Management of neobladder complications: endoscopy comes first

Moeen, Ahmed M; Safwat, Ahmed S.; Elderwy, Ahmad A.; Behnsawy, Hosny M.; Osman, Mahmoud M.; Hameed, Diaa A.

doi:10.1080/21681805.2017.1290677

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…All-grade Clavien complication rate was 48.9%, which is slightly lower than reported > 60%, with up to 7% of mortality in some series, which could proof a good patient selection for ON reconstruction, as further confirmed by a median hospital stay of 7 days. Moreover, median EBL and intraoperative transfusion rates were exceptionally lower than those reported by other authors for totally intracorporeal ON (31,32).…”

Section: Discussioncontrasting

confidence: 60%

Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

Romagnoli

D’Agostino²,

Salvaggio³

et al. 2019

Arch Ital Urol Androl

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Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time continence recovery during a 12-month follow up. Materials and methods: We prospectively collected data from 42 consecutive patients who underwent RARC with totally intracorporeal ON and extended pelvic lymph node dissection (PLND) at our Institution from June 2014 to October 2017. Prior to the urethro-neobladder anastomosis we reconstructed the Denonvilliers Fascia (DF) as previously described for radical prostatectomy using a bidirectional barbed suture. Day and night-time recovery rates were reported at 3, 6 and 12 months after surgery, with continent patients being those using either no urinary pads or 1 safety pads. Results: Median age at surgery was 63 yrs, 41 (97.6%) patients were male. 28 (66.7%) patients presented a clinical T2 disease. Median operative time and median ON reconstruction time were 450 minutes and 180 minutes respectively. 13 (31%) individuals had non-organ confined disease, with 11 (26.2%) patients with positive lymph nodes (median 3 positive lymph nodes) and 2 (4.8%) with non-urothelial cancer at final pathologic examination. Median hospital stay and median catheterization time were 7 (IQR 7-8) and 21 (IQR 19-22). During first 30 post-operative days we recorded 7 (16.7%) low-grade Clavien and 2 (4.8%) IIIa Clavien complications, whereas between 30 and 90 postoperative days we recorded 4 (9.5%) low-grade, 4 (9.5) IIIa and 1 (2.4%) IIIb complications. Day-time and night-time continence rates were 61.9% vs 52.4%, 73.8% vs 64.3% and 90.5% vs 73.8% at three, six and twelve months follow up. Day-time continence was significantly superior in the younger group (97% vs 57%, p 0.01); night-time continence rates were also superior among < 70 yrs patients, despite not reaching statistical significance (77% vs 57%, p 0.3). Conclusions: Posterior muscle-fascial reconstruction aids continence recovery in BC patients undergoing RARC with ON, with younger and fitter patients most benefitting from ON reconstruction.

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Section: Discussioncontrasting

confidence: 60%

Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

Romagnoli

D’Agostino²,

Salvaggio³

et al. 2019

Arch Ital Urol Androl

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“…The only high-grade late complication recorded was ureteral stenosis, which is one of the most common late complication after RC. Despite open surgery being still considered as the gold standard, its management could still be ‘less-invasive’ with good surgical results, as reported by other authors [33, 34], without adding further surgical distress.…”

Section: Discussionmentioning

confidence: 87%

Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience

Romagnoli

D’Agostino

Corsi

et al. 2019

Cent european J Urol

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Introduction The aim of this study was to assess surgical and functional outcomes of 17 consecutive patients undergoing robot- assisted radical cystectomy (RARC) with palliative intent in a monocentric single surgeon series. Material and methods We collected data from 17 consecutive patients who underwent RARC with palliative intent performed by a single surgeon at our institution. Patients undergoing palliative RARC were those with advanced bladder cancer (BC) or advanced comorbidities. Clinical, surgical and functional outcomes were prospectively collected. Patients completed a specific questionnaire (Functional Assessment of Cancer Therapy-Bladder Cancer, FACT-BL) before and after surgery to assess the role of palliative RARC in terms of quality of life improvement. Results Median age at surgery was 78 years, with median Charlson Comorbidity Index (CCI) and age-adjusted CCI of 3 and 7, respectively. Clinical stage was T2, T3 or T4 in 7, 8 and 2 patients respectively, with 52.9% and 29.4% with cN+ and cM+ disease. Median estimated blood loss was 200 ml, with 1 patient requiring intra-operative blood transfusion. Median hospital stay was 7 days. A total of 3 and 2 patients were re-hospitalized during the first 30 and 30–90 post-operative days, respectively. One major Clavien grade complication was recorded. At median follow-up of 8 months, 9 and 2 patients succumbed due to tumor progression and other causes. Pre-operative and post-operative FACT-BL scores improved significantly in each domain. Conclusions A RARC is a safe and feasible technique which could be offered as part of palliative care in patients with advanced BC or comorbidities. Precise guidelines for palliating BC patients should be better.

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“…Treatment of diversion stones typically involves endoscopic procedures as this is currently considered the safest method compared to open surgical procedures. However, a large stone will require extensive manipulation in the urethra, possibly jeopardizing the sphincter [ 7 ]. For this reason, others have described great success with endoscopic percutaneous cystolithotomy and adopted this approach as their preferred technique [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Robotic-Assisted Cystolithotomy in a Complicated Urinary Diversion: A Feasible and Safe Approach

Haffar

Crigger

Trump

et al. 2021

Case Reports in Urology

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Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.

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Management of neobladder complications: endoscopy comes first

Abstract: Endourological management of orthotopic neobladder problems is the safest choice. It avoids the difficulties and complications of open surgery and has durable results.

Cited by 11 publications

References 24 publications

Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience

Minimally Invasive Robotic-Assisted Cystolithotomy in a Complicated Urinary Diversion: A Feasible and Safe Approach

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