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Urinary diversion
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
An ileal conduit diversion is very uncommon nowadays in children because of the high incidence of complications. However, in very carefully selected cases, this may be a useful option, for example in children with neuropathic bladder or pelvic malignancy who, along with their carers, may prefer this to major urinary tract reconstruction and continent diversion in the short to medium term.
Laparoscopic Management of T4 Tumor and Pelvic Exenteration for Locally Advanced Tumors
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
In LACRC, whenever the rectal growth is at least 5 cm from the anal verge, anterior resection along with the involved organ like the uterus, vagina, bladder may be resected rather than doing total pelvic exenteration. In such cases, an ileal conduit will be needed when the complete bladder is removed.
Urinary Diversion
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Véronique Phé, Gilles Karsenty
Ileal conduit is offered to neuro-urological patients after failure of conservative therapies or as a salvage therapy, as a last resort procedure. However, high perioperative morbidity and late complication rates have been reported.24
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
Alternatives to allow effective bladder emptying include the usage of an indwelling catheter, intermittent catheterization, external sphincterotomy in male patients, and incontinent urinary diversion via a urostomy. Although intermittent catheterization is generally preferred due to the preservation of continence, tetraplegic patients often have either diminished upper extremity function precluding independent self-catheterization. Females with SCI may find it challenging to perform intermittent catheterization, not only because of functional neurologic deficits, but also because of difficulty identifying and accessing the urethral meatus, particularly in those who use a wheelchair. Reconstructive options for incontinent urinary diversion include either the creation of an ileal conduit or incontinent ileovesicostomy. The ileal conduit bypasses the bladder entirely by routing the ureters into a segment of ileum that is then brought through the abdominal wall to form a stoma. Creation of an ileal conduit is usually, but not always, combined with cystectomy to avoid pyocystis and other complications of leaving a defunctionalized bladder in in place.
Urostomal ileal conduit complications in association with abdominal wall mesh implantation
Published in Scandinavian Journal of Urology, 2022
L. Jakobsson, A. Montgomery, J. Ingvar, A. Löfgren, F. Liedberg
An ileal conduit is the most common type of urinary diversion fashioned in conjunction with radical cystectomy (RC). The surgery is either carried out with robotic-assisted laparoscopy or through a lower midline incision. Similarly, during pelvic exenteration surgery, an ileal conduit is constructed in addition to an ostomy for the bowel diversion, the latter most commonly as an end sigmoidostomy. The cystectomy itself is associated with abdominal wall-related complications such as incisional hernias in up to 20% of the patients at follow-up [1,2]. In addition, stoma-related complications such as protrusion of abdominal content through a local defect in the abdominal wall at the site of the ileal conduit can occur, i.e. a parastomal hernia (PH) [3]. A PH does frequently cause an ill-fitting ostomy bandage, bowel and/or urinary obstruction, as well as considerable discomfort [4]. Similarly, after colorectal surgery, PHs frequently occur and many patients have some type of symptoms due to their PH [5]. Stoma site fascial incisions of >35mm, age >70 years, BMI >25, diabetes, and increased abdominal pressure are risk factors associated with the development of a PH [6].
Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
Published in Scandinavian Journal of Urology, 2019
Malin Böös, Tomas Jerlström, Eva Beckman, Mats Bläckberg, Johan Brändstedt, Petter Kollberg, Annica Löfgren, Per-Uno Malmström, Göran Sahlén, Anne Sörenby, Anders Vikerfors, Anna Åkesson, Fredrik Liedberg
Patient, tumour and treatment characteristics of the 429 patients from four hospital units who were included in the validation are given in Table 1. Non-muscle-invasive bladder cancer (< cT2) was the indication for surgery in 109 patients (25%) and 218 patients (51%) had tumour stage cT2. Pre-operatively, 13% of the included patients had lymph node metastasis and 35% received neoadjuvant chemotherapy. Ileal conduit was performed in 367 patients (86%), 46 patients (11%) received an orthotopic neobladder and eight underwent continent cutaneous diversion (three Lundiana-pouches [10] and five Kock-pouches); also, one patient received a colonic conduit and seven patients had a permanent percutaneous nephrostomy, of which two were subjected to ureteroureterostomy with unilateral nephrostomy (Table 1).