Assessment of health-related quality of life of male patients with ileal orthotopic neobladder compared to cutaneous ureterostomy.

INTRODUCTION: The aim of this article was to compare patients' health-related quality of life (HR-QoL) outcomes between ileal orthotopic neobladder (IONB) and standard bilateral cutaneous ureterostomy (CU) using validated diversion-specific HR-QoL questionnaires. MATERIAL AND METHODS: This study utilized a retrospective cohort design, including all male patients who underwent open radical cystectomy with either IONB or CU from January 2010 until December 2017. In total, 69 and 57 male patients with a minimum of 12 months of follow-up were included in each group respectively, after applying the following exclusion criteria: female, pre- and postoperative radio- and chemotherapy and palliative surgery. For every patient, HR-QoL was evaluated using the European Association of Research and Treatment of Cancer Quality of Life Core (EORTC-QLQ-C30) and Functional Assessment of Cancer Therapy for patients undergoing radical cystectomy (FACT-Bl-Cys) validated questionnaires. RESULTS: In multivariable analysis, the type of the urinary diversion, and the occurrence of early and late postoperative complications were independently associated with the change of scores of HR-QoL domains. When comparing the 2 surgical methods (IONB vs. CU), after adjusting for confounders, such EORTC-QLQ-C30 domains as physical functioning (66.5 vs. 57.9, p = 0.011) and global health status (58.1 vs. 42.6, p <0.001) were superior in the IONB arm which was statistically significant. Similarly, functional health (15.3 vs. 11.9, p <0.001) and total score (110.1 vs. 101.7, p = 0.009) from the FACT-Bl-Cys questionnaire were superior in the IONB arm. CONCLUSIONS: In our study, patients with IONB possessed statistically significant, better scores of HR-QoL domains assessed with EORTC-QLQ-C30 and FACT-Bl-Cys questionnaires compared to those with CU. The occurrence of early major and late complications negatively affected patients' HR-QOL.

A new modification of tubeless cutaneous ureterostomy following radical cystectomy.

PURPOSE: Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients. MATERIALS AND METHODS: In 2016-2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis. RESULTS: The patients' mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1-37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value = 0.013). No statistically significant differences were observed between two groups for late complications and readmission rates. CONCLUSIONS: Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.

Long ureteric stricture replacement by buccal mucosa graft: an Armenian experience case series report.

INTRODUCTION: The aim of this study is to demonstrate the results of a case series concerning the replacement of long ureteric strictures using buccal mucosa grafts. MATERIAL AND METHODS: Five patients (3 men, 2 women), with a mean age of 35 years old, underwent reconstructive ureteral surgery using buccal mucosa graft with omental wrapping during the period of 2010-2013. In all cases, the location of strictures was in the proximal ureters with the length of strictures varying from 2.5 to 5.0 cm. RESULTS: We did not observe any major complications postoperatively. Two patients complained of constipation, which was resolved on the second day without any special treatment. Only one patient experienced fever (39°C) on the seventh day after the surgery due to inadequate drainage of the nephrostomic tube. Mean follow-up time was 39.6 months (range 26-52 months), mean hospital stay length was 10.6 days. Intravenous and antegrade urography were performed after removing JJ stents. Results were favorable without any signs of stricture. Repetitive ultrasound and radiologic imaging was performed at month 3, 6, 12 in the first year and every half-year thereafter. Intravenous urography showed no signs of strictures. Hydronephrosis was resolved in all patients by the sixth month following the surgery. CONCLUSIONS: Postoperatively, we observed favorable results in all patients in terms of absence of short term-surgical complications. This technique could be considered for patients with long ureteric strictures in whom ureteral replacement with bowel interposition or kidney auto-transplantation is contraindicated.