VIP neobladder (Padovana) reconstruction following radical cystectomy for bladder cancer Complications, functional outcome and quality of life evaluation in 95 cases.

The Authors report a complete study concerning complications, the imaging and functional results, the clinical outcome and the quality of life in patients treated with VIP. 95 patients with localized bladder TCC (T2N0M0) were evaluated. Follow up points were 1st, 3rd, 6th, 12th, 18th, 24th and 36th month with clinical and ultrasound evaluation. At 6th, 12th and 36th month CT pyelography and urodynamic evaluation were performed and we used a questionnaire for subjective bladder function and the EORTC QLQ C-30 questionnaire to evaluate quality of life. Perioperative complications were ileus (2 patients; 2.1%) (Clavien Grade IIIb), one postoperative death (1.0%) (Clavien Grade V) and a resuscitated cardiac arrest (1.0%) (Clavien Grade IVa). Postoperative complications were incisional hernias (n=4 patients; 4.21%) (Clavien Grade I) and hydronephrosis in five patients (5.26%) due to ureteric/neobladder stricture (Clavien Grade IIIb). Urine retention due to neobladder neck stenosis was observed in one patient (1.0%) (Clavien Grade IIIb) and an ileo-neobladder fistula in one (1.0%) patient (Clavien Grade IIIb). During follow up there were two cancer related deaths (2.1%). According to urodynamic evaluations neobladder capacity increased, end-filling pressure and Qmax decreased while residual urine and the number of intrinsic contractions remained stable. Continence rates and quality of life were high and stable during follow up. VIP technique for bladder substitution is a relatively easy technique with low rate of complications, good functional results which respect the patient's quality of life.

An anatomical study of the pterygospinous and pterygoalar bars and foramina - their clinical relevance.

AIM: To describe the incidence and the detailed anatomy of the pterygospinous and pterygoalar bony bridges, their variations, and their clinical relevance. These bony structures are ossified ligaments extending from distinct points of the lateral surface of the lateral pterygoid lamina to the undersurface of the greater wing of the sphenoid bone, and located close to the foramen ovale. By means of the completely ossified ligaments two individual foramens are formed, respectively: the pterygospinous (Cinivini's) foramen and the pterygoalar foramen (porus crotaphitico-buccinatorius). MATERIAL AND METHODS: The existence of the pterygospinous and pterygoalar bony bridges and foramina was studied in 50 Greek dry skulls. RESULTS: In this study, complete ossified pterygospinous ligaments were found in only one skull bilaterally (two out of 100 observations) and incomplete ossification in 25 out of the 100 cases. Complete and incompletely ossified pterygoalar ligaments were found unilaterally in one and in seven out of the 100 observations, respectively. CONCLUSION: Bearing in mind the relatively small sample of the study the incidence of the pterygospinous bony bridges seems to be higher than the pterygoalar bridges. Also, complete ossification of both foramina may appear less frequently than the incomplete ossification. The knowledge of the detailed anatomy of these structures can increase the success of diagnostic evaluation and approaches to the region.