Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients

ABSTRACT Objective: To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. Materials and Methods: Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. Results: Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. Conclusions: The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.

Modified Wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion

ABSTRACT Purpose: To compare perioperative outcomes, complications and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy (RC) with modified Wallace anastomotic technique versus traditional ileal conduit. Materials and methods: Study enrolled 180 patients, of whom 140 were randomized and underwent RC; seventy were randomized to group I and the seventy to the group II. For the primary objective, we hypothesized that the rate of ureteroenteric strictures would be at least 20 % lower in the second group. Secondary end points included rate of anastomotic leak, surgical time, deterioration of the upper tract, intraoperative blood loss and patient-reported quality of life (HRQOL). The modified Wallace 1 technique involved eversion of the ureteral plate and bowel mucosa edges, which were anastomosed together in running fashion, while the outher anastomotic wall was augmented with sero-serosal interrupted sutures. Results: The mean (SD) follow-up time was 26.1 (5.7) months in group I and 25.2 (4.8) months in group II, during which, anastomotic stricture was observed in 8 patients (12%) from the first and 2 patients (3%) from the second group (p < 0.05). The anastomotic leakage rate was significantly higher in first group (17% vs. 8.5%, p< 0.05), while patient-reported HRQOL outcomes were similar between groups after the 12 month follow-up period. Conclusions: By using a modified Wallace technique, we were able to significantly lower anastomotic stricture and anastomotic leakage rates, which are major issues in minimizing both short- and long-term postoperative complications.

Discrimination of different body structure indexes of elite athletes in combat sports measured by multi frequency bioimpedance method / Discriminación de diferentes índices de estructura corporal de atletas de elite en deportes de combate medidos por el método de bioimpedancia de múltiples frecuencias

In order to achieve high results in sports, it is necessary to provide an adequate status of an athlete in according to various factors, among which the body structure is one of greater importance. The aim of this research is to define the most discriminated indicators of body structure indexes, thanks to which a specific change of physical structure can be observed according to a branch of sport and type of combat sport. Variables in the research were: body height, body mass, body mass index, free fat mass index, fat mass index, protein mass index, skeletal muscle mass index, percent of body fat, percent of skeletal muscle mass and protein fat index. The measuring of the body composition is realized by using multichannel segmental bioimpedance with InBody 720 apparatus, applied on the total of 112 male high level senior-age athlete members of different national team's member of Republic of Serbia (62 judokas, 29 Greco-Roman style wrestlers and 21 karatekas). The discriminative analysis has shown that subsamples of the athletes statistically differ in morphology on Wilks' lambda level (0.435, p = 0.000), and that following variables have the highest discrimination compared to athlete respondents in sport function: percent of skeletal mass (0.34), percent of body fat (0.28) and protein fat index (0.26), as the first isolated factor (p = 0.000) by which is explained 86.3 %, that is body weight (0.74), skeletal muscle index (0.73), protein mass index (0.72), body mass index (0.72) and free fat mass index (0.70), as the second factor (p = 0.030) by which 13.7 % variability of measured body structure space is explained. By establishing body structure models of judokas, wrestlers and karatekas for variables examined and by using modern technological method of measuring (InBody 720, 2008) we got new information that characterize specificity of the sport, which all contribute to spreading and improving already existing knowledge in the sports sciences and sport body morphology area.

Para obtener logros deportivos de alto nivel, es necesario conseguir el estatus adecuado dependiendo de varios factores, entre los cuales destaca el factor morfológico. El objetivo de este estudio fue definir los indicadores más discriminantes de la composición corporal o índices morfológicos, por lo cual se puedan monitorear los cambios específicos en la estructura del cuerpo en relación con la rama del deporte y el tipo de deportes de combate. Las variables del estudio fueron: altura del cuerpo, masa corporal, índice de masa corporal, índice de masa grasa, índice de proteína masa, índice de masa del músculo esquelético, porcentaje de grasa corporal, porcentaje de masa del músculo esquelético y el índice grasa proteína. La medición de la composición corporal fue realizada utilizando la bioimpedancia segmentaria multicanal con Inbod café 720 sobre una muestra de 112 deportistas de sexo masculino de categoría sénior, miembros nacionales seleccionados de la República de Serbia (62 practicantes de judo, 29 practicantes de lucha grecorromana y 21 practicantes de karate). El análisis discriminativo demostó que las submuestras de los atletas en general difieren significativamente en la morfología a nivel de lambda de Wilks ­ 0.435, (p = 0.000), y que las siguientes variables tienen la mayor discriminación en relación con la prueba de los atletas en la función del deporte: porcentaje de la masa esquelética (0.34), porcentaje de grasa corporal (0,28) y el índice de grasa proteína (0.26), como el primer factor aislado (p = 0.000), lo que explica 86,3 %, respectivamente la masa corporal (0.74), el índice de músculo esquelético (0,73), el índice de proteína de masa (0,72), índice de masa corporal (0,72), e índice de masa libre de grasa (0,70), como el segundo factor (p = 0,030), lo que explica 13,7 % de las mediciones espaciales de variabilidad. Al definir los módulos morfológicos de los practicantes de judo, karate y lucha grecorromana para las variables investigadas y usando el método tecnológico de medida más nuevo (InBody 720), hemos obtenido nuevas informaciones que caracterizan las especificidades de los deportes, lo que contribuye a la ampliación y el desarrollo de los conocimientos anteriores sobre dicho asunto.