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Long-term urologic and gynecologic follow-up in anorectal anomalies: The keys to success
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Geri Hewitt, Daniel G. DaJusta, Christina B. Ching
Currently no evidence-based guidelines regarding mode of delivery (vaginal vs. cesarean delivery) in women with ARM exist. Recommendations, therefore, are individualized with careful discussion of the inherent risks and benefits of both modes of delivery and shared medical decision-making between obstetrician and patient. Patients with a bowel neo-vagina and/or repaired cloacal malformations are generally encouraged to deliver by cesarean section. Patients with a native vagina and adequate perineal body after repair of IA may consider vaginal delivery. If the patient already has poor anal continence, she may be more willing to risk potential obstetrical anal sphincter injury and attempt a vaginal delivery. Prior to delivery, all previous abdominal and pelvic surgery (including Mitrofanoff appendicovesicostomy and Malone appendicostomy) should be reviewed to determine the best type and location of abdominal and uterine incisions. Pre- and intraoperative collaboration with colorectal surgeons and urologists is beneficial.
Fecal incontinence in the neurogenic bladder patient
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Jennifer H. Yang, Nima Harandi, Paula J. Wagner, Anthony R. Stone
Alternatives to appendix If the appendix has been removed, it is unsuitable for use as a conduit, or the clinician may wish to use it for a Mitrofanoff (appendicovesicostomy) construction, several alternative strategies are available. There are reports in the literature of using the terminal ileum, necessitating an ileotranverse anastomosis to restore intestinal continuity. In addition, some authors have formed a Monti-type bowel tube for this purpose.33 We prefer to use a cecal flap to construct a neoappendix, as it obviates the need for an additional bowel anastomosis. An anterior cecal flap with its base at the antimesenteric border is dissected. This is rolled into a tube over a 12 or 14F catheter and then folded back over the cecum. The adjacent cecum is then imbricated over the tube to support it and form a valve.34 This neoappendix may be brought out at the umbilicus or iliac fossa in similar manner to a native appendix.
Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?
Published in Arab Journal of Urology, 2023
Ahmed M. Harraz, Adel Nabeeh, Ramy Elbaz, Abdalla Abdelhamid, Mohamed Tharwat, Amr A. Elbakry, Ahmed S. El-Hefnawy, Ahmed El-Assmy, Ahmed Mosbah, Mohamed H. Zahran
Likewise, a history of previous urethroplasty is suggested to increase the likelihood of reintervention. Recurrent stenosis after urethroplasty is significantly associated with more severe scarring and devitalized tissues secondary to the previous dissection. In 50 patients with previous failed repair, the success rate was 75% [19]. In a recent systematic review of literature, the success rate of PU for recurrent strictures varied from 69–100% [20]. It is to be noted that these surgeries might require additional ancillary procedures including supra-crural rerouting and Mitrofanoff appendicovesicostomy. Nevertheless, none of our patients required additional procedures beyond inferior pubectomy. In addition, in cases of severe extensive fibrosis and the proximal end of the urethra was not identified, the urethra was anastomosed to the prostate anteriorly provided that the BN was intact.
Long-term results of continent catheterizable urinary channels in adults with non-neurogenic or neurogenic lower urinary tract dysfunction
Published in Scandinavian Journal of Urology, 2019
Ilse M. Groenendijk, Joop van den Hoek, Bertil F. M. Blok, Rien J. M. Nijman, Jeroen R. Scheepe
Many patients with neurogenic or non-neurogenic lower urinary tract dysfunction are dependent on either clean intermittent catheterization (CIC) or an indwelling catheter for bladder emptying. Despite good instructions and feasible equipment, both approaches may give rise to problems such as urinary tract infection, pain and bleeding [1–3]. CIC requires a good dexterity, which may be challenging for people with spinal cord injury, especially those patients that are wheelchair-bound. If management with CIC or an indwelling catheter affects a patient’s quality-of-life too much, the alternative is to construct a continent catheterizable urinary channel (CCUC) [4]. Mitrofanoff appendicovesicostomy and the Monti ileovesicostomy are the most often used catheterizable channels [5–7]. These procedures have been used in children and adolescents for more than three decades. Recently, our group showed that an appendicovesicostomy is an effective and durable solution for children when CIC is not feasible [8]. Little is known about the feasibility and risk factors for complications of CCUCs in adults. Publications so far show a wide range of complication rates and most cohorts included only patients with a neurogenic bladder dysfunction [7,9–11].
Expanding the indications of robotic surgery in urology: A systematic review of the literature
Published in Arab Journal of Urology, 2018
Raj P. Pal, Anthony J. Koupparis
Murthy et al. [97] reported outcomes from a cohort of 15 paediatric patients undergoing a RAI, performing a non-randomised retrospective comparison against open augmentation enterocystoplasty. Indications for surgery included neuropathic bladder dysfunction (poor compliance, detrusor overactivity refractory to medical treatment, high detrusor leak point pressure) or bladder dysfunction secondary to posterior urethral valves. Most cases also had a concomitant robotic procedure (Mitrofanoff appendicovesicostomy, antegrade colonic enema channel, bladder neck closure). The RAI technique involved intracorporeal isolation bowel division and end-to-end anastomosis, and then bi-valving the bladder with a coronal cystotomy and a subsequent ileal graft continuous anastomosis (all performed intracorporeally). Although the authors report a shorter median LOS with RAI (6 vs 8 days; P = 0.01), there were no differences in median blood loss, opiate requirement, and return to full diet, although epidural usage was less in the robotic cohort [97]. Functional outcomes and complications were similar in both groups. The operative duration for RAI in this study was 623 min (vs 265 min for open) indicating this procedure remains in its infancy [97].