Laparoscopy assisted versus open ileocystoplasty in pigs.

PURPOSE: We compared laparoscopy assisted and open ileocystoplasty in an experimental model in pigs. We evaluated intraoperative aspects, postoperative recovery, peritoneal adhesions and functional results. MATERIALS AND METHODS: The study included 30 male pigs divided into 4 groups, including 10 with laparoscopy assisted ileocystoplasty, 10 with open surgery, 5 with sham laparoscopy and 5 with sham open surgery. Variables studied were total operative time, ileovesical anastomosis time, postoperative urodynamic findings (bladder capacity and compliance), daily and weekly weight gain, and intraperitoneal adhesions (incidence, type and score). RESULTS: Mean operative time in the laparoscopic and open groups was 179.4 and 69.6 minutes, respectively, which was significantly different (p <0.05). Mean ileovesical anastomosis time was also significantly different for laparoscopic vs open surgery (74.8 vs 31.8 minutes, p <0.05). Significant differences were observed in mean weekly weight gain during the first 4 weeks after surgery. Postoperatively bladder capacity and compliance differences among the groups were not significantly different (p >0.05). The overall incidence of intraperitoneal adhesions was not significantly different in all groups (p >0.05). However, in the open vs laparoscopy, sham laparoscopy and sham open surgery groups adhesion complexity was greater and mean score was higher (4.2 vs 2.8, 2.0 and 2.0, respectively), which was statistically significantly different (p <0.05). CONCLUSIONS: Laparoscopy assisted ileocystoplasty requires more operative time than open surgery. However, postoperative recovery is more rapid and intraperitoneal adhesions are less complex in pigs with laparoscopy assisted ileocystoplasty vs conventional surgery. Functional results are comparable for open and laparoscopy assisted ileocystoplasty.

Quality of life of neurogenic patients: translation and validation of the Portuguese version of Qualiveen.

OBJECTIVE: Questionnaires for adequate assessment of the urinary function of neurological patients are not available in Portuguese. The Qualiveen, developed in France for evaluation of general and urinary-related impact on QoL, has been successfully used in neurological patients. AIM: To translate the Qualiveen, to adapt it crossculturally, and to validate it for Portuguese. METHODS: Fifty-one patients with spinal cord injury (SCI), multiple sclerosis (MS), and myelomeningocele (MMC) completed both Qualiveen and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) twice, at an mean interval of 15.5 days. RESULTS: A reliability study revealed internal consistency (Cronbach's alpha coefficients 0.75-0.90 for all four domains). Test-retest reliability demonstrated moderate to strong stability (intraclass correlation coefficient range from 0.62 to 0.86). Construct validity was assessed using the Qualiveen's scores and ICIQ-SF final score. It was significant for the majority of Qualiveen's score domains compared with the ICIQ-SF final score. CONCLUSION: The Portuguese version of the Qualiveen was successfully adapted and validated. It can be used for evaluation of general and urinary QoL in neurological patients.

Laparoscopic ileocystoplasty: an experimental study in pigs.

BACKGROUND AND PURPOSE: Bladder dysfunction may lead to urinary incontinence and progressive kidney deterioration. When clinical treatment fails, bladder augmentation is the operation of choice in most cases. The purpose of this study was the standardization of the technique of videolaparoscopic ileocystoplasty in a porcine model and demonstration of a tutor-supervised learning curve. MATERIALS AND METHODS: The study was conducted on 15 Large-White male pigs (20-25 kg) that underwent ileocystoplasty with 15 cm of distal ileum shaped into a using extracorporeal technique and laparoscopic ileovesical anastomosis. Operative time, ileovesical anastomosis time, intraoperative complications, and extravasation after anastomosis were evaluated. To assess the learning curve, the animals were divided into three groups of five: group I (operated on in collaboration with a tutor), group II (treated under the supervision of tutor), and group III (without the tutor's collaboration or supervision). RESULTS: Total surgical time and ileovesical anastomosis time revealed significant differences (P < 0.05) between groups I and III (70% reduction) as well as between groups II and III (64% reduction). CONCLUSIONS: Laparoscopic ileocystoplasty in pigs is feasible without special laparoscopic material. Ten initial procedures with a tutor's help were important for technique acquisition and mastery. A sharp increase in efficiency occurs between the tenth and fifteenth procedures. These procedures should be executed at least ten times in the presence of the tutor to enable the surgeon to overcome the learning curve.