ABSTRACT
Objectives: to evaluate the efficacy and outcome of continent cutanuous urinary diversion using the extramural serous lined tunnel [CCD] and compare it with the standard ileal conduit procedure [ICD] after radical cystectomy due to bladder cancer
Patients and Methods: Between 1998 and 2002, 68 patients were underwent radical cystectomy and were not candidates for orthotopic diversion. Of these patients, 24 underwent CCD as described by Abo-Enein and Ghoneim in 1995 and 44 patients underwent ICD. Outcome analysis included operative time, hospital stay, early postoperative complications, quality of life and cosmetic appearance
Results: Overall, mean age at surgery and follow up was 55, 3 years, respectively. Mean operative time was 8.3 and 6.8 hours for CCD and ICD, respectively. Sixty cm of ileum was used to fashion the CCD pouch compared to 1520 cm used in ICD. Mean capacity of the pouch was 450 in CCD. Of CCD patients, 23 were continent and only one patient had cutaneous incontinence, one had stoma1 stenosis and one had pouchoureteral reflux associated with continence. Serum creatinine, Na, K acid acid-base profile were within normal. Most of the patients had better quality of life than ICD group. Eady postoperative complications were comparable. No intraoperative or postoperative mortality was encountered
Conclusion: Continent Cutaneous diversion is technkally feasible, aapplnce free, applicable for urinary diversion with low complication rate and good quality of life with cosmetically accepted stoma for this selected group of patients. It is considered an alfemative diversion when orthotopic type is not feasible
ABSTRACT
Objectives: To analyze the efficacy and outcome of extravesical [EUR] and intravesical ureteral re-implantation [IR] techniques in primary and secondary vesicoureteral reflux [VUR] in children
Patients and Methods: Between 1997 and 2000, 218 patients [339 ureters] admitted to the Hospital for Sick Children, Toronto, Canada, underwent ureteral reimplantation. The patients were stratified into four groups: primary or secondary VUR and EUR or IR. We analyzed the success rates, contralateral VUR, postoperative retention, de-novo hydronephrosis and surgical complications
Results: The mean age at presentation and surgery was 2.5 [birth-12 years] and 5.5 [1-19 years] years, respectively. Mean followup was 15 months. Hospital stay was 2.3 and 4.2 days for EUR and IR, respectively. In primary VUR, 147 patients [235 ureters] underwent EUR and 6 [12 ureters] IR. Success rates were 94.5% and 91.7% at 3 months, and 97.3% and 91.7% at 15 months, respectively. In secondary VUR, 41 [56 ureters] and 24 patients [36 ureters] had EUR and IR, respectively; the success rates were 93% and 88.9% at 3 months and, 98.2% and 91. 7% at 15 months, respectively [p=ns]. Contralateral VUR was detected in 11.8% after EUR and de-novo hydronephrosis in 14.2% and 28.6% in both groups, respectively. Six patients had retention after bilateral EUR and one after bilateral IR
Conclusion: Both the extravesical and intravesical re-implantation methods yield excellent results in the treatment of vesicoureteral reflux. However, the easy application of the extravesical approach, its high success rate in primary as well as secondary reflux, the brief hospital stay and the decrease in the urinary retention rate after bilateral surgery with technical improvements make it our preferred approach for open surgical repair in primary and secondary VUR