Study Type – Preference (case studies)
Level of Evidence 4 OBJECTIVE To examine the rate at which patients undergo various types of urinary diversion (UD) and the reasons why they had the given reconstruction, analysed in the context of a standardized preoperative protocol for patients undergoing radical cystectomy (RC) at our institution, as there is wide variation in the distribution of patients undergoing continent (CUD) vs incontinent (ICUD) after RC. PATIENTS AND METHODS Between September 2004 and December 2008, 200 patients had RC with UD by one surgeon. Each patient was given standardized preoperative counselling; the charts were reviewed retrospectively to determine the relative frequencies of the various types of UD, and the reasons why patients had an ICUD assessed, including medical contraindications and personal choice. RESULTS During preoperative counselling, 149 patients (75%) were assessed as being eligible for a CUD, while 51 (25%) had one or more contraindication; 140 (70%) ultimately had a CUD, and the remaining 60 (30%) a ICUD. Of the 149 patients eligible for a CUD, only nine (6%) chose to undergo ICUD for personal reasons. CONCLUSION Few patients choose to have an ICUD in the absence of an absolute medical contraindication. Proper patient selection and thorough, standardized preoperative counselling result in a higher rate of CUD than ICUD after RC.

Pediatric renovascular hypertension is typically managed with revascularization, angioplasty, or radical nephrectomy. We describe the case of a 13-year-old boy with medically refractory renovascular hypertension who presented to our institution after a failed arterial bypass. Subsequent angiography and renin sampling of the segmental renal veins suggested that the lower pole of the kidney was affected exclusively by the relative hypoperfusion. We proceeded with an open partial nephrectomy in order to excise the affected region of the kidney, while preserving maximum renal function. The patient was normotensive off all antihypertensive medication and without complications 8 months postoperatively. We believe that partial nephrectomy is a reasonable treatment for children with renovascular hypertension secondary to segmental hypoperfusion, and it should be considered as alternative therapy.

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