Retrosigmoid Versus Traditional Ileal Conduit for Urinary Diversion After Radical Cystectomy

Ficarra, Vincenzo; Giannarini, Gianluca; Crestani, Alessandro; Palumbo, Vito; Rossanese, Marta; Valotto, Claudio; Inferrera, Antonino; Pansadoro, Vito

doi:10.1016/j.eururo.2018.06.023

Cited by 16 publications

(17 citation statements)

References 15 publications

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“…With classic IC, the left ureter is widely dissociated and pulled towards the right side for anastomosis with ileum, increasing the potential risk for complications related to uretero-ileal anastomosis. This complication has also been reported by many other studies [18,24]. To avoid such complications, many scholars have modi ed the Bricker IC.…”

Section: Discussionsupporting

confidence: 58%

“…Then, the left ureter was anastomosed almost in situ to the ileum by end-to-side anastomosis, and a single J tube was placed inside the ureter-ileum as an internal stent for drainage. Moreover, the proximal IC was xed to the left psoas major aponeurosis [24]. At the promontory of the sacrum, a retroperitoneal channel was separated towards the right (Fig 1B ), and the outlet end of the conduit was passed from the retroperitoneum to the right side and led out from the prepositioned skin stoma.…”

Section: Surgical Techniquementioning

confidence: 99%

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Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Zhang

Bai

et al. 2021

Preprint

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Background: To evaluate the surgical effects and oncological outcomes of modified ileal conduit (IC) after radical cystectomy (RC) for bladder cancer.Methods: A single-centre cohort of 211 consecutive bladder cancer patients who underwent RC + modified IC from September 2012 to August 2019 were retrospectively studied. Demographic data, perioperative results, complications 30 and 90 days after surgery and oncological outcomes were recorded. Kaplan–Meier method was used to plot the stage-specific survival results. The 5-year recurrence-free survival (RFS）and overall survival (OS) rate was calculated. Univariate and multivariate Cox regression analyses assessed the predictive risk factors on survival rate.Results: Overall, 211 patients received modified IC after RC. The median operative time (OT) was 315 minutes (IQR, 260–375 minutes), and the median estimated blood loss (EBL) was 500 ml (IQR, 300–900 ml). There were a total of 103 (48.8%) complications. There were 35, 54, 11, and 2 cases of grade I, II, III, and IV complications, respectively; of which 89 cases were grade I and II, accounting for 87.3% of total cases. There were 38 cases of preoperative hydronephrosis and 22 cases of postoperative hydronephrosis. There were 19, 24, 108, 40, and 20 cases of PT0, T1, T2, T3, and T4, respectively, in postoperative pathological stages. The median lymphadenectomy was 14 (IQR, 6–18), and lymph node was found positive in 18 patients. The median follow-up time was 26 months (IQR, 13–43), with a total survival of 177 (83.9%), an RFS of 171 (81%), and 34 deaths. The estimated 5-year OS and RFS rates were 76.80% and 79.10%. Preoperative comorbidities, pathological stage, grade, and lymph node involvement were important influencing factors for OS, while preoperative comorbidities and high pathological grade were important influencing factors for RFS.Conclusions: Modified IC after RC not only can achieve lower postoperative complications, especially the lower incidence of uretero-ileal anastomosis and stoma-related complications but can also achieve the established oncological outcomes of critical radical surgery.

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Section: Discussionsupporting

confidence: 58%

Section: Surgical Techniquementioning

confidence: 99%

Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Zhang

Bai

et al. 2021

Preprint

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“…Ureteroileal anastomotic stricture (UAS) is an infrequent but potentially severe complication that may ultimately lead to renal impairment. In addition to patient-and diseaserelated risk factors, UAS can be a consequence of a poor surgical technique (3). Therefore, new techniques of ureteroileal anastomosis should be developed to reduce postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Modified Wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion

et al. 2020

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Purpose: To compare perioperative outcomes, complications and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy (RC) with modifi ed Wallace anastomotic technique versus traditional ileal conduit. Materials and methods: Study enrolled 180 patients, of whom 140 were randomized and underwent RC; seventy were randomized to group I and the seventy to the group II. For the primary objective, we hypothesized that the rate of ureteroenteric strictures would be at least 20 % lower in the second group. Secondary end points included rate of anastomotic leak, surgical time, deterioration of the upper tract, intraoperative blood loss and patient-reported quality of life (HRQOL). The modifi ed Wallace 1 technique involved eversion of the ureteral plate and bowel mucosa edges, which were anastomosed together in running fashion, while the outher anastomotic wall was augmented with sero-serosal interrupted sutures. Results: The mean (SD) follow-up time was 26.1 (5.7) months in group I and 25.2 (4.8) months in group II, during which, anastomotic stricture was observed in 8 patients (12%) from the fi rst and 2 patients (3%) from the second group (p < 0.05). The anastomotic leakage rate was signifi cantly higher in fi rst group (17% vs. 8.5%, p< 0.05), while patient-reported HRQOL outcomes were similar between groups after the 12 month follow-up period. Conclusions: By using a modifi ed Wallace technique, we were able to signifi cantly lower anastomotic stricture and anastomotic leakage rates, which are major issues in minimizing both short-and long-term postoperative complications.

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“…The retrosigmoid tunnel may also increase the risk for angulation and/or compression of the left ureter. In this study (2), the authors presented their results with a technique involving the retrosigmoid transposition of the ileal conduit from the right to the left side of the body in order to avoid the problems associated with the crossing of the left ureter to the right side.…”

Section: Introductionmentioning

confidence: 99%

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

Gomes¹,

Laferreira²

2018

Transl. Androl. Urol

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Retrosigmoid Versus Traditional Ileal Conduit for Urinary Diversion After Radical Cystectomy

Cited by 16 publications

References 15 publications

Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Modified Wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

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