Comparison between a serous‐lined extramural tunnel and T‐limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial

Osman, Yasser; Abol‐Enein, Hassan; El-Mekresh, Mohsen; Gad, Hossam M.; El‐Hefnawy, Ahmed S.; Ghoneim, Mohamed A.

doi:10.1111/j.1464-410x.2009.08574.x

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…Osman et al. presented the short‐term RF outcomes of a prospective randomized study comparing extraserosal tunnel vs T‐pouch using the same antireflux mechanism as that introduced by Abol‐Enein and Ghoneim . The authors noted that both techniques were similar in terms of functional results with a modest rate of stricture formation.…”

Section: Discussionmentioning

confidence: 99%

Impact of the type of ureteroileal anastomosis on renal function measured by diuretic scintigraphy: long‐term results of a prospective randomized study

et al. 2014

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Objective• To determine the long-term effects of the direct refluxing-type ureteroileal anastomosis technique with those of an antireflux technique on individual renal units, using diuretic scintigraphy in a prospectively randomized study. Patients and Methods• Between 2002 and 2006, a prospective randomized study was conducted on 102 patients undergoing radical cystectomy and urinary diversion.• In every patient, both ureters were randomized to be implanted using a direct refluxing technique or an antireflux, serous-lined extramural tunnel (SLET) technique.• Renal function (RF) was evaluated using 99m Tc-MAG-3 diuretic scintigraphy. The serial changes in corrected glomerular filtration rate (cGFR) for each technique and for each side were compared. Results• Over a median follow-up of 6 years, the patients in both the direct refluxing and the SLET technique groups were found to have a significant reduction in mean (SD) cGFR between baseline and last follow-up: cGFR decreased from 59.4 (12.4) to 45.6 (15.3) mL/min (P < 0.001) and from 54.3 (11.2) to 46.3 (12.8) mL/min (P = 0.002), respectively. • Five patients (4.9%) in the SLET group developed obstruction (four left-sided and one right-sided) compared with one (0.9%) in the direct refluxing group (right-sided). The onset of obstruction was noted 1-7 months after radical cystectomy.• There was no significant difference between the groups in reductions in cGFR across the timepoints.• Comparison of the two techniques according to the side of ureter implantation showed that the direct refluxing technique trended towards better functional outcomes on the left side. Conclusions• There was no observed difference in the RF of individual renal units between the SLET and the direct refluxing groups in the long term.• The need to incorporate an antireflux technique should be questioned and tailored according to the surgeon's experience and confidence.

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Section: Discussionmentioning

confidence: 99%

Impact of the type of ureteroileal anastomosis on renal function measured by diuretic scintigraphy: long‐term results of a prospective randomized study

et al. 2014

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“…In one study, the authors presented their initial data of a prospective randomised study while patients' accrual had not yet been completed and they further presented their results as a conference abstract , but the full‐length manuscript has not been published as of the time of writing of this review, therefore, this paper was excluded from the analysis. Only three randomised trials were selected and all were from the same centre . Nevertheless, these trials were not appropriately designed as there was no power calculation and various definitions of the outcomes were lacking.…”

Section: Which Is Better the Direct Free‐refluxing Or Anti‐refluxingmentioning

confidence: 99%

“…Other anti‐reflux techniques included Goodwin, Leadbetter and Padua . In two studies, comparison was between two different anti‐reflux techniques . Different types of OBS were used, with the most popular being Hautmann and Studer pouches.…”

Section: Which Is Better the Direct Free‐refluxing Or Anti‐refluxingmentioning

confidence: 99%

“…In three studies, isotope renography was used; dimercaptosuccinic acid (DMSA) scan was used to assess renal scarring , 99m technetium mercapto‐acetyltriglycine (MAG3) renography was used to assess UIA obstruction , while in the other publication, the type of isotope was not mentioned . Nevertheless, in the studies assessing morphological changes, none provided a definition for deterioration or improvement based on the radiological procedures.…”

Section: Which Is Better the Direct Free‐refluxing Or Anti‐refluxingmentioning

confidence: 99%

“…In another two publications of SLET UIA, anastomotic strictures occurred in five (8.3%) and three (2.7%) patients, respectively. In two randomised control trials (RCTs) from the same centre, the SLET technique was compared with a ‘T'‐limb (one stricture in each group) and urethral Kock pouch (two strictures in each group) attaining comparable stricture rates ( P values >0.05). In a more heterogeneous comparison including the direct Nesbit vs three anti‐reflux techniques, the anti‐reflux procedures resulted in 16 (13%) strictures vs 1 (1.7%) in the direct procedure ( P < 0.05) .…”

Section: Which Is Better the Direct Free‐refluxing Or Anti‐refluxingmentioning

confidence: 99%

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Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature

et al. 2014

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Renal function (RFn) after orthotopic bladder substitution (OBS) is a critical point to be assessed. We performed a systematic review of MEDLINE for full length peer reviewed English articles from the year 2000 till January 2013. We included only original articles and excluded reviews, editorials and replies and abstracts presented in conferences. The outcome is formulated in research questions; what is the status of RFn after OBS? Which is better, the direct free-refluxing or anti-refluxing ureteroileal anastomosis (UIA) techniques? Studies reporting RFn as secondary outcome were also reported. A total of 129 publications were reviewed for full text and only 41 were included in this review. All studies were of low level of evidence and grade of recommendations. Only 3 randomized controlled trials were included and were of poor quality. Renal function after OBS was poorly described in the literature with no universal definition about RFn deterioration or outcome with no consensus on the best evaluation method. Urinary obstruction, chemotherapy and pyelonephritis appeared significant factors but with insufficient evidence. There is a universal trend to use the free refluxing technique for UIA to avoid complications of anti-refluxing techniques. However, the anti-reflux technique proved acceptable outcome in experienced hands. There is marked heterogeneity and underestimation of RFn evaluation among reported outcomes after OBS with most publications reporting the incidence of UIA and pyelonephritis with paucity reporting absolute figures about RFn measurements. In conclusion, urinary tract obstruction remains the main factor of RFn deterioration after OBS. Methods evaluating RFn, definitions of RFn outcome and factors predicting it are poorly studied in the literature and the current evidence is relatively weak to draw solid conclusions. Further well-designed studies and consensus about method of assessment and definitions of RFn are warranted.

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Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

Cody

Nabi

Dublin

et al. 2012

Cochrane Database of Systematic Reviews

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Comparison between a serous‐lined extramural tunnel and T‐limb ileal procedure as an antireflux technique in orthotopic ileal substitutes: a prospective randomized trial

Cited by 10 publications

References 27 publications

Impact of the type of ureteroileal anastomosis on renal function measured by diuretic scintigraphy: long‐term results of a prospective randomized study

Impact of the type of ureteroileal anastomosis on renal function measured by diuretic scintigraphy: long‐term results of a prospective randomized study

Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy

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