Studer orthotopic ileal bladder substitute construction - surgical technique and complication management: one-center and 12-year experience.

PURPOSE: We have performed Studer neobladder creation in 61 patients (53 male and 8 female). The aims of this study were to evaluate the clinical outcomes, to review the surgical technique modification, postoperative complications management and metabolic disturbances. MATERIAL AND METHODS: All patients were retrospectively studied and followed-up. The follow-up: 12 years to 2 months. 44 patients (41 male and 3 female) returned for a control visit. All completed IIQ-7 questionnaire. Continence was analysed. Kidney ultrasound, post void residual and uroflowmetry, blood tests (electrolytes, kidney markers, acid-base balance) were performed. All patients were divided into two groups: I (with Zuber mineral water intake) and group II (without Zuber mineral water intake) for acid-base balance analysis. RESULTS: Early complications occurred in 13.1% (enterocolitis, neobladder-urethral anastomosis leakage, pyelonephritis, and lymphorrhoea). Late complications occurred in 14.0% (stricture of the neobladder-urethra anastomosis, urosepsis secondarily to bilateral hydronephrosis, stone formation, and pyonephrosis). In the follow-up 88.6% of patients revealed normal continence. The nocturnal incontinence, nocturia, and external or indwelling catheter were reported in 9, 6 and 5 patients, respectively). In IIQ-7 the mean negative impact of continence level on patients quality of life was 10.08% ± 14.47%. The mean Qmax., Qave., post void residual were 15.8 ± 4.9 ml/s, 7.9 ± 3.0 ml/s, and 151.2 ± 139.2 ml, respectively. Patients who regularly intake the Zuber present significant decrease of BE deficiency as compared to patient without Zuber usage. CONCLUSIONS: The Studer neobladder is the alternative urinary diversion. This is the difficult, skill demanding procedure, nevertheless gaining experience with self modifications resulted in decrease of complications. The Zuber mineral water intake ameliorates the base excess deficiency after Studer creation.

[Esophagopleural fistula; a rare complication after pneumonectomy (author's transl)]. / Osophagopleurale Fisteln als seltene Komplikation nach Lungenresektion.

This work deals with 8 own cases of esophagopleural fistula observed in 807 pneumonectomies with mortality rate of 37%. The pathogenesis as well as the treatment of esophagopleural fistulae based on world literature and own experience are discussed. The esophagopleural fistula is serious complication usually connected with pneumonectomy. Esophagography which should be done in every case after pneumonectomy ensures the diagnosis and before the operation shows any pathology of esophagus in its course and position. Small esophagopleural fistulae heal best after gastrostomy but larger ones require beside a double row suture of esophageal wall and additional covering with muscle flap.