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Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Complications of sacral nerve stimulation include failure and the need to reoperate (1). Complications of botulinum toxin A include failure and the need to self-catheterize; also, injections have to be repeated every nine months to one year (2). Complications of augmentation cystoplasty include bowel disturbance, metabolic acidosis, the need to self-catheterize, mucus retention and malignant change (2). Complications of urinary diversion include bowel disturbance and stoma herniation and retraction (1).
Urinary diversion
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Sender Herschorn, Greg G. Bailly
An outline of management of neurogenic bladder in relation to urinary diversion is shown in Figure 50.1. Urinary diversion, although once frequently employed in the past for the treatment of neurogenic bladder dysfunction, is now only required in special circumstances. The commonly accepted indications include hydronephrosis that may be accompanied by progressive renal deterioration secondary to ureteral obstruction from a thick-walled bladder or intractable ureterovesical reflux, recurrent episodes of urosepsis, and persistent storage or emptying failure when CIC is impossible.6 If, in the opinion of the urologist, the upper tract deterioration and/or storage problem cannot be managed with bladder augmentation surgery alone then urinary diversion may be indicated. Another reason for diversion is when urethral CIC is not feasible.
Anorectal Malformations
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
A cloaca is a complex malformation in which the urethra, vagina, and rectum all open to one common channel on the perineum. On physical examination a cloaca can be suspected when there is only a single orifice identified on examination (51.6). A cloaca is a gynecourologic emergency as there is a high incidence of urinary tract or vaginal obstruction. An abdominal ultrasound evaluating for hydronephrosis or hydroureter is essential. The urinary obstruction may result from hydrocolpos of the vagina obstructing the bladder trigone and the urethra. The obstruction may also cause a palpable abdominal mass. Cloacas range from a spectrum of ‘short channel’ cloacas to ‘long channel’ cloacas that need complex reconstruction and may have poor long-term continence (51.7). After diagnosing a cloaca a colostomy is indicated to divert stool from the urinary stream. If the vagina is dilated, a vaginostomy may be indicated. Urinary diversion is occasionally needed. After the infant is approximately 6 months old, a total urogenital mobilization is performed that allows for reconstruction of the anatomy.
Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators
Published in Acta Oncologica, 2018
Jihane Boustani, Aurélie Bertaut, Matthew D. Galsky, Jonathan E. Rosenberg, Joaquim Bellmunt, Thomas Powles, Federica Recine, Lauren C. Harshman, Simon Chowdhury, Guenter Niegisch, Evan Y. Yu, Sumanta K. Pal, Ugo De Giorgi, Simon J. Crabb, Matthieu Caubet, Loïc Balssa, Matthew I. Milowsky, Sylvain Ladoire, Gilles Créhange
Between 1988 and 2015, 164 patients with non-metastatic MIBC were included: 92 (56.1%) underwent RC and 72 (43.9%) had RCT. Flow charts are shown in Figure 1. Patients’ characteristics were comparable between RC and RCT groups (Table 1). Median age was 82 years (range, 80–100) in the RC group and 83 years (range, 80–93) in the RCT group. The majority of tumors were T2–T3 (91.5%) and N0 − Nx (92.7%). There were significantly more women in the RCT group (p = .01). Severe comorbidities were less frequent in patients treated with RCT (non-adjusted CCI ≥ 3: 22.2% versus 43.5%, p = .004). Eight (8.7%) patients had neoadjuvant chemotherapy before surgery. In the RCT group, 91.7% of patients received concurrent carboplatin or cisplatin alone and only two patients in association with 5 fluorouracil. Three patients were treated with paclitaxel and three other with gemcitabine (Table 2). The total radiation dose to the bladder is shown in Table 3. Data were missing in two patients. The majority of patients in the surgery group had open RC (89.1%), four (4.3%) had laparoscopic cystectomy and six (6.5%) had robotic cystectomy. The type of surgery was unknown in one patient. Urinary diversion types were ileal conduit, neobladder and Indiana pouch reservoir in 78 (84.8%), 7 (7.6%) and 2 (2.2%) patients, respectively. It was unknown in five cases.
Total Colpectomy Increases the Risk of Postoperative Hydronephrosis in Vaginal Cancer Patients
Published in Journal of Investigative Surgery, 2019
Octavian Constantin Neagoe, Mihaela Ionica, Dorin Nicolae Agapie
Presence of hydronephrosis has been shown to negatively impact quality of life and survival in cervical cancer patients.8–11 Similarly, 5-year OS for vaginal cancer patients has recorded a 72.2% survival in the group of patients without hydronephrosis, while only 28.6% of patients with hydronephrosis were alive at 5 years. Survival for vaginal cancer has been reported to various values ranging from 53% at 5 years for stage II and up to 91% at 5 years for stage I, depending on treatment type.2,7,8 Urinary diversion procedures have shown in our study to increase survival, with a 5 OS of 42.1% compared to no patients surviving at 5 years if no treatment was performed.
End-to-end ureteroureteroanastomosis with unilateral nephrostomy: revival of a forgotten technique suitable for a modern context?
Published in Scandinavian Journal of Urology, 2019
Georg Jancke, Gediminas Baseckas, Johan Brändstedt, Petter Kollberg, Anne Sörenby, Fredrik Liedberg
Ureteroureterostomy combined with unilateral nephrostomy as an alternative urinary diversion was originally described more than 50 years ago [1]. However, the cornerstone of urinary diversion in elderly and comorbid patients has been the ileal conduit until recently, when cutaneous ureterostomy with single stoma was proposed as an alternative approach that might decrease morbidity and complications after cystectomy [2]. The surgical technique, technical details, experience and outcome for this type of urinary diversion has not been reported since 1969, and at that time only for three patients [3]. With the continuous development of perioperative medicine, older patients and individuals with severe comorbidities are now more frequently subjected to cystectomy. In this context, it is plausible that ureteroureteroanastomosis with unilateral nephrostomy can be an alternative to conventional urinary diversion, especially in patients in whom a nephrostomy tube has been inserted preoperatively due to obstruction of the upper urinary tract, and in those considered unsuitable for cutaneous ureterostomy or being treated in a palliative setting. Furthermore, performing one ureteroureteroanastomosis rather than one bowel anastomosis and two uretorointestinal anastomoses reduces the complexity of the urinary tract reconstruction. Here we report our initial experiences and technical details regarding the use of end-to-end ureteroureteroanastomosis in a case series comprising eight patients. We have considered ureteroureterostomy with unilateral nephrostomy and carried out this surgery in eight such patients over a period of 4 years at the Cystectomy Unit of the Departments of Urology in Malmö and Helsingborg in southern Sweden.