RESUMEN
PURPOSE: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. METHODS: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. RESULTS: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. CONCLUSION: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.
Asunto(s)
Cistectomía , Herniorrafia , Laparoscopía , Derivación Urinaria , Humanos , Cistectomía/métodos , Cistectomía/efectos adversos , Masculino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Femenino , Anciano , Persona de Mediana Edad , Herniorrafia/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Hernia Incisional/etiología , Hernia Incisional/cirugía , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
BACKGROUND: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. PATIENTS AND METHODS: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. RESULTS: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). CONCLUSIONS: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.
Asunto(s)
Anastomosis Quirúrgica , Cistectomía , Complicaciones Posoperatorias , Uréter , Derivación Urinaria , Humanos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Cistectomía/efectos adversos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Tasa de Filtración Glomerular , Íleon/cirugía , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía , Resultado del Tratamiento , Creatinina/sangre , Laparoscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiologíaRESUMEN
PURPOSE OF REVIEW: This review paper summarizes the available literature on the evolution of surgical approach to radical cystectomy in female bladder cancer patients and its impact on functional outcomes in orthotopic neobladder. RECENT FINDINGS: Traditionally, radical cystectomy in female bladder cancer patients has been maximally extirpative with pelvic exenteration. Recently, new techniques which include pelvic organ-sparing, nerve-sparing and vaginal-sparing have demonstrated improved rates of urinary incontinence and retention. Additional techniques include prophylactic apical suspension which reduces the likelihood of pelvic organ prolapse, a risk factor for voiding dysfunction in the setting of orthotopic neobladder. Surgical management of bladder cancer in female patients has evolved to include surgical approaches which center quality of life and functional outcomes that are unique to female patients who have undergone radical cystectomy with ileal neobladder and can be optimized based on considerations regarding an approach that limits pelvic floor and pelvic nerve disruption.
Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria , Reservorios Urinarios Continentes , Humanos , Femenino , Cistectomía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Resultado del Tratamiento , Calidad de Vida , Derivación Urinaria/métodosRESUMEN
PURPOSE: To report perioperative and long-term postoperative outcomes of cystectomy patients with ileal conduit (IC) urinary diversion undergoing parastomal hernia (PSH) repair. METHOD: We reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence. RESULTS: Thirty-six patients with a median (IQR) age of 79 (73-82) years were included. The median time between cystectomy and PSH repair was 30 (14-49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7-47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7-24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence. CONCLUSIONS: In this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches.
Asunto(s)
Cistectomía , Herniorrafia , Hernia Incisional , Derivación Urinaria , Humanos , Derivación Urinaria/métodos , Anciano , Masculino , Cistectomía/métodos , Femenino , Herniorrafia/métodos , Anciano de 80 o más Años , Estudios Retrospectivos , Resultado del Tratamiento , Hernia Incisional/cirugía , Hernia Incisional/etiología , Hernia Incisional/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hernia Ventral/cirugía , Recurrencia , Mallas Quirúrgicas , Neoplasias de la Vejiga Urinaria/cirugía , Factores de TiempoRESUMEN
Following an ileal conduit (IC) urinary diversion for intractable urinary incontinence, a woman in her 50s presented with deteriorating renal function during a routine follow-up. This decline prompted further investigation with an ultrasound scan (USS), which demonstrated bilateral hydroureteronephrosis and an atrophic left kidney. Although the mercaptoacetyltriglycine (MAG-3) renogram was inconclusive in revealing urinary obstruction, a subsequent computed tomography (CT) scan uncovered a calcified tube-like structure within the IC and hydroureteronephrosis extending to this level.To address the obstructive uropathy, a right nephrostomy was inserted, which resulted in improved renal function. A looposcopy was then performed, revealing an encrusted urethral catheter within the IC. Using techniques adapted from percutaneous nephrolithotomy, we were able to endoscopically fragment the encrustation on the catheter and remove it intact through the IC.
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Catéteres Urinarios , Derivación Urinaria , Humanos , Femenino , Persona de Mediana Edad , Derivación Urinaria/efectos adversos , Catéteres Urinarios/efectos adversos , Hidronefrosis/etiología , Hidronefrosis/cirugía , Tomografía Computarizada por Rayos X , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/complicacionesRESUMEN
PURPOSE OF REVIEW: The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. RECENT FINDINGS: In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.
Asunto(s)
Anastomosis Quirúrgica , Uréter , Derivación Urinaria , Humanos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Uréter/cirugía , Complicaciones Posoperatorias/etiología , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Factores de RiesgoRESUMEN
OBJECTIVE: To identify risk factors for stenosis and compare management strategies for stenosis etiology and to examine the efficacy of each approach. Patients with classic bladder exstrophy (CBE), a rare genitourinary malformation, may require construction of a continent urinary stoma (CUS) if incontinence persists. Stomal stenosis is a challenging complication as it is common, progressive, and recurrent. METHODS: CBE patients who underwent CUS were retrospectively reviewed for risk factors for stenosis including stoma type, prior midline laparotomy number, and umbilicoplasty suture material. Stenosis etiology and management strategies were further reviewed. RESULTS: A total of 260 CBE patients underwent CUS creation. Stenosis developed in 65 patients (25.0%) at a median interval of 1.9 years. Etiology included scar contracture (n = 41), keloid (n = 17), and hypertrophic scar (n = 7). Multifilament suture was the only variable associated with an increased risk of stenosis compared to monofilament suture (P = .009). Almost all patients required surgical intervention. Most scar contractures underwent stomal incision with success in 100%. Hypertrophic scars and keloids responded best to excision with local tissue rearrangement (66.7%). At last follow-up, all patients achieved success. CONCLUSION: Stomal stenosis is common and challenging for the reconstructive surgeon. Strategies to prevent and effectively manage this are greatly desired. Use of multifilament suture for the umbilicoplasty increased stenosis perhaps from a greater inflammatory response and scarring, while monofilament suture may reduce its incidence. Stomal incision for treating scar contractures, and excision with local tissue rearrangement for hypertrophic scars and keloids may improve successful primary surgical intervention.
Asunto(s)
Extrofia de la Vejiga , Complicaciones Posoperatorias , Estomas Quirúrgicos , Derivación Urinaria , Humanos , Extrofia de la Vejiga/cirugía , Extrofia de la Vejiga/complicaciones , Estudios Retrospectivos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Factores de Riesgo , Femenino , Masculino , Constricción Patológica/etiología , Constricción Patológica/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Estomas Quirúrgicos/efectos adversos , Niño , Preescolar , Lactante , Adolescente , Reservorios Urinarios Continentes/efectos adversosRESUMEN
Case 1 : A 75-year-old man was emergently admitted to our hospital with a complaint of continuous bleeding from the ileal conduit. The conduit was constructed by a total pelvic resection for sigmoid colon cancer that invaded the urinary bladder 24 years ago. Swollen cutaneous mucosa was seen around the ileal conduit, but no obvious bleeding spot was observed. The contrast-enhanced computed tomographic (CT) scan and 3D visualization revealed varices extending to the abdominal wall. Percutaneous transhepatic embolization successfully stopped the bleeding, but it was needed again after two years. Case 2 : A 72-yearold man with a history of open cystectomy and ileal conduit for bladder cancer came to our hospital two years after the surgery, complaining of continuous bleeding from the conduit. The skin around the stoma site was discolored purple, but no obvious bleeding site or bloody urine was observed. The CT scan similar to Case 1 revealed varices in the ileal conduit, and percutaneous transhepatic embolization successfully stopped the bleeding, but it was needed again after five months. After that, three months passed without recurrence.
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Derivación Urinaria , Várices , Humanos , Masculino , Anciano , Várices/cirugía , Várices/diagnóstico por imagen , Embolización Terapéutica , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/complicaciones , Hemorragia/etiología , Hemorragia/cirugía , Hemorragia/diagnóstico por imagenRESUMEN
Evaluation of neobladder function in patients with long-term survival and no recurrence after laparoscopic radical cystectomy and intracorporeal Xing's neobladder. The clinical data of laparoscopic radical cystectomy and intracorporeal Xing's neobladder in long-term survival patients with bladder cancer treated in Beijing Chaoyang Hospital from July 2013 to July 2018 were analyzed retrospectively. All 17 patients underwent the surgery by the same surgical team, including 15 males and 2 females, whose mean age at the time of operation was (55.9±7.6) years. Thepostoperative urinary function and renal function were summarized. All operations were successfully completed. The mean operative time was (340±62) min. All patients were followed up for a long time, with a median follow-up time of 80(70, 96) months, Urinary continence was achieved in 17 (100%)casesduring the day and 13 (76.5%) cases at night, with a median bladder volume of 350 (200, 400) ml. All patients had good urinary control after surgery, and no hydronephrosis or creatinine increase was found in reexamination.After the application of Xing's neobladder operation, the patient maintained acceptable urinary control status after the operation, and the long-term follow-up effect was satisfactory.
Asunto(s)
Cistectomía , Laparoscopía , Neoplasias de la Vejiga Urinaria , Vejiga Urinaria , Reservorios Urinarios Continentes , Humanos , Masculino , Femenino , Persona de Mediana Edad , Laparoscopía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Estudios Retrospectivos , Cistectomía/métodos , Estudios de Seguimiento , Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Tempo OperativoRESUMEN
Studies of right colon pouch urinary diversion have widely varying estimates of the risk of perioperative complications, reoperation, and readmission. We sought to describe the association between specific risk factors and complication, readmission, and reoperation rates following right colon pouch urinary diversion. Patients undergoing robot-assisted right colon pouch urinary diversion from July 2013 to December 2022 were analyzed. Outcome measures include high-grade (Clavien-Dindo grade ≥ 3) complications within 90 days, readmission within 90 days, and reoperation at any time during follow-up. Specific risk factors such as age, gender, body mass index (BMI), diabetes, Charlson comorbidity index (CCI), and prior radiation were analyzed to establish an association with these outcomes. During the study period, 77 patients underwent the procedure and were eligible to study. The average follow-up was 88.7 (SD 14) months. 90-day high-grade complications were 24.67%, and 90-day readmission was 33.76%. The cumulative rate of any reoperation was 40.2%, and major reoperation was 24.67%. Female gender (OR 3.3, p = 0.015), 1 kg/m2 increase in BMI (OR 3.77, p = 0.014), diabetes (OR 3.49, p = 0.021), higher CCI (OR 1.59, p = 0.034), prior radiation (OR 1.97, p = 0.026), lower eGFR (OR 0.99, p = 0.032) and BMI ≥ 25 kg/m2 (OR 3.9, p value 0.02) was associated with Clavien III-IV complications. Female gender (OR 3.3, p = 0.015), diabetes (OR 3.97, p = 0.029), higher Charlson Comorbidity Index (OR 1.73, p = 0.031), prior radiation (OR 1.45, p = 0.029), lower eGFR (OR 0.87, p = 0.037) and BMI ≥ 25 kg/m2 (OR 3.86, p = 0.031) were predictive of reoperation. Overall, the rate of postoperative complications, readmissions, and reoperation was high but consistent with other studies. This study helps further characterize surgical outcomes after right colon pouch urinary diversion and highlights patients who may benefit from enhanced preoperative management for minimising complications.
Asunto(s)
Cistectomía , Readmisión del Paciente , Complicaciones Posoperatorias , Reoperación , Procedimientos Quirúrgicos Robotizados , Derivación Urinaria , Humanos , Cistectomía/métodos , Cistectomía/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Femenino , Masculino , Derivación Urinaria/métodos , Derivación Urinaria/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Persona de Mediana Edad , Anciano , Reoperación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Factores de Riesgo , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía , Colon/cirugía , Índice de Masa CorporalRESUMEN
OBJECTIVE: This study seeks to explore the impact of fast track surgery (FTS) with three-port in patients treated with laparoscopic radical cystectomy and ileal conduit on postoperative recovery, hospital stay and the complications. METHODS: This retrospective study analyzed 230 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy at the Second Hospital of Anhui Medical University between December 2011 to January 2023. 50 patients received conventional surgery (CS) and 180 patients received FTS with three-port. Patients were assessed for time to normal diet consumption, time to passing first flatus, number of postoperative recovery days and complications. Trends of serum C-reactive protein levels were monitored preoperatively and on postoperative days 1, 3 and 7. RESULTS: Patients who underwent FTS with three-port had a shorter duration to first flatus (P < 0.05). And number of postoperative hospital days and the length of hospital stay were notably shorter in contrast to the CS group (P < 0.05). Serum CRP levels on postoperative day 7 were markedly reduced in those of the FTS group compared to the CS group (P < 0.05). Those of the CS group experienced more frequent rates of complications compared to those of the FTS with three-port group (P < 0.05). CONCLUSION: Our findings demonstrate that the FTS with three-port program hastens postoperative recovery and reduces duration of hospital stay. It is safer and more effective than the CS program in the Chinese population undergoing laparoscopic radical cystectomy.
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Cistectomía , Laparoscopía , Tiempo de Internación , Complicaciones Posoperatorias , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/métodos , Cistectomía/efectos adversos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Masculino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Femenino , Estudios Retrospectivos , Derivación Urinaria/métodos , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Estudios de Seguimiento , Pronóstico , Atención Perioperativa/métodos , China/epidemiologíaRESUMEN
With increasing life expectancy there is also an increased need for the management of older (≥â¯80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.
Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Calidad de Vida , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/métodosRESUMEN
Reconstructive surgeries are often challenged by a lack of grafting tissue. In the treatment of urogenital malformations, the conventional solution has been harvesting gastrointestinal tissue for non-orthotopic reconstruction due to its abundance to reestablish normal function in the patient. The clinical outcomes after rearranging native tissues within the body are often associated with significant morbidity; thus, tissue engineering holds specific potential within this field of surgery. Despite substantial advances, tissue-engineered scaffolds have not yet been established as a valid surgical treatment alternative, mainly due to the costly and complex requirements of materials, production, and implantation. In this protocol, we present a simple and accessible collagen-based tubular scaffold embedded with autologous organ-specific tissue particles, designed as a conduit for urinary diversion. The scaffold is constructed during the primary surgical procedure, comprises commonly available surgical materials, and requires conventional surgical skills. Secondly, the protocol describes an animal model designed to evaluate the short-term in vivo outcomes post-implantation, with the possibility of additional variations to the procedure. This publication aims to demonstrate the procedure step-by-step, with special attention to the use of autologous tissue and a tubular form.
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Modelos Animales , Porcinos Enanos , Ingeniería de Tejidos , Animales , Porcinos , Ingeniería de Tejidos/métodos , Andamios del Tejido/química , Urotelio/cirugía , Derivación Urinaria/métodosAsunto(s)
Cistectomía , Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/métodos , Derivación Urinaria/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Procedimientos Quirúrgicos Robotizados/métodos , Reservorios Urinarios Continentes , Pronóstico , Complicaciones Posoperatorias , Tasa de SupervivenciaRESUMEN
The clinical presentation of enteric duplication cysts is dependent on the location of the cyst with symptoms varying from nausea and vomiting to abdominal distension, pain and perforation. Four patients were identified who were diagnosed with enteric duplication cysts within the period from 2019 to 2023. Three of the patients presented with signs of intestinal obstruction-abdominal distension and pain, while one had an antenatally detected abdominal mass. There were three boys and one girl with ages ranging from 4 months to 14 years. Three cases of ileal and one case of caecal duplication cyst were reported. Most of the cases showed ileal/caecal mucosa while one case demonstrated ectopic gastric mucosa. The treatment of these cysts includes surgical excision. Although radiological investigations help in arriving at a provisional diagnosis, the final diagnosis can be confirmed only after histopathological examination. Early treatment prevents complications and results in a good prognosis for the patient. (AU)
La presentación clínica de los quistes de duplicación entérica depende de la ubicación del quiste, y los síntomas varían desde náuseas y vómitos hasta distensión abdominal, dolor y perforación. Se identificaron cuatro pacientes que fueron diagnosticados con quistes de duplicación entérica en el período de 2019 a 2023. Tres de los pacientes presentaron signos de obstrucción intestinal (distensión abdominal y dolor), mientras que uno tenía una masa abdominal detectada prenatalmente. Eran tres niños y una niña con edades comprendidas entre 4 meses y 14 años. Se notificaron tres casos de quiste de duplicación ileal y un caso de quiste de duplicación cecal. La mayoría de los casos mostraron mucosa ileal/cecal, mientras que un caso mostró mucosa gástrica ectópica. El tratamiento de estos quistes incluye la escisión quirúrgica. Aunque las investigaciones radiológicas ayudan a llegar a un diagnóstico provisional, el diagnóstico final solo puede confirmarse después del examen histopatológico. El tratamiento precoz previene complicaciones y redunda en un buen pronóstico para el paciente. (AU)
Asunto(s)
Humanos , Quistes , Errores Innatos del Metabolismo , Derivación Urinaria , Ácido Gástrico , Náusea , VómitosRESUMEN
Bladder cancer (BCa) represents the second most common malignancy of the genitourinary tract. The major risk factors include age, gender, smoking attitude, and occupational exposure, while the exact etiopathogenesis is still uncertain. Patients diagnosed with a BCa showing invasion of the muscle layer below the submucosa must undergo radical cystectomy (RC) with urinary diversion (UD). Many different surgical approaches to UD have been developed. Packaging an orthotopic neobladder (ON) with a bowel tract represents the gold standard when certain patient selection criteria are satisfied. Using PRISMA guidelines, we performed a systematic review assessing early (within 90 days) and late (beyond 90 days) post-procedural complications of different ON surgical approaches. A comprehensive systematic search was conducted in PubMed, Scopus, and Google Scholar databases to identify papers starting from 2012 using dedicated keywords ("neobladder", "orthotopic neobladder", "complications'' and "outcomes"). A total of 27 articles were found to satisfy the inclusion criteria and selected. Although the ON is a safe procedure that guarantees the patient the best quality of life (QoL), it is not free from risks. Many complications could occur during and after the surgical time which imposes the necessity of strict follow-up and careful checks over time, which should be properly discussed with patients before.
Asunto(s)
Cistectomía , Complicaciones Posoperatorias , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Reservorios Urinarios Continentes , Humanos , Complicaciones Posoperatorias/etiología , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Cistectomía/efectos adversos , Cistectomía/métodos , Reservorios Urinarios Continentes/efectos adversos , Pronóstico , Calidad de VidaRESUMEN
Background and Objectives: This study evaluated the efficacy and safety of temporary ureteral occlusion combined with urinary diversion using a single-access route created by inserting a balloon catheter through a pigtail nephrostomy drainage catheter. With this approach, we aimed to offer an alternative for patients with ureteral leaks who are suboptimal surgical candidates. Materials and Methods: This retrospective study included nine patients (eight of which were bilateral cases and one was unilateral, totaling seventeen cases) who underwent the surgery between September 2023 and March 2024. The method involved gaining percutaneous access to the pelvicalyceal system, inserting a 4-French Fogarty balloon catheter through a pigtail nephrostomy catheter, and inflating the balloon at the proximal or mid-ureter. Results: All 17 cases achieved technical successful with no major complications. The procedure effectively relieved symptoms associated with urinary leakage in most patients. However, the significant deflation of the balloon catheter occurred in five cases (29.4%), with three (17.6%) experiencing complete deflation. In these five cases, the final balloon size was 5.81 mm (range: 0-8.9 mm), confirming a 25.0% decrease in size from pre- to post-procedure. Ureteral occlusion was 28.3 d long on average (range: 8-57 d). All patients experienced symptom relief during temporary ureteral occlusion. Except for two patients lost to follow-up, three patients showed symptom improvement with only PCN and four patients underwent surgical closure of the fistula tract before or after balloon catheter removal. Conclusions: This study confirms that this approach is safe and effective.