Orthotopic Urinary Diversion

Ja, Freeman; Dg, Skinner

doi:10.1016/b978-1-4160-6911-9.00087-6

Cited by 15 publications

(7 citation statements)

References 213 publications

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“…The indications for voiding cystourethrogram in prenatal HN cases were based on physician discretion and included high grade HN (SFU III/IV), ureteral dilation and bladder abnormalities on ultrasound (large capacity and thickening of the wall). Our indications for surgery were in keeping with those described by Wein et al who state that surgery should be considered in the setting of symptoms or recurrent UTIs, progressive unremitting dilatation on ultrasound, differential renal function <40% and/or significant decreases in differential renal function of 5% or great on renal nuclear functional studies (9). Based on the institutional protocol, all patients with PM and high grade HN were initiated on continuous antibiotic prophylaxis (CAP) from birth until 12 months of age, except for 33 children whose CAP status was unknown due to concomitant enrollment in a randomized controlled trial (10).…”

Section: Methodssupporting

confidence: 74%

“…PM was defined as HN with ureteral dilation ≥ 7 mm, which was confirmed on postnatal ultrasound and absent VUR as documented by voiding cystourethrogram. This definition is in accordance with the Campbell-Walsh textbook, which states that megaureter is a descriptive term that denotes dilatation of the ureter that is 7 mm or greater, irrespective of cause (9). The indications for voiding cystourethrogram in prenatal HN cases were based on physician discretion and included high grade HN (SFU III/IV), ureteral dilation and bladder abnormalities on ultrasound (large capacity and thickening of the wall).…”

Section: Methodsmentioning

confidence: 86%

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Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Dekirmendjian

Braga

2019

Front. Pediatr.

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Background: The risk of febrile urinary tract infection (fUTI) in children with primary non-refluxing megaureter (PM) has been extensively studied in the literature, however, a paucity of information exists regarding risk factors for surgical intervention and spontaneous resolution. We sought to analyze data from our prospectively collected PM cohort to determine risk factors that would predict surgery and resolution in this population. Methods: Patients with PM were identified from our prospectively-collected prenatal hydronephrosis (HN) database from 2008 to 2017. Primary outcomes included surgical intervention and hydroureter resolution. Spontaneous resolution was defined as ureteral dilation <7 mm at last follow-up. Age at presentation, gender, development of fUTI, HN grade [low (SFU I/II) vs. high (SFU III/IV)], anteroposterior diameter (APD) measurements and ureteral diameter at baseline and last follow-up were recorded. Univariate and multivariable analyses (binary logistic and Cox regression) were performed. Results: Of 101 patients, 86 (85%) were male, and 80 (79%) had high grade HN. Median age at baseline and last follow-up were 2 (0–23) and 29 (2–107) months, respectively. Overall, 23 (23%) patients underwent surgery at a median age of 22 (3–35) months. Mean ureteral diameter was larger in surgical patients vs. those treated non-surgically (14 ± 4 vs.11 ± 3 mm; p < 0.01). Of the 78 (77%) non-surgical patients, 43(55%) showed resolution of their ureteral dilation at a median age of 24(4–56) months. Survival analysis demonstrated that 12 patients resolved by year 1, 22 by year 2, 30 by year 3, 40 by year 4, and 43 by year 5. However, when considering resolution as APD <10 mm, 62(79%) children resolved their HN by last follow-up (29 months). Univariate and multivariable analyses ( Table 1 ) revealed that high-grade HN at baseline, development of fUTI, and ureteric dilation ≥14 mm were significant risk factors for surgical intervention. Cox regression ( Figure 2 ) found that ureteral dilation <11 mm was the only independent risk factor significantly associated with PM resolution ( Table 2 ). Conclusion: Patients with PM and high-grade HN, as well as individuals with ureteral dilation ≥14 mm and fUTI were more likely to undergo surgical intervention. Ureteral dilation <11 mm was the only independent risk factor significantly associated with spontaneous resolution of PM.

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Section: Methodssupporting

confidence: 74%

Section: Methodsmentioning

confidence: 86%

Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Dekirmendjian

Braga

2019

Front. Pediatr.

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“…Evaluation of a larger cohort of patients with Studer pouches is warranted, especially given that the majority of neobladder reconstructions in the United States remain the Studer type. [2][3][4] In our experience the most challenging aspect of retrograde access in neobladders is localization of the ureteral orifice, which accounted for 42.1% of failed cases in our cohort, followed by cannulation of the orifice (31.6% of failures) and anatomical tortuosity (26.3% of failures). In patients with ureters implanted into an afferent limb, identification of the limb is crucial yet difficult, given the lack of landmarks and movement from bowel peristalsis.…”

Section: Discussionmentioning

confidence: 77%

“…Since the 1970s various neobladder designs have been described, with the Studer pouch being the most commonly used type in the United States. [2][3][4][5] The evaluation and treatment of upper tract abnormalities in patients with neobladder reconstructions are complicated by difficult retrograde access to the upper collecting system. Retrograde access to the neobladder chimney as well as identification and cannulation of the ureteroneobladder orifice pose challenges when performing endoscopy.…”

mentioning

confidence: 99%

Experience with 45 Consecutive Patients with Neobladders Undergoing Retrograde Ureteroscopy for Upper Tract Abnormalities

et al. 2015

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Introduction: In this study we reviewed the feasibility, technique, complications and outcomes of retrograde ureteroscopy in patients with orthotopic neobladders. Methods: We retrospectively reviewed our retrograde ureteroscopic experience in patients with orthotopic ileal neobladder diversions. Data were collected and analyzed regarding patient characteristics, indications, technique, success and complications of the procedure. Results: Between 1995 and 2013, 45 patients with neobladders underwent 77 retrograde ureteroscopy sessions on 97 renal units for filling defects (47 cases), urothelial thickening (9), calculi (4), positive cytology (27) and/or positive fluorescence in situ hybridization (15) on followup. The ureter and renal pelvis were successfully instrumented in 78 of 97 units (80.4%), with 85.3% success in Hautmann-type neobladders (75 renal units attempted), 50% in Studer-type neobladders (8 renal units attempted) and 71.4% in unascertained-type neobladders (14 renal units attempted). Causes of failure involved the inability to locate the ureteral orifice (8 cases), to cannulate the orifice (6 cases) or to advance the ureteroscope due to tortuosity (5 cases). Among the successful attempts with appropriately documented findings 35.9% of cases with filling defects (39) were confirmed malignant and 61.5% were confirmed benign by ureteroscopy. All cases with a positive cytology (23) and 85.7% of cases with positive fluorescence in situ hybridization (14) were confirmed malignant by retrograde ureteroscopy, and 2 of the 4 cases of calculi were successfully managed retrogradely. Conclusions: Retrograde ureteroscopic evaluation of upper tract abnormalities is feasible and practical in patients with orthotopic neobladders. Identification and cannulation of the ureteral orifice are challenging, particularly in tortuous situations, but difficulties can be overcome with fluoroscopic techniques. Retrograde ureteroscopy avoids the morbidity of percutaneous access with minimal complications.

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“…Bowel reconstruction to create a new bladder after cystectomy has been well described in the literature. 8 Neobladders are anastomosed to the native urethra to re-establish the integrity of the urinary tract and preserve urinary continence. This advanced reconstructive surgery aims to improve the patient's quality of life after cystectomy.…”

Section: Discussionmentioning

confidence: 99%