Evaluation of the residual prostate cancer rate on cystoprostatectomy specimen in patients treated with radiotherapy for prostate cancer.

PURPOSE: To evaluate the residual cancer rate after cystoprostatectomy (CPT) in patients with a history of radiation therapy for prostate cancer and the postoperative complication rates. MATERIAL AND METHODS: We conducted a retrospective study involving 21 patients who had a CPT over 7 years and who had a history of radiotherapy for prostate cancer. To compare results, two additional groups were created: a group of patients without a history of radiotherapy in whom a CPT was performed, and a group without a history of radiotherapy and in whom was accidentally discovered a prostate cancer after CPT on histology specimens. RESULTS: The median age at the time of radiotherapy was 69 years. The median age at the time of cystoprostatectomy was 78 years. The median PSA at the time of the intervention was 0.6 ng/ml in the group with a history of radiotherapy. The residual cancer rate was 24%. No patients had criteria for biological recurrence. There were no additional surgical complications in the radiotherapy group (p = 0.2). The rate of cutaneous ureterostomy was higher (p = 0.0006) due to increased surgical difficulties (p = 0.0009). CONCLUSION: The residual cancer rate was 24% after radiotherapy for prostate cancer. PSA alone does not appear to be sufficient to detect the persistence of residual prostate cancer after radiotherapy. There were no more surgical complications after prostate radiotherapy.

Valoración del paciente cistectomizado tras el alta hospitalaria en relación a la incontinencia y la urostomía / No disponible

Las secuelas en una cistectomía radical suponen un reto en personas que la sufren para incorporarse a su vida normal. Es competencia enfermera evaluar estas circunstancias. El objetivo es conocer problemas y necesidades del paciente cistectomizado en el ámbito domiciliario. Se realiza una encuesta relacionada con el manejo de la incontinencia urinaria y de los dispositivos de urostomía en el domicilio tras el alta hospitalaria en pacientes con cistectomía radical y derivación urinaria diferente (neovejiga ileal ortotópica, tipo Bricker, tipo Mainz II). En los casos de neovejiga, la incontinencia urinaria ralentiza su reinserción sociofamiliar y demandan información sobre recuperación de la continencia diurna y en manejo de colectores. Los urostomizados demandan instrucción e información en el manejo de los dispositivos. Como conclusión, consideramos la necesidad de elaborar una guía de recomendaciones al alta

The aftermath in a radical cystectomy is a challenge for people affected to go on with his normal life. It is a nursing competence to evaluate those circumstances. The objective is to know problems and needs of the patient with cystectomy at home. A survey related to the management of urinary incontinence and urostomy devices at home after hospital discharge in patients with radical cystectomy and different urinary diversion (orthotopic ileal neobladder, Bricker, Mainz II type) is conducted. In the case of neobladder, urinary incontinence delays social and family reintegration. Additionally those patients demand information regarding recovery daytime continence management and collectors. Patients with an urostomy demands training and information about devices management. In conclusion, we consider it is need to design a guide of recommendations at home

[Childhood ureteropelvic junction obstruction in a regional treatment center: spectrum and therapy]. / Kindliche Ureterabgangsstenose in einem Zuweisungszentrum : Spektrum und Therapie.

BACKGROUND: Ureteropelvic junction obstruction is the most frequent malformation of the upper urinary tract and treatment with conservative or operative management remains controversial. In this study we present the retrospective analysis of 129 children with ureteropelvic junction obstruction who underwent conservative or operative management. MATERIAL AND METHODS: A total of 129 children with ureteropelvic junction obstruction, who were treated in the department of pediatric nephrology at the University of Essen from 1998-2005, were included into the analysis. Clinical charts were reviewed for the parameters urinary tract infections (total number, severity, bacteriology), antibiotics, ultrasound, Tc-99 diuresis renography, and management (conservative or operative). Statistical analysis was performed using the SPSS software (Version 11.0) RESULTS: A total of 89 urinary tract infections was observed in 52 children. The mean width of renal pelvis was 3.04 ± 1.33 cm in the operative group and 1.98 ± 1.2 cm in the conservative group (p=0.001, ANOVA test). Tc-99 diuresis renography was performed in 70 children of which 46 children received primarily conservative management and 24 children were operated. In the conservative group 6 children underwent pyeloplasty later on due to aggravation of renal function. In 59 out of 129 cases diuresis nephrography was not performed due to only mild ectasia. CONCLUSIONS: This study demonstrates that conservative management is safe in children with ureteropelvic junction obstruction with no or only little constricted renal function, if a close-meshed surveillance protocol is followed and parental compliance is given.

Cutaneous uretero-ureterostomy: a technique of urinary diversion for high-risk patients with bladder cancer.

A simplified technique of cutaneous ureterostomy (CU) is presented for the treatment of high-risk bladder cancer patients. From 1968 to 2003, 2118 cystectomies with CU were performed for bladder cancer patients with uremic manifestations. The mean age was 67.4 +/- 27.3; 1206 patients were men and 912 were women. Cutaneous uretero-ureterostomy (CUU) was performed by three methods: (a) one ureter was brought across the midline and anastomosed end-to-side to the other ureter (end-to-side uretero-ureterostomy, ESUU); (b) the two ureters were placed side by side in a double-barrel fashion (double-barrel ureterostomy, DBU); or (c) the two distal ureteric ends were anastomosed together before fixation to the skin (side-to-side uretero-ureterostomy, SSUU). Selection of the technique depended on ureteric length and girth. No complications specific to CUU have occurred. Serum creatinine was normalized and intravenous pyelogram (IVP) showed improvement of obstructive manifestations and renal function. Ureterostomy stenosis was more common in ESUU than in DBU and SSUU; it responded to dilatation. This simple and easy procedure is shown to have a low rate of operative and postoperative complications and is indicated for high-risk patients with bladder cancer.

Ureterocalicostomy: a contemporary experience.

OBJECTIVES: To report our contemporary experience with ureterocalicostomy to determine whether the indications or results have changed in modern practice. Ureterocalicostomy is a well-established treatment for patients with complicated ureteropelvic junction (UPJ) obstruction and other forms of proximal ureteral obstruction. Although both retrograde and antegrade endourologic interventions have become accepted forms of management, the success rates do not approach those of open or even laparoscopic interventions, potentially leading to a greater number of patients with treatment failure and the need for more complicated reconstruction. METHODS: Between July 1991 and February 2004, 11 patients (4 women and 7 men), aged 19 to 68 years (mean 38), underwent open surgical ureterocalicostomy. The indications for surgery were primary UPJ obstruction in 4, failed cutting balloon incision for UPJ obstruction in 3, proximal ureteral stricture after ureteroscopic stone removal in 2, and obliterated UPJ after percutaneous nephrolithotomy and failed antegrade endopyelotomy in 1 patient each. RESULTS: Hospitalization ranged from 4 to 7 days (mean 5.1). No patient experienced a significant perioperative complication. With follow-up ranging from 5 to 32 months (mean 10.1), relief of obstruction was evident in all patients as documented by intravenous urography or nuclear renography. Furthermore, differential function on the involved side improved from a mean of 54.6% preoperatively to 60.1% postoperatively (P <0.05). CONCLUSIONS: The spectrum of indications for ureterocalicostomy has changed, although excellent results can still be achieved. Although laparoscopic approaches are currently being evaluated, most patients currently undergoing this reconstructive procedure still require open operative intervention.

[The modified ureterosigmoidostomy (Mainz pouch II) as a continent form of urinary diversion]. / Die modifizierte Ureterosigmoidostomie (Mainz Pouch II) als kontinente Form der Harnableitung.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to examine the outcome of the "Mainz Pouch II" urinary diversion at two different centers (the Klinik und Poliklinik für Urologie, Bonn and the Ospedale "San Salvadore", Pesaro, Italy) in terms of different techniques of ureteral implantation. MATERIALS AND METHODS: Between March 1995 and February 2003, the procedure was performed on 83 patients with 165 renal units (RU). Ureteral implantation with the Goodwin-Hohenfellner technique was performed in 57 RU, with the Abol-Enein modification in 23 RU and the Le-Duc procedure in 85 RU. Follow-up was available for 71 patients (85%) with a period of 1 to 82 months (mean 19.5 months, median 12 months). A non-validated questionnaire was used in the Bonn series to determine specific urinary diversion items. RESULTS: Early complications occurred in 12%, three requiring surgical intervention. Two patients died within the first 30 days after initial surgery. Pyelonephritis occurred in 12 RU (14% of the patients, 8.5% of the RU). Ureteral stenosis requiring reimplantation was found in two RU. The continence rate was 100% during daytime in the Bonn series; all but one patient had to get up for urination at night. A total of 63% of the patients were able to distinguish between stool and urine. CONCLUSION: Mainz pouch II is a quick, safe and easy to perform urinary diversion which serves as a satisfying alternative to other forms of continent diversion. Follow-up shows a low complication rate with good results in terms of continence; however, long term results have to be evaluated. There are no significant differences in complication rates for the different ureteral implantation techniques.

[Single-stitch extravesical ureteroneocystostomy in kidney transplantation (Taguchi's technic)]. / Ureteroneocistostomía extravesical con punto único en el trasplante renal (técnica de Taguchi).

Presentation of our experience with single access extravesical ureteroneocystostomy in 79 renal transplants performed over a 2-year interval. Description of the surgical technique, a modification of that described by Taguchi in 1968. The complications were 2 urinary fistulae (2.52%), one ureteral and one vesical, both at the beginning of the series and related to technical errors. There were no stenosis and in the 4 cases where CUMS was conducted no reflux vas noted. We conclude that this technique is useful for its simplicity, speed and good results.

Complicaciones urológicas en 72 trasplantes de riñón efectuados en el Hospital San Juan de Dios / The Urological complications of 72 renal transplants performed in the Hospital San Juan de Dios

Se revisaron los expedientes de 72 trasplantes de riñón efectuados en el Hospital San Juan de Dios entre 1977 y 1991 con el objetivo principal de determinar la frecuencia y el tipo de complicaciones urológicas más frecuentes. Se encontraron complicaciones mayores en 7 casos (8,33%) siendo la obstrucción de la ureteroneocistostomía la complicación más temible porque tuvo como consecuencia la pérdida del riñón trasplantado en el 50%de los casos. Se encontró obstrucción de la unión ureterovesical en el 2.77%, fistulas vesicales en 5.5%y un caso de un linfocele que representa el 1.4%. Se encontraron además complicaciones menores en el 7%de los riñones trasplantados como lo son : el edema de genitales, la formación de un hidrocele masivo, retención urinaria en el postoperatorio con orquiepididimitis por la presencia de la sonda uretral y finalmente un caso de infección urinaria no complicada varios años después de hecho el trasplante. No se encontró ningún caso de litiasis urinaria. Se revisa la literatura al respecto y se describe el uso de una técnica extraversical de ureteroneocistostomía la cual hemos usado más recientemente describiendo sus ventajas sobre la técnica usual de Leadbetter-Politano.