical cystectomy for bladder cancer during 2001-2005. They determined acute postoperative medical and surgical complications from ICD-9 codes and compared complication rates by reconstruction type using the nearest neighbor propensity score matching method and multivariate logistic regression models. RESULTS: Adjusting for case-mix differences between reconstructive groups, continent diversions conferred a lower risk of medical, surgical, and disposition-related complications that was statistically significant for bowel (3.1% lower risk; 95% confidence interval [95% CI], ,6.8% to ,0.1%), urinary (1.2% lower risk; 95% CI, ,2.3%, to ,0.4%), and other surgical complications (3.0% lower risk; 95% CI, ,6.2% to ,0.4%), and discharge other than home (8.2% lower risk; 95% CI, ,12.1% to ,4.6%) compared with ileal conduit subjects. Older age and certain comorbid conditions, including congestive heart failure and preoperative weight loss, were associated with significantly increased odds of postoperative medical and surgical complications in all subjects. CONCLUSIONS: Mode of urinary diversion after radical cystectomy for bladder cancer is not associated with increased risk of immediate postoperative complications. These results may encourage broader consideration of continent urinary diversion without concern for increased complication rates. Cancer 2010. © 2010 American Cancer Society. [source] | ||||||||||