Objectives: To investigate and compare Wallace direct ureteroileal anastomosis with Le Duc anti-reflux procedure in modified Studer orthotopic neobladder reconstruction after radical cystectomy. Methods: A total of 72 consecutive patients who underwent modified Studer orthotopic bladder reconstruction after a radical cystectomy for bladder cancer were investigated. They were examined for vesicoureteral reflux, hydronephrosis, and pyelonephritis at 6 months after surgery according to the type of ureteroileal anastomosis. Results: Vesicoureteral reflux occurred in 29 ureters (38.2%) after the Wallace procedure compared to six ureters (9.6%) with the Le Duc (P < 0.05). Hydronephrosis was detected in 12 ureters (18.8%) in the Le Duc patients compared to seven (9%) in the Wallace patients (P > 0.05). Six months after the operation, all three patients with vesicoureteral reflux-related hydronephrosis improved using clean intermittent catheterization in the Le Duc patients; five of seven patients were cured by clean intermittent catheterization and two improved without any treatment in the Wallace patients. Seven of nine cases of ureteroileal anastomosis stenosis causing hydronephrosis were cured without any treatment but one case resulted in a non-functional kidney despite treatment of the stenosis. Conclusions: Direct ureteroileal anastomosis using the Wallace method is effective for minimizing ureteroileal anastomosis stenosis and it represents a simple surgical procedure when combined with a modified Studer procedure.

No abstract

We recommend modified apical dissection to preserve the urethral striated sphincter, which can be useful in improving the early incontinence rate and the recovery of continence.

Malacoplakia is a relatively rare form of chronic granulomatous inflammation. Which occurs most frequently in the genito-urinary system, but renal parenchymal involvement is rare. We present a case of malacoplakia of the renal parenchyma. A 69-year-old woman with left renal mass was referred to our department. Abdominal enhanced CT scan revealed heterogeneous mass in the left kidney (50 x 45 mm). CT-guided percutaneous left renal needle biopsy confirmed the diagnosis of renal malakoplakia. We successfully treated her with oral levofloxacin. The lesion resolved after the 4-months-therapy, and there has been no recurrence for 22 months since the treatment.