The concept of functional preservation after orthotopic neobladder construction has gradually attracted attention. Reconstruction of urine storage and voiding is the basic function preservation of orthotopic neobladder. Clinical exploration mainly focuses on the optimization of neobladder reconstruction methods and procedures, and there is still a lack of summary of existing surgical characteristics and high-quality functional comparative studies. For strictly selected patients, on the basis of tumor control and standardized postoperative rehabilitation guidance, most patients with preserved nerve can retain satisfied sexual function after surgery. The protection of neurovascular bundle and ancillary structures combined with postoperative exercise is crucial to the improvement of urinary continence. According to the characteristics of patients, choosing the appropriate urinary diversion methods and function preserving can help patients establish a normal life style after surgery and improve their self-image and quality of life.
Humans ; Urinary Reservoirs, Continent/physiology* ; Cystectomy/methods* ; Urinary Bladder Neoplasms/surgery* ; Quality of Life ; Urinary Diversion/methods*

OBJECTIVE: To summarize the initial clinical experience and follow-up results of the treatment for ureteroileal anastomotic stricture after radical cystectomy with Allium coated metal ureteral stent. METHODS: From September 2018 to September 2019, 8 patients with ureteroileal anastomotic stricture after radical cystectomy underwent Allium ureteral stent insertion in Peking University People's Hospital and People's Hospital of Daxing District. The preoperative renal pelvis width under ultrasound was collected to evaluate the postoperative hydronephrosis, creatinine and urea nitrogen (BUN) before and after surgery, perioperative infection, and stent-related complications. The serum creatinine and BUN, renal pelvis width under ultrasound, urography and abdominal plain film (KUB) were reviewed at the end of 1, 3, and 6 months and annually postoperatively to observe the stent position and morphology. The long-term stent patency rate, complication rate, renal function and hydronephrosis were followed up and analyzed. The t-test or rank-sum test was used to compare the measurement data of the matched sample from the preoperative to the last follow-up. RESULTS: In the study, 6 cases (7 sides) were ureteral ileal conduit stricture, and 2 cases (3 sides) ureteral orthotopic neobladder stricture. Before surgery, 5 patients underwent long-term indwelling of a single J ureteral stent, with an average indwelling time of (20.6±8.8) months and an average replacement frequency of (3.6±1.3) months/time. The mean width of renal pelvis was (26.5±9.1) mm on preoperative renal ultrasonography. Among them, 6 patients were successfully indwelled with Allium coated metal ureteral stent by retrograde approach, and 2 patients by combination of double-endoscopy and ante-retrograde approach. No surgery-related complications during perioperative period were observed. The mean follow-up period was 9.8 months and Allium stent and ureter remained unobstructed in all the patients at the last follow-up without replacement or removal. Compared with preoperative data, the mean width of renal pelvis and mean blood urea nitrogen (BUN) in the last follow-up period were significantly reduced [(26.5±9.1) mm vs. (13.4±2.5) mm, P=0.008; (11.6±2.3) mmol/L vs. (10.2±2.2) mmol/L, P=0.017], however, there were no significant differences in the average serum creatinine or hemoglobin (P>0.05). Ureteroileal anastomotic re-stricture and other stent-related complications were not observed in all the patients by antegrade urography. CONCLUSION Allium coated metal ureteral stent could be used for the treatment for ureteroileal anastomotic stricture, which could maintain relatively long-term patency rate and protect renal function. The indwelling time was longer and it could improve quality of life of patients.
Allium ; Anastomosis, Surgical ; Constriction, Pathologic ; Cystectomy ; Follow-Up Studies ; Humans ; Metals ; Quality of Life ; Stents ; Treatment Outcome ; Ureter ; Ureteral Obstruction/surgery* ; Urinary Diversion

Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), Staphylococcus aureus nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), “No Touch” technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.
Anti-Bacterial Agents ; Erectile Dysfunction ; Evidence-Based Medicine ; Hair Removal ; Hand ; Health Care Costs ; Humans ; Immunosuppression ; Male ; Obesity ; Penile Prosthesis ; Prostheses and Implants ; Risk Factors ; Sexual Dysfunction, Physiological ; Smoke ; Smoking ; Spinal Cord Injuries ; Staphylococcus aureus ; Stress, Psychological ; T-Lymphocytes ; Tobacco ; Urinary Diversion

PURPOSE: The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. MATERIALS AND METHODS: This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral periodwith consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. RESULTS: The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recently. CONCLUSION: We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.
Cohort Studies ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Methods ; Prognosis ; Rage ; Referral and Consultation ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Diversion

BackgroundRobot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.

MethodsFrom January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.

ResultsLRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.

ConclusionsICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

Aged ; Cystectomy ; methods ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Bladder Neoplasms ; surgery ; Urinary Diversion ; methods

OBJECTIVE: To determine the effect of surgeon experience on intraoperative, postoperative and long-term outcomes among patients undergoing pelvic exenteration for gynecologic cancer. METHODS: This was a retrospective analysis of all women who underwent exenteration for a gynecologic malignancy at MD Anderson Cancer Center, between January 1993 and June 2013. A logistic regression was used to model the relationship between surgeon experience (measured as the number of exenteration cases performed by the surgeon prior to a given exenteration) and operative outcomes and postoperative complications. Cox proportional hazards regression was used to model survival outcomes. RESULTS: A total of 167 exenterations were performed by 19 surgeons for cervix (78, 46.7%), vaginal (43, 25.8%), uterine (24, 14.4%), vulvar (14, 8.4%) and other cancer (8, 4.7%). The most common procedure was total pelvic exenteration (69.4%), incontinent urinary diversion (63.5%) and vertical rectus abdominis musculocutaneous reconstruction (42.5%). Surgical experience was associated with decreased estimated blood loss (p < 0.001), intraoperative transfusion (p = 0.009) and a shorter length of stay (p = 0.03). No difference was noted in the postoperative complication rate (p = 0.12–0.95). More surgeon experience was not associated with overall or disease specific survival: OS (hazard ratio [HR] = 1.02; 95% confidence interval [CI] = 0.97–1.06; p = 0.46) and DSS (HR = 1.01; 95% CI = 0.97–1.04; p = 0.66), respectively. CONCLUSION: Patients undergoing exenteration by more experienced surgeons had improvement in intraoperative factors such as estimated blood loss, transfusion rates and length of stay. No difference was seen in postoperative complication rates, overall or disease specific survival.
Cervix Uteri ; Female ; Genital Neoplasms, Female ; Humans ; Length of Stay ; Logistic Models ; Pelvic Exenteration* ; Postoperative Complications ; Pregnancy ; Pregnancy Outcome ; Rectus Abdominis ; Retrospective Studies ; Surgeons ; Urinary Diversion

Intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine is a very rare long-term complication after complete urethral reconstruction of the bladder. The probability of its occurrence is low. However, in recent years, it has been proved to be objective, but there is rare literature about its diagnosis and treatment methods. This article describes a case of cystectomy and Studer ileal conduit in Peking University Third Hospital due to bladder cancer. After 9 years, he was discovered with a primary intestinal-derived adenocarcinoma in the bladder substitutes by the intestine. A male patient, 64 years old, with persistent abdominal pain in the lower abdomen for two weeks. There was carrion-like material in the urine, no gross hematuria, no urinary frequency, urgency, dysuria, and no abnormalities in the examination. Urinary CT showed intestinal metaplasia in the bladder. There was 5.7 cm×2.4 cm×4.8 cm irregular tissue shadow, and ureteroscopy found, on the right side, the bladder tumor whose diameter was 4-5 cm. We performed open lumpectomy and repaired the bladder, and postoperative pathology showed middle-high differentiated adenocarcinoma. The patient recovered well after the surgery. This article reviewed the similar intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine and found that it had the highest incidence in the elderly male population. The pathogenetic factor was most closely related to the smoking. If the patients developed hematuria, carrion-like substances in the urine, and bladder irritation, the possibility of tumor development should be suspected. Then the patients should promptly take the tests, such as urine exfoliation cytology, urine FISH, urinary system B-ultrasound, cystoscopy, etc. The microscope was the most direct observation of the lesion site examination. If the pathological tumor occurred ,and then the tumor should be immediately removed, and a new urinary diversion was needed to avoid further progress of the tumor. And postoperative smoking was strictly prohibited, also the patients should strictly control their eating habits and regularly adhere to the follow-up at least 4 years or more, but the lifelong follow-up and review was a must. The mechanism of intestinal primary intestinederived adenocarcinoma of the bladder substituted by the intestine is still unclear. Studies suggest that it may be related to N-nitroso compounds, smoking, and postoperative inflammatory reactions.
Adenocarcinoma/surgery* ; Cystectomy ; Humans ; Intestines ; Male ; Middle Aged ; Urinary Bladder Neoplasms/surgery* ; Urinary Diversion

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization* ; Quality of Life* ; Urethra ; Urinary Bladder, Neurogenic* ; Urinary Diversion

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization* ; Quality of Life* ; Urethra ; Urinary Bladder, Neurogenic* ; Urinary Diversion

These days, genitourinary tuberculosis (GUTB) rarely occurs in conjunction with pulmonary tuberculosis. Reconstructive surgery for GUTB has also decreased but may still be done in case of a grossly distorted genitourinary anatomy and dysfunction that are unlikely to regress with chemotherapy alone. Reconstructive bladder surgery for GUTB is a well-established procedure. The various complications associated with the reconstructive surgery have also been well documented. We present a case of an uncommon complication after ileocystoplasty.
Drug Therapy ; Tuberculosis* ; Tuberculosis, Pulmonary ; Tuberculosis, Urogenital ; Urinary Bladder* ; Urinary Diversion