Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

The learning curve of retroperitoneoscopic urologic surgery: A systematic review

INTRODUCTION@#Retroperitoneal laparoscopic (RPL) urologic surgery offers comparable surgical and functional outcomes to the traditional transperitoneal approach, with the advantage of circumventing the need to enter the intraabdominal space. This precludes the necessity to encounter small intestinal and colonic segments, encounter abdominal adhesions, and mobilize adjacent organs, translating to better peri-operative and post-operative conditions. However, RPL demands a strong knowledge of the retroperitoneal anatomy coupled with a level of laparoscopic dexterity, this results in a steep learning curve. Unfortunately, the evidence on the learning curve for RPL is diverse and scarce. The aim of this systematic review was to consolidate the available literature and determine the minimum required number of cases to efficiently and safely perform RPL.@*METHODS@#This is a systematic review of the literature via PubMed, EBSCO and Science Direct of all studies published since 2000 to 2019. The search was conducted by combining the following terms, “Retroperitoneoscopy”, “Retroperitoneoscopic”, “posterior laparoscopy”, “Learning”, “Nephrectomy”, “Adrenalectomy”, and “Ureterolithotomy”. Outcomes of interest were learning curve, mean operative time, mean intra-operative blood loss and mean hospital stay.@*RESULTS@#After the screening phase and application of the eligibility and exclusion criteria, the review included a total of 6 studies on the learning curve for RPL. The learning curve for retroperitoneoscopic adrenalectomy was 40 cases and 24 to 42 cases, based on the evidence from Uitert, et al. (2016) and Vrielink, et al. (2017), respectively. For retroperitoneoscopic nephrectomy, the minimum required number of cases is 30 – 70, based on the studies by Pal, et al. (2017), Zhu, et al. (2018) and Tokodai, et al. (2013). Ercil, et al. (2014) demonstrated the learning curve for retroperitoneoscpic ureterolithotomy to be at 30 cases. Review of each literature showed that completion of the learning curves translated to better peri-operative and post-operative conditions (i.e. shorter operative time, lesser intra-operative blood loss, shorter hospital stay). Overall, the evidence in this review suggests that for posterior retroperitoneal laparoscopy, a mean learning curve of 31 to 56 cases is required to safely and efficiently perform the procedure. @*CONCLUSION@#Retroperitoneal laparoscopic surgery is a valid alternative to the traditional transperitoneal approach. It offers comparable anatomic and functional results, albeit better peri-operative and post-operative outcomes. However, its performance requires a strong knowledge and familiarity of working within the retroperitoneum which can be achieved through progressive experience in RPL. The evidence consolidated by this review suggests a learning curve of 31 to 56 cases prior to effectively performing the procedure.

Cambios fisiológicos y consideraciones anestésicas en cirugía robótica no cardíaca / Physiological changes and anaesthetic considerations in non-cardiac robotic surgery

Resumen: La cirugía robótica ofrece numerosas ventajas sobre la cirugía laparoscópica convencional y la cirugía abierta. El anestesiólogo debe conocer los cambios que suceden en el paciente al ser sometido a cirugía robótica en el campo de la ginecología, urología, cirugía general, torácica y transoral. Los cambios fisiológicos son múltiples e involucran todos los sistemas: cardiovascular, respiratorio, neurológico, digestivo, renal; por lo que es de suma importancia el conocimiento de éstos para evitar complicaciones durante el período perioperatorio. De igual manera, es importante conocer el protocolo de seguridad para el retiro de los brazos del robot al verse con la necesidad de convertir la cirugía a laparoscópica o abierta. Se resumen las principales consideraciones anestésicas así como los cuidados específicos que el anestesiólogo debe tener durante cirugía robótica no cardíaca.

Abstract: Robotic surgery offers numerous advantages over conventional laparoscopic or open surgery. The anesthesiologist must have full knowledge of the physiological changes that happen when the patient undergoes robotic surgery; it being gynecological, urological, general surgery, thoracic or trans-oral surgery. There are multiple changes during robotic surgery involving the cardiovascular, respiratory, neurologic, digestive and renal systems. It is of utter importance the full knowledge of these changes in order to avoid complications during and after surgery. Also, it is important to fully know the emergency protocol for undocking if need be, to convert to laparoscopic or open surgery. We have summarized the main anesthetic considerations as well as the key points of care anesthesiologists must have during non-cardiac robotic surgery.

Anesthetic management of a patient with multiple sclerosis - case report / Controle anestésico de paciente com esclerose múltipla - relato de caso

Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

Resumo Justificativa e objetivos: Esclerose múltipla é doença desmielinizante do cérebro e da medula espinhal, caracterizada por fraqueza muscular, disfunção cognitiva, perda da memória, alterações de personalidade. Fatores que promovem exacerbação da doença são estresse, trauma físico, infecções, cirurgias, hipertermia. O objetivo é descrever a abordagem anestésica de um caso encaminhado a cirurgia urológica. Relato de caso: Paciente do sexo feminino, 44 anos, portadora de esclerose múltipla, com o diagnóstico de nefrolitíase, é encaminhada a ureterolitotripsia endoscópica. Optou-se por anestesia geral balanceada com midazolam, propofol e remifentanil em infusão alvo-controlada, sevoflurano sob máscara laríngea e ventilação espontânea. Tendo apresentado dificuldade ventilatória por tórax rígido, optou-se por interromper a infusão de remifentanil. Não se registraram outras intercorrências nem exacerbação da doença no pós-operatório. Conclusão: O uso de bloqueadores neuromusculares (tanto despolarizantes como não-despolarizantes) constitui um problema nestes pacientes. Como não havia necessidade de relaxamento muscular neste caso, eles foram omitidos. Concluímos que a associação de propofol e sevoflurano foi satisfatória, não resultando em instabilidade hemodinâmica nem exacerbação da doença.

Comparisons of combined spinal-epidural anesthesia in different puncture of gaps in urologic surgery anesthesia / 中国基层医药

Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter (each group had 54 cases).Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia (t =2.73,2.29,2.29,all P ＜ 0.05),the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing (24.1％,14.8％),was significantly lower than incidence of group A (44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05) the set of initial plane of anesthesia of group a was significantly higher than that of group B (t =2.91,P ＜ 0.05),the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B (t =2.42,P ＜ 0.05) the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A (t =2.61,P ＜ 0.05).There were no significant differences in the anesthesia quality rate (P ＞ 0.05).Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in initial level of anesthesia,the time the drug arrive to the sixth thoracic vertebrae and additional lidocaine doses,leading no effects on superior rate of anesthesia.Thus the clinical significance is not very big.

Analysis and prevention of pulmonary embolism after urologic surgery / 中国综合临床

Objective To analyze the clinical features of pulmonary embolism(PE) after urologic surgery in order to provide the theory base for preventing pulmonary embolism Methods CNKI database was used to look for our subjects who were with PE after urologic surgery from January 2005 to December 2011.Ten cases were selected.Three related patients simultaneously in Xuancheng Central Hospital were also recruited as our subjects.The information of diagnosis and treatment information and clinical features were collected.Results Among the 13 patients,3 were women and 10 were men with confirmed PE.Their age ranged from 48 to 79 years old and the average was 61.Among the 13 patients,2 conducted routine surgery,and the other 11 conducted mini-invasion operation.The 13 patients underwent PE from 2 to 18 days after urologic surgery and 7 patients (53.85％) died of PE.Conclusion No specificity of clinical feature for PE was found to contribute to cure rate.Early diagnosis and prevention of PE are important,and anticoagulant treatment and immediate thrombolytic are critical.

Application and innovation of urological laparoendoscopic single-site surgery in China / 中华泌尿外科杂志

Objective　To evaluate the status of urological laparoendoscopic single-site surgery (LESS) technique in China.　Methods　We had conducted a systematic review of literatures of urological laparoendoscopic single-site surgery published from Chinese institutions using WanFang,CNKI,VIP,CBM,GoogleScholar and MEDLINE databases.All relevant articles were selected with consensus and analyzed according to the inclusion and exclusion criteria.　Results　Overall,205 articles from 66 different centers all over China published between January 2009 and June 2012 were included in the analysis. Of which,there were 26 articles of science citation index papers and 179 articles from Chinese academic journals.The included literature was mainly composed of case series reports ( 133 articles,64.9％ ),comparison studies (13 articles,6.3％ ),reviews or comments (20 papers,9.8％ ),nursing related papers (28 pieces,13.7％ ),animal surgery studies (6 articles,2.9％ ),and training (5 articles,2.4％ ).A total of 1790 clinical cases were reported during the study period,56.9％ of these were procedures done in the upper urinary tract,only 5.8％ were in the lower urinary tract,and 37.3％ were genital or other procedures.Procedures of tumor-related and reconstruction required accounted for 18.8％ and 18.7％,respectively.Pure single-port technique was applied on 58.3％ of cases.In cases of a single-port platform used,45.6％ used the commercially available devices and 54.4％ used homemade devices.Transperitoneal accesses were adopted in 59.5％ of cases and the other 40.5％ were performed through extraperitoneal approaches.The umbilicus was used as the site of access in 58.5％ of cases.A total of 25 indications were reported,including adrenalectomy,nephrectomy and ureterolithotomy,etc. in the upper urinary tract,radical cystectomy,radical prostatectomy and transvesical enucleation of the prostate,etc.in the lower urinary tract,and varicocelectomy,orchidopexy and others. The three most often done procedures were varicocelectomy (601　cases,33.6％ ),renal cyst decortication (408 cases,22.8％ ) and adrenalectomy ( 179 cases,10.0％ ).The overall conversion rate was 5.5％,and complications were encountered in 3.4％ of cases.　Conclusions Laparoendoscopic single-site surgery has been widely adopted by Chinese urologists and largely covered the spectrum of conventional urologic laparoscopic procedures,with most of these being non-reconstructive operations for the treatment of benign diseases.In large,we are still under the initial stage of LESS application in urology.And more work on creative innovation and well-designed studies are needed to further evaluate its role in the urological minimally invasive surgery.

Analysis of cumulative series of laparoendoscopic single-site surgery in urology : with 209 consecutive cases report / 中华泌尿外科杂志

Objective　To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization.　Methods　Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted.　Results　There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％　cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy).　Conclusions　A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first.

Accuracy of the epidural catheter position during the lumbar approach in infants and children: a comparison among L2-3, L3-4, and L4-5 approaches / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the accuracy of the position of the epidural catheter inserted from three different lumbar intervertebral spaces, L2-3, L3-4, and L4-5, in infants and children. METHODS: Seventy-five children were randomly allocated to 3 groups according to the epidural catheter insertion site (L2-3, L3-4, and L4-5). The epidural catheter tip was identified using 50% diluted Iohexol and fluoroscopy. The incidence of correct position was compared among the groups and between infants and children. RESULTS: The incidence of correct position was significantly higher in the L2-3 group as compared to the L3-4 and L4-5 groups (P = 0.023 and P = 0.046 respectively). The incidence of correct position was higher in infants compared to children (P = 0.017). CONCLUSIONS: The L2-3 intervertebral space is preferable during epidural catheter insertion in children older than 1 year, but a low lumbar level should be considered in infants because they have a higher risk of neural damage.

Studies of Cognitive Dysfunction and Depression in Urologic Patients Aged 75 Years or Older, Pre and Post-operative Assessment / 대한비뇨기과학회지

PURPOSE: Cognitive impairment and psychiatric symptoms are relatively common in the elderly people. Recognizing them is important and mental status assessment may be needed for elderly patients to establish their competence for making a will, or for giving informed consent for procedure. We investigated the incidence of depression and cognitive dysfunction in geriatric patients undergoing surgery pre and postoperatively. MATERIALS AND METHODS: A total of 50 patients 75 to 97 years old(mean age 80.5) were included in the study. Of the 50 patients 36 had benign prostatic hyperplasia, 5 prostate cancer and 9 had bladder tumor. We obtained questionnaires from 50 patients undergoing operation pre and postoperatively. We used two forms of questionnaires, Short Portable Mental Status Questionnaire(SPMSQ) and short version of Geriatric Depression Scale(GDS). RESULTS: Pre and postoperative mean score of GDS was 8.8 and 8.4, respectively. Pre and postoperative mean error of SPMSQ was 0.9 and 0.6, respectively. The incidence of depression and cognitive dysfunction was 80.0%(40/50 patients) and 14.0%(7/50 patients), respectively. Of 7 patients with cognitive dysfunction, 6 patients revealed delirium but remaining one was difficult to differentiate delirium from dementia until discharge. Patients with depression increased(from 40 to 41 patients) postoperatively. In contrast, patients with cognitive dysfunction decreased(from 7 to 2 patients) at discharge. CONCLUSIONS: A screening assessment of depression and cognitive function is recommended before and after urologic surgery of elderly patients to predict prolonged hospitalization, functional dependency and legal problems.

Use of the Isolated Segments of Intestines in Urologic Surgery / 대한비뇨기과학회지

In the field of urological surgery, the use of bowel has been established as a method of urinary diversion or reconstruction of urinary tract since ileal conduit was settled by Bricker in 1950. 14 cases of urinary diversion or reconstruction with the use of intestinal segments were performed on the patients admitted to the Department of Urology in Jeonbug National University Hospital in last three years. The results were as follows. 1. The age distribution was from 3rd to 7Ih decade and 9 cases were male and 5 cases were female. 2. The patients were consisted of 7 cases of bladder cancer, 4 cases at contracted bladder due to tuberculosis and I case of vesicovaginal fistula, congenital UPJ stricture and tuberculous UVJ stricture with tuberculous cystitis. 3. In operation, ileal conduit for 4 cases of bladder tumor and 1 case of vesicovaginal fistula, sigmoid conduit for 3 cases of bladder tumor, ileocecal cystoplasty for 2 cases of contracted bladder due to tuberculosis and 1 case of tuberculous UVJ stricture, sigmoid cystoplasty for 2 cases of contracted bladder due to tuberculosis and ileal ureter for 1 case of congenital UPJ stricture. Accompanying ileal conduit and sigmoid conduit for bladder tumor total cystectomy was performed in all cases. 4. The postoperative complications included wound infection, urine leakage, evisceration, prolonged ileus, pyelonephritis and pelvioileal stricture. Operative mortality was 7.2%. 5. After ileocecal and sigmoid cystoplasty for contracted bladder the interval of urination was prolonged to 2 hours or more at 3 months after operation. 6. Antireflux procedure was performed in total 6 cases including 3 cases of sigmoid conduit and 3 cases of ileocecal cystoplasty.

A Clinical Observation on 30 Cases of Urologic Surgery Using the Intestinal Segments / 대한비뇨기과학회지

A clinical observation was made on 30 patients of urologic surgery using the intestinal segment who had been admitted to the Department of Urology, Chungnam National University Hospital from May, 1976 to April, 1982. The results are as follows; 1. The age distribution of the most of cases were fifth and sixth decades (66.7%), and the male to female ratio was 3.3 to 1. 2. Majority of underlying diseases was bladder tumor (76.6%). The other causes were neurogenic bladder (10.0%), Vesicovaginal fistula (10.0%) and contracted bladder (3.3%). 3. Of the 30 cases of urinary diversion, 24 cases were ureteroileocutaneostomy with or without total cystectomy, 3 cases were ureterocolocutaneostomy with total cystectomy, 2 cases were ureteroileocecocutaneostomy with total cystectomy and 1 case was augmented ileocecocystoplasty. 4. Operation mortality was 10%, in which underlying diseases were bladder cancer. 5. Major complications were acute renal failure, septicemia, wound disruption, urine leakage, fecal fistula, ileus, bleeding, pneumonia and evisceration. 6. In the 23 cases of bladder cancer 21 cases were transitional cell carcinoma and 2 cases were adenocarcinoma. Most of the former were composed of stage B & C (66.7%) and grade II & III (71.4%). 7. In cases of malignant disease the overall postoperative survival rate at 1, 3 and 5 years of bladder cancer were 73.9%, 50% and 20% respectively.

Clinical Observation on Use of Isolated Segments of Intestines in Urological Surgery / 대한비뇨기과학회지

Clinical observation was performed on 11 patients of urinary diversion and 6 patients of remodeling of the urinary tract using isolated segments of intestines from April. 1968 to April, 1976 in the Department of Urology. Chonnam University Medical School. 1. The age was distributed from 25 years to 67 years and the most of cases (47%) were found over the fifties. 2. Among the 17 cases, 14 were male and 3 were female with the ratio of 4.7: 1. S. Majority of etiologic disease was bladder tumor (70.5%). The other causes were left renal tuberculosis with contracted bladder (11.8%). prostatic cancer (5.9%), urethral cancer with vesicovaginal fistula (5.9%) and bilateral ureteral obstruction due to cervical cancer (5.9%). 4. The methods of urinary diversion were as follows; ileal conduit in 8 cases and rectal bladder in 3 cases. The methods of remodeling of the urinary tract were as follows; sigmoidocystoplasty in 2 cases, ureterosigmoidourethrostomy in 2 cases. ureteroileourethrostomy in 1 case and ureteroileocystostomy in 1 case. 5. Complication was followed as conduit bleeding, urinary leakage and paralytic ileus, ureteroileal stenosis and hiccough, wound disruption and advanced uremia and acidosis (death) in 5 cases.

Use of Ileum for Urologic Surgery: 1 Clinical Review on 11 Cases / 대한비뇨기과학회지

The operations using ileum in 11 patients during the period from Nov. 1971 to Oct. 1973 in the Department of Urology, National Medical Center were performed for urinary diversion in 9 patients and ileocystoplasty in 2 patients. 1) The age distributions in cases of urinary diversion showed more than 50 years of age who had malignant disease except a I4 year old boy suffered from traumatic urethral stricture with fistula and in cases of ileocystoplasty were more younger. 2) Ureteroileocutaneostomy with total cystectomy, vesicoileocutaneostomy with urethrectomy, simple vesicoileocutaneostomy and ileocystoplasty were the method of operations. 3) Ureteroileal anastomoses by conjoining the spatulated ureters with suturing to the opened proximal end of the ileal segment were accomplished. 4) There was an operative death who was expired on the 3rd postoperative day due to acute renal failure. 5) We experienced 3 cases of technical failures which were corrected immediately during operations; a case of poor blood supply in the site of ileoileostomy, a case of antiperiataltic ureteroilealanastomosis and a case of ileal segmentalnecrosis. 6) The early complications were wound infection(6 cases), acute pyelonephritis(a cases) and intestinal obstruction(a case).