We report the case of a 48-year-old man with ischemic stroke, diabetes and chronic renal failure admitted for fever with LUTS associated with nausea and vomiting.The physical examination showed a depressible abdomen, painful prostate on digital rectal examination.A biological inflammatory syndrome with diabetic ketoacidosis.The abdominopelvic CT scan confirmed the diagnosis by the presence of gas in the prostate,and the CBUE was positive for Enterobacter cloacae .The patient was treated with appropriate antibiotic therapy with transrectal aspiration of the prostate collection,but the evolution was marked by the worsening of the patient's condition leading to his death after two weeks of treatment.

We report the case of a 58-year-old male with a history of diabetes who presented with a macroscopic hematuria. On physical examination, he was afebrile. Investigations revealed an anemia. A CT scan showed a tumor of the bladder and upper excretory system with multiple lung, spleen and liver metastases. The patient received blood transfusions and a trans-urethral resection of the tumor was performed. The patient’s condition later deteriorated and skin lesions appeared on the back and the scalp. A biopsy of the lesions confirmed their metastatic nature. The patient’s condition deteriorated and he died 4 weeks later.

INTRODUCTION AND OBJECTIVES: Limited outcome studies exist for subtypes of continent cutaneous urinary diversions (CCUD). This study evaluates two subtypes of CCUD; Indiana Pouch (IP) and Appendico-umbilicostomy (AU), by investigating diversion-specific complications and quality of life after diversion. METHODS: A retrospective review of an IRB-approved database was conducted for perioperative and outcome data. The EORTC QLQ-C30 questionnaire was used to assess quality of life; all responses were dated >6 months after diversion. RESULTS: 58 patients (33 IP under 2 surgeons, 25 AU under 1 surgeon) were identified for this study (2010-2016). All 3 surgeons were fellowship-trained urologic oncologists. Patient characteristics are summarized in Table 1. Higher age and higher Charlson Comorbidity Index (CCI) !3 were seen in the AU cohort (p[0.002, 0.006, respectively). Outcome data are listed in Table 2. After a median follow up of 21 months (range:0.8-81.0), more stoma complications were reported for the AU cohort (p[0.049). In both types of diversions, >60% of stoma complications occurred at skin/fascia level. In the 90-day postoperative period, a higher continence rate was reported for the IP cohort (p[0.017). 24 responses were recorded for the EORTC questionnaire (14 IP, 10 AU): for both cohorts >70% of patients reported little to no disturbance of daily functions and rated overall quality of life as !70% (Table 3). CONCLUSIONS: The Indiana Pouch and Appendicoumbilicostomy urinary diversions are associated with high rates of continence and patient satisfaction. Stoma complications are common and are mostly seen at superficial level. Our Appendicoumbilicostomy cohort had a higher rate of stoma complication and a lower 90-day continence rate; however, this may be attributed to higher age and CCI in this cohort.

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