Aims:This study aims to describe our surgical technique and report our preliminary experience with laparoscopic ileal or appendicovesicostomy in adult patients with neurogenic bladder caused by spinal cord injury.Subjects and Methods:From January 2014 to March 2017, seven patients were submitted to an appendicovesicostomy under Mitrofanoff procedure and two patients to an ileovesicostomy under Yang-Monti procedure by laparoscopy. Clinical indications were patients with a history of neurogenic bladder secondary to spinal cord pathology, with proper dexterity and willing to have a more accessible continent derivation. Surgical steps include: (1) identification and mobilization of appendix; (2) ligation of appendix' base; (3) endoloop reinforcement of proximal end; (4) silicon catheter insertion in appendix' lumen; (5) mesoappendix dissection; (6) Retzius space opening; (7) posterior bladder dissection; (8) anterior transcutaneous bladder dome fixation; (9) vertical midline detrusor incision; (10) opening of bladder mucosa; (11) excision and espatulation of appendix tip; (12) appendico vesical anastomosis; and (13) exteriorization of appendix through umbilicus and creation of catheterizable stoma. In the two patients submitted to a Yang-Monti diversion, the ileum reconfiguration and calibration was done extracorporeally. One patient had simultaneous bladder augmentation.Results:The mean follow-up was 21.5 ± 11.9 months. The mean operative time was 161 min (123–220). There was no conversion to laparotomy and no need of postoperative blood transfusion. The mean hospitalization length was 4 days. No early postoperative complication was registered. Late postoperative complications were: one surgical stoma revision, one false-passage (solved by transient catheterization), and one bladder stone (solved by endoscopic approach). All patients are continent.Conclusions:This series presents our laparoscopic technique for continent urinary diversions, showing that it is feasible and safe in adult patients with neurogenic bladder.

Objectives To update the outcomes and analyse the safety of laparoscopic implantation of an artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) as a result of intrinsic sphincter deficiency (ISD). Patients and Methods Seventy‐four women with SUI caused by ISD underwent laparoscopic AUS implantation between 2005 and 2018 in our centre. Urodynamic assessment was required. The AUS was implanted using a transperitoneal laparoscopic approach to the Retzius space. The cuff was placed around the bladder neck between the peri‐urethral fascia and the vagina. Postoperative functional outcomes were defined as success (total continence), improvement (>50% decrease in number of leakages or in number of pads used), or failure (<50% improvement, persistent or increased leaking). Data on peri‐operative and long‐term complications were also collected. Results The mean ± sd operating time was 119.7 ± 48.9 min, with no conversion to laparotomy. With a mean ± sd (range) follow‐up of 44.5 ± 40.5  (1–149) months, 78.3% of the women were totally continent and 18.6% reported improvement. One vaginal and one urethral perforation were the only intra‐operative complications, both solved during surgery. Late complications included recurrent urinary tract infection (5.4%), acute urinary retention (6.8%), urethral (4%) and vaginal erosion (2.7%), and urgency urinary incontinence (2.7%). Reimplantation of AUS was performed in 13.5% of the women as a result of mechanical failure (n =9) and erosion (n = 1). Permanent removal was performed in 10.8%. Conclusion To our knowledge, this is the largest series with the longest follow‐up of women with urinary incontinence treated with laparoscopic AUS implantation, demonstrating its safety, feasibility and effectiveness, and showing a very positive impact on the quality of life of the women.

No abstract

No abstract