Perioperative and long-term surgical complications for the Indiana pouch and similar continent catheterizable urinary diversions

Myers, Jeremy B.; Lenherr, Sara

doi:10.1097/mou.0000000000000300

Cited by 13 publications

(4 citation statements)

References 23 publications

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“…[6] Myers et al had reported that perioperative complications after Indiana pouch creation or similar continent diversion may be complicated by wound infection (12%–33%), bowel leakage (1%–6%), and ureteral stricture (1%–21%). [7] However, internal herniation caused by ureteral adhesion is extremely rare. We report the first case, to our knowledge, of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after the procedure of robot-assisted radical cystectomy (RARC).…”

Section: Introductionmentioning

confidence: 99%

Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion

Tsai

Li²,

Chen³

et al. 2019

Medicine

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Rationale:Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC).Patient concerns:A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit.Diagnosis:Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion.Interventions:The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found.Outcomes:Both patients recovered smoothly after second operation.Lessons:The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.

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Section: Introductionmentioning

confidence: 99%

Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion

Tsai

Li²,

Chen³

et al. 2019

Medicine

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show abstract

Section: Introductionmentioning

confidence: 99%

“…16 Each of the procedures have risk of infection, strictures, retention, fistulas, and other complications that vary by both the procedure type as well as between individual studies; thus, comparisons between the procedures are difficult to make. 17,18 We sought to evaluate methods for predicting complications as well as identifying operative parameters related to complications in patients older than 75 years undergoing cystectomy. Patients were treated at two large academic institutions and preoperative risk scores were measured using Eastern Cooperative Oncology Group (ECOG) Scores and ASA Physical Status Classification System.…”

Section: Introductionmentioning

confidence: 99%

Elderly patients undergoing cystectomy, comparing preoperative American Society of Anesthesiology and Eastern Cooperative Oncology Group scores and operative approaches

et al. 2019

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Objective: To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions. Methods: In total, 212 patients aged 75–95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. The rates of Grade 3 Clavien-Dindo complications and above were also compared by urinary diversion type. Logistic regression was used to control for source institution. Results: In total, 199 cases were included in the primary analysis. Neither of the preoperative scoring systems were predictive for identification of radical cystectomy patients with ⩾Grade 3 Clavien-Dindo complications. In secondary analysis (n = 212, including partial cystectomy), none of the urinary diversion types associated with radical cystectomy had a significantly different rate of complications. However, partial cystectomy (n = 13) had a significantly lower rate of complications. Conclusion: Complication rates among elderly patients undergoing cystectomy for muscle invasive bladder cancer were very high. For patients who are approved for surgery after the history and physical exam, none of our objective metrics adequately predicted operative risk. A unique diversion procedure described by the Bolzano group, uretero-ureterocutaneostomy, had equivalent complication rates to the more common diversion procedures. It also appears based on outcomes in this cohort that partial cystectomy is a particularly favorable option within the elderly population in terms of perioperative morbidity.

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“…Meyers et al conducted a comprehensive literature review focusing on the long‐term surgical risks associated with right colon continent urinary diversions and concluded that despite a risk of reoperation of up to 69%, such rates are considered acceptable given the generally satisfactory functional outcomes 12 . Similarly, in the study by Nieuwenhuizen et al the reported continence rates were excellent with a remarkable 96% daytime continence rate 9 .…”

Section: Discussionmentioning

confidence: 99%

Very long‐term follow‐up of Indiana Pouches proves durability

Polm,

Wyndaele,

de Kort

2023

Neurourology and Urodynamics

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IntroductionAn Indiana Pouch (IP) is a heterotopic, continent, urinary diversion from an ileocolonic segment. Numerous studies have investigated its long‐term outcomes, albeit none extending beyond a 5‐year follow‐up period. IPs can be used as urinary diversion for benign indications and as such are constructed in typically young patients. As a consequence of their extended lifespan, there is a need for very long‐term (>5 years) IP outcome data and comprehensive complication analysis.Materials and MethodsIn this retrospective cohort study, the data of all patients attending our academic functional urology tertiary referral center for surveillance between 2015 and 2022 after an earlier IP procedure without uro‐oncological indication were analyzed. The primary objective was to identify the prevalence of complications associated with IP, including stomal stenosis, ureter‐pouch stenosis, pouch calculi, stomal leakage, pouch perforation, and parastomal herniation, and to determine the time span between creation of the IP and occurrence of complications.ResultsA cohort of 33 patients (23 female) was analyzed. Median age at IP creation was 38 (range 5–62) years. Median follow‐up was 258 (range 24–452) months. During follow‐up, 22 (67%) patients underwent at least one surgical revision. In total, 45 revision procedures were performed. The estimated mean revision‐free survival was 198 (95%‐CI 144–242) months.ConclusionTwo‐thirds of our IP patients required surgical revision during very long‐term follow‐up. However, the mean revision‐free survival was 198 months. This establishes the IP as a durable and resilient option for urinary diversion, yet underlines the need for lifelong follow‐up as some of these complications and indication were subclinical. These results contribute significantly to patient counseling when discussing different options for urinary diversion, especially at a younger age.

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Perioperative and long-term surgical complications for the Indiana pouch and similar continent catheterizable urinary diversions

Cited by 13 publications

References 23 publications

Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion

Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion

Elderly patients undergoing cystectomy, comparing preoperative American Society of Anesthesiology and Eastern Cooperative Oncology Group scores and operative approaches

Very long‐term follow‐up of Indiana Pouches proves durability

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