ABSTRACT
ABSTRACT Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably influence how the patient accepts the new condition.
Subject(s)
Humans , Male , Female , Quality of Life/psychology , Urinary Diversion/rehabilitation , Cystectomy/rehabilitation , Time Factors , Urinary Diversion/methods , Urinary Diversion/psychology , Cystectomy/methods , Cystectomy/psychology , Surveys and Questionnaires/standards , Treatment OutcomeABSTRACT
Pacientes submetidos a radioterapia pélvica poderäo necessitar de derivaçöes urinárias, seja por recidiva local, estenose ureteral ou cistite actínica grave. A maioria das técnicas descritas para a confecçäo de reservatórios continentes exigem o emprego de segmentos íleocolônicos que sofrem igualmente os efeitos deletérios da irradiaçäo. Nesta situaçäo, o estômago tem sido nova opçäo primária. Os autores relatam dois casos em que houve falha no uso de tecido gástrico na reconstruçäo urinária pós-radioterapia, discutem uma proposta alternativa para resoluçäo desta situaçäo, aspectos técnicos envolvidos e os resultados iniciais
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gastric Stump/surgery , Urinary Diversion/rehabilitation , Pelvis/radiation effects , Plastic Surgery Procedures , Colectomy/rehabilitation , Gastrectomy/rehabilitationABSTRACT
En 47 pacientes a quienes se les efectuó un reservorio urinario continente, revisamos los estudios radiológicos realizados como control de su intervención quirúrgica. El radiólogo debe estar familiarizado con estas nuevas técnicas para efectuar una correcta evaluación posterior de ellas
Subject(s)
Humans , Child , Adolescent , Adult , Middle Aged , Urinary Diversion/methods , Urinary Bladder Diseases , Urinary Bladder, Neurogenic/surgery , Urinary Diversion/rehabilitation , Urinary Bladder , Urinary Bladder/surgeryABSTRACT
Os autores discorrem sobre a importância de um adequado atendimento à criança com derivaçäo intestinal ou urinária, analisando os principais tipos de "stomias" e a atuaçäo do pediatra junto à família do paciente "stomizado" - cuidados gerais, tratamento das complicaçöes mais freqüentes, orientaçäo dietética e terapêutica medicamentosa