Rupture of Ileal Neobladder due to Urethral Obstruction by Mucous Plug

Haupt, Gerald; Pannek, Jürgen; Knopf, H.-J.; Schulze, Harald; Senge, Th.

doi:10.1016/s0022-5347(17)39571-x

Cited by 45 publications

(15 citation statements)

References 9 publications

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“…On average, the patients were followed for 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) months, when both objective and subjective parameters had been prospectively studied. Objective parameters were evaluated by urodynamic examination, imaging methods and laboratory tests.…”

Section: Methodsmentioning

confidence: 99%

“…Intestinal segments produce mucus in the amount of 37 g/day [27]. The mucus can mechanically obstruct the urethra in 3% of patients [10], which results in postmicturition residual urine and rarely in perforation of the bladder [7,28]. Another negative property of the mucus is its lithogenic potential and the increased risk of infection [28,29].…”

Section: Complicationsmentioning

confidence: 99%

“…It is feared that possible qualitative changes of the dysfunction of the lower urinary tract may develop, accompanied by the deterioration of the overall health status, of the mobility of upper extremities and spasticity of lower extremities, mental disorders and psychic instability, which all can influence the postoperative state of the patients. It is probably for these reasons that so far groups of patients that had undergone augmentation cystoplasty only comprise individual cases of patients with multiple sclerosis [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Augmentation Cystoplasty in Patients with Multiple Sclerosis

Zachoval

Piťha²,

Medova³

et al. 2003

Urol Int

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Introduction: Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in patients with progressive diseases such as multiple sclerosis (MS). Materials and Methods: Augmentation ileocystoplasty (Goodwin ‘cup-patch’) was performed in 9 patients (7 females, 2 males). The average Expanded Disability Status Scale score was 4.1 (range 3.0–6.5); 7 patients had relapse-remitting MS and 2 patients secondary-progressive MS. The indication was a detrusor hyperreflexia refractory to conservative treatment in 8 patients and a detrusor hyperrefluxia with third degree bilateral vesico-ureteral reflux and renal insufficiency in 1 patient. Pre- and postoperative objective parameters were evaluated by urodynamic examination, imaging methods and laboratory examination. Subjective evaluation was performed using a questionnaire on micturition symptoms (score 0–5) and on quality of life (score 0–6). Results: With a follow-up of 6–19 months, we recorded an average increase of the maximum detrusor capacity from 105 to 797 ml and decrease of maximum detrusor pressure from 53 to 30 cm H₂O. Postmicturition residual urine >25% of the maximum capacity was present in 6 patients who performed clear intermittent autocatheterization postoperatively (2 patients preoperatively). In all patients there was a significant improvement in the irritation micturition symptomatology (pollakisuria, nycturia, urgency and urge incontinence) and the quality of life score improved on average from 5 to 0.7. In the case of the patient with renal insufficiency, the creatinine level decreased from 286 to 150 µmol/l; in the other patients renal function remained normal. Conclusions: Augmentation cystoplasty is a safe and effective method for indicated patients, which significantly enhances their quality of life.

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Section: Methodsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Augmentation Cystoplasty in Patients with Multiple Sclerosis

Zachoval

Piťha²,

Medova³

et al. 2003

Urol Int

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“…The quality of life of these patients is affected by recurrent urinary tract infections, stone formation, excessive mucus production and an increased risk of colonic neoplasia leading to malignancy [27][28][29]. Indeed, many studies have demonstrated that in artificial urinary bladder, secretomotor function is maintained in the long term with mucus production and problems related to its excessive production are not decreasing with time [30][31][32][33][34]. Over the past 15 years, the proportion of patients receiving a neobladder has increased significantly and it becomes necessary to characterize the changes in mucin expression and glycosylation in transposed segments to better understand the relation structure/function of these proteins under abnormal conditions.…”

Section: Introductionmentioning

confidence: 99%

Glycosylation of the two O-glycosylated domains of human MUC2 mucin in patients transposed with artificial urinary bladders constructed from proximal colonic tissue

et al. 2007

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Transposition of intestinal segments is frequently used for bladder reconstruction. Following transposition, bowel segments continue to produce mucus and a correlation between excessive mucus production and complications such as urinary tract infection or catheter blockage has been observed for a long time. However, no information is currently available on the change of mucin expression and glycosylation under these abnormal conditions. In this study, the variable number tandem repeat region and the irregular repeat domain of human MUC2 were isolated as two glycopeptide populations after reduction and trypsin digestion followed by gel chromatography from urine of patients transposed with urinary bladders. After alkaline borohydride treatment, the oligosaccharides released from the whole MUC2 mucin and the two glycosylated domains were investigated by nanoESI Q-TOF MS/MS (electrospray ionization quadrupole time-of-flight tandem mass spectrometry). More than 60 different glycans were identified, mainly based on sialylated core 3 structures. Some core 1, 2 and 4 oligosaccharides were also found. Most of the structures were acidic with NeuAc residues mainly alpha2-6 linked to the N-acetylgalactosaminitol and sulphate residues exclusively 3-linked to galactose. No expression of blood group A and B or Sda/Cad determinants was observed. Similar patterns of glycosylation were found in the tandem repeat region and the irregular repeat domain and the level of expression of the major oligosaccharides were in the same order of magnitude. The most interesting feature of this study was that sialyl-Tn antigen, which is considered as a tumour antigen, was the oligosaccharide most highly expressed. This result suggests that mucins from intestinal transposed segments are abnormally glycosylated.

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“…tive early and late complications as well as the metabolic consequences of this technique have been examined extensively [2,[6][7][8][9][10][11][12][13][14] . In contrast to orthotopic neobladders, where ruptures obviously occur more often and have therefore been described in detail [14][15][16][17][18][19][20][21][22][23] , ruptures of heterotopic continent ileocecal reservoirs have only been mentioned in individual case reports or as part of nationwide surveys [24][25][26] , mostly due to their sporadic occurrence.…”

mentioning

confidence: 99%

Diagnosis and Clinical Management of Ruptured Ileocecal Pouches for Continent Cutaneous Urinary Diversion

Kalogirou

Kocot²,

Mulfinger³

et al. 2016

Urol Int

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Background and Objectives: The study aimed to report on pouch ruptures in 5 patients with ileocecal reservoirs for continent cutaneous urinary diversion. Patients and Methods: Five male patients aged 48-89 were referred to our department between 2000 and 2016 with a ruptured ileocecal pouch 16-175 months postoperatively. Results: With an incidence of 0.95% in our series (5 ruptures in 529 pouch patients out of a pool of 1,182 radical cystectomies) a rupture of the ileocecal pouch is a rare but severe complication. In all the cases, the rupture was supported by the over-distension of the reservoir, while a traumatic self-catheterization was reported in 2 patients. The rupture occurred on the right lateral wall of the ileocecal pouch in 4 out of 5 cases and led to acute abdominal pain and inflammation. Pouchography was performed in all the patients and revealed a leakage in 4 of them. The rupture was verified intraoperatively in 1 patient. Open surgical exploration, drainage and repair were successfully performed in all 5 cases. Conclusions: Early diagnosis and immediate intervention are mandatory in the cases of pouch rupture to manage this severe complication, which is often related to reduction in patient compliance. Consequently, it is essential to raise awareness of this potentially life-threatening complication in patients with ileocecal pouches.

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Rupture of Ileal Neobladder due to Urethral Obstruction by Mucous Plug

Cited by 45 publications

References 9 publications

Augmentation Cystoplasty in Patients with Multiple Sclerosis

Augmentation Cystoplasty in Patients with Multiple Sclerosis

Glycosylation of the two O-glycosylated domains of human MUC2 mucin in patients transposed with artificial urinary bladders constructed from proximal colonic tissue

Diagnosis and Clinical Management of Ruptured Ileocecal Pouches for Continent Cutaneous Urinary Diversion

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