ABSTRACT
Urothelial malignancies are frequently encountered among elderly persons. Host susceptibility and the presence of urothelial carcinogens are of primary importance in the development of these cancers. The natural history of these cancers produces a spectrum of disease processes with varying tendencies regarding invasion, spread, and multicentric origin. Consequently, a multitude of treatment options exist for the clinician and patient dealing with urothelial tumors. Essential to the reduction of morbidity and mortality attributable to these malignancies is the elimination of known risk factors, coupled with prompt diagnosis and treatment. Finally, the high propensity for these tumors to recur necessitates an aggressive cancer surveillance program in the patient population at risk.
Subject(s)
Carcinoma, Transitional Cell , Urologic Neoplasms , Aged , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/etiology , Carcinoma, Transitional Cell/therapy , Female , Humans , Male , Nurse Clinicians , Prognosis , Urinary Diversion/nursing , Urologic Neoplasms/diagnosis , Urologic Neoplasms/etiology , Urologic Neoplasms/therapyABSTRACT
With the increasing incidence of bladder cancer, many different operations have been devised to reconstruct the lower urinary tract in a continent fashion. The incontinent type of urinary reservoir (ileal conduit) has been a surgical preference for many years. However, the continent urinary reservoir (CUR), neobladder, and rectal bladder offer the capable and motivated patient an alternative to an incontinent permanent stoma. Nursing management of patients requiring diversional surgery requires continual updating of these specialized surgical procedures and unique aspects of care.
Subject(s)
Urinary Reservoirs, Continent/nursing , Adult , Child , Female , Genital Neoplasms, Male/surgery , Humans , Male , Patient Education as Topic , Postoperative Care , Preoperative Care , Self Care , Urinary Reservoirs, Continent/instrumentation , Urinary Reservoirs, Continent/methodsABSTRACT
The modified continent Indiana pouch is based upon the terminal 8 to 12 cm. of ileum and 26 to 30 cm. of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27 to 85 years) with followup ranging between 3 and 24 months. There have been 5 hospitalizations for urinary tract infections or gastrointestinal complications. Open surgical revision (4%) has been necessary for incontinence in 1 case, for a redundant ileal limb and difficult catheterization in 1, and for ureteral stenosis in the mid portion of the left ureter in 1. A revision procedure is pending for inadequate reservoir volume. Endoscopic meatotomy of ureterocolonic junction strictures has been necessary in 2 cases. All patients are continent day and night with easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate, and an excellent continence rate.
Subject(s)
Urinary Diversion/methods , Adult , Aged , Aged, 80 and over , Colon/surgery , Colonic Neoplasms/complications , Female , Genital Diseases, Male/complications , Humans , Ileum/surgery , Male , Middle Aged , Reoperation , Ureteral Obstruction/surgery , Urinary Catheterization , Urinary Incontinence/etiology , Urinary Incontinence/physiopathology , Urinary Incontinence/surgery , Urodynamics/physiology , Uterine Cervical Neoplasms/complicationsABSTRACT
The modified continent Indiana pouch is based upon the terminal 8-12 cm of ileum and 26-28 cm of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple, and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27-85 years) with follow-up ranging between 3-24 months. There have been five hospitalizations for urinary tract infections or gastrointestinal complications. Three open surgical revisions (4%) have been necessary: one for incontinence, one for a redundant ileal limb and difficult catheterization and one for ureteral stenosis in the mid-portion of the left ureter. One revision is pending for inadequate reservoir volume. Two endoscopic meatotomies of ureterocolonic junction strictures have been necessary. All patients are continent day and night, enjoy easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate and an excellent continence rate.
Subject(s)
Colon/surgery , Ileum/surgery , Urinary Diversion/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Complications/surgery , Reoperation , Ureter/surgery , Urinary Diversion/adverse effectsABSTRACT
Between July 1986 and July 1988, 55 urinary diversion procedures were performed: 18 ileal conduits, 12 Kock pouches and 25 Indiana pouches. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function, and short-term followup including re-hospitalizations, revisions, and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch patients. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit was 5:27 hours and 1290 cc's versus 5:30 hours and 1201 cc's for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all three groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no re-hospitalizations or revisions; the Indiana pouch group had four re-hospitalizations and no revisions; the Kock pouch group had nine re-hospitalizations and three revisions. The day and night-time continence rate was 100% in both the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, has similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be just as safely and effectively accomplished in any patient requiring an ileal conduit.
Subject(s)
Urinary Diversion/methods , Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Postoperative Complications/etiologyABSTRACT
Six patients underwent translumbar amputation (TLA), a life-saving procedure, after standard modalities of therapy failed to control the progression of the disease. The primary diagnoses were as follows: pelvic arterial-venous (A-V) malformation, 1; sacral chordoma, 3; giant cell tumor of the sacrum, 1; and paraplegia with squamous cell cancer arising in intractable decubitus, 1. There were no operative deaths. The following postoperative complications developed in five patients: urinary fistulae, 2; small bowel obstruction, 1; intraabdominal bleeding, 1; hypertension, 2; small bowel fistula, 1; and dehiscence of skin closure, 1. Two patients died with distant metastases (24 months) and distant metastases with local recurrence (6 months). The remaining four patients were alive and well 72, 56, 48, and 18 months after the surgical procedure. All of these patients have reached the rehabilitation goals.
Subject(s)
Amputation, Surgical , Lumbar Vertebrae , Adolescent , Adult , Amputation, Surgical/methods , Amputation, Surgical/rehabilitation , Anesthesia, General , Arteriovenous Malformations/surgery , Chordoma/surgery , Female , Giant Cell Tumors/surgery , Humans , Male , Middle Aged , Ostomy , Paraplegia/surgery , Pelvic Neoplasms/surgery , Pelvis/blood supply , Physical Therapy Modalities , Pressure Ulcer/surgery , Prostheses and Implants , Spinal Canal/surgery , Spinal Neoplasms/surgeryABSTRACT
Between July 1986 and July 1988, 55 urinary diversions were performed, including 18 ileal conduits, and 12 Kock and 25 Indiana pouch procedures. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function and short-term followup, including rehospitalizations, revisions and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch groups. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit were 5 hours 27 minutes and 1,290 cc versus 5 hours 30 minutes and 1,201 cc for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all 3 groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no rehospitalizations or revisions, the Indiana pouch group had 4 rehospitalizations and no revisions, and the Kock pouch group had 9 rehospitalizations and 3 revisions. The day and nighttime continence rate was 100% in the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be accomplished safely and effectively in any patient requiring an ileal conduit.