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SCHU-35: Complications Related to the Use of Intestinal Mechanic Sutures in Urinary Procedures
SOCIEDAD CHILENA DE UROLOG´IA
Table, SCHU-35 Technical Mechanic Manual P
Urinary Infection Yes No 9 (20%) 37 (80%) 14 (19%) 59 (81%) 0.913
changes were found in 24 % of the cases: 18% after SSC, 23% after ON, 24% after IC and 26% after HN (p⬎0.01). For HN, complete daytime (87%) and nighttime continence (75%), was achieved; while the figures were 94%/81% after ON and 94%/ 60% after SSC. The impact on QoL was acceptable for daytime life in all patients. The QLQ-C30 showed a significative better acceptance in the SSC and ON groups (score 2/7, 3/7 respectively), versus HN and IC groups (score 4/7 and 5/7 respectively). Conclusions: Urinary diversion after radical cystectomy is still a surgical procedure with considerable morbidity. The orthotopic diversion has more general complications, but better functional results and a higher approval rate by the patients compared to HN or IC. We found no evidence that age, gender, ASA score, TNM stage (extravesical tumor growth and positive lymph nodes) were a contraindication per se for any type of diversion. SCHU-35 Complications Related to the Use of Intestinal Mechanic Sutures in Urinary Procedures Marchetti P, Go ´ mez R, Catala´n G Service of Urology, Hospital del Trabajador de Santiago, Santiago, Chile Introduction and Objectives: The use of intestinal segments in urology is frequent; in these patients, intestinal continuity is restored with mechanic stapling sutures. This technique is attractive because is fast and prevents intestinal content spillage. However, this anastomosis may not be functional, leading to transit problems. In addition, staples left in the loop used for bladder reconstruction may cause stones. We compared immediate and long-term complications in patients undergoing augmentation enterocystoplasty (with or without an abdominal stoma) or continent urinary diversion using either mechanical or manual intestinal sutures. Materials and Methods: We reviewed the charts of patients submitted to augmentation enterocystoplasty, continent urinary diversion or continent catheterizable urinary channel, between August
S14
Urinary Lithiasis Yes No 21 (47%) 25 (53%) 9 (12%) 64 (88%) ⬍0.001
Intestinal Complications Yes No 15 (33%) 31 (67%) 7 (10%) 66 (90%) 0,002
1986 and March 2008. The type of suture used to restore intestinal continuity, the incidence of bladder stones, urinary tract infection and intestinal complications (defined as prolonged ileus, intestinal anastomotic leakage or intestinal obstruction) were recorded. Results: There were 119 procedures done in 116 patients (101 men and 15 women) with a mean age of 41 years (range 15 to 71). The mean follow-up was 8.4 years (0.1 to 27). Preoperative diagnosis was neurogenic bladder with refractory detrussor overactivity in 86 cases, neurogenic bladder with hypotonic sphincter in 9, urethral damage preventing urethral catheterization in 4, incontinent stomas in 3, invasive bladder cancer in 11, post-prostatectomy incontinence in 4 and interstitial cystitis in 2 cases. A total of 58 patients underwent augmentation enterocystoplasty, 42 underwent augmentation enterocystoplasty with an abdominal stoma, 9 underwent orthotopic urinary diversion, 3 underwent continent supravesical urinary diversion, and 7 underwent continent catheterizable urinary channel. Comparison of the complications found is shown in Table 1. We found a statistically significant difference in the incidence of urinary lithiasis and intestinal complications in the group who received mechanical sutures. Conclusions: The use of mechanical sutures is associated to a higher rate of intestinal complications and bladder stones. SCHU-36 Open vs. Laparoscopic Enterocystoplasty Gomez R1, Castillo O2, Marchetti P1, Catalan G1 1 Department of Urology, Hospital del Trabajador de Santiago, Santiago, Chile; 2 Section of Endourology and Laparoscopic Urology, Clı´nica Santa Marı´a, Santiago, Chile Introduction and Objectives: Laparoscopic enterocystoplasty (LE) is a new treatment alternative for hyperactive neurogenic bladder. Because LE is a minimally invasive procedure, even though requires training and can be more time-consuming, it may be beneficial. We report a prelimi-
Total 46 73 119
nary comparison of LE with the traditional open enterocystoplasty (OE). Materials and Methods: Since 1986, we have performed 65 enterocystoplasties. From November 2002 to March 2008, all enterocystoplasty cases entered a prospective non-randomized protocol comparing OE (G1) with LE (G2). The kind of surgery was chosen by the surgeon. OE is performed through a 14 cm infraumbilical laparotomy; a 30 cm loop of ileum is isolated, preserving at least 15cm of terminal ileum to avoid malabsortion. This isolated loop is opened longitudinally, folded as a U or S patch for detubularization and sutured to the opened bladder. In LE, 5 trocars are used: two 12 mm (one at the umbilicus and the other one at the left paraumbilical area) and three 5mm (right paraumbilical area and in both iliac fossae). The bladder is dissected and opened; a 7 cm periumbilical laparotomy is performed to externalize the loop of ileum, which is isolated and folded just like in OE. The patch of ileum is returned to the abdominal cavity; after incision closure, the procedure is completed suturing the patch to the bladder intracorporeally. Results: Nineteen paraplegic patients underwent surgery: 9 with OE and 10 with LE. In one patient, LE failed because of extensive adhesions from previous peritonitis. All patients were male and underwent a detubularized iliocystoplasty. Mean age was 44/40 years in G1/G2 respectively (p: 0.488). One G1 patient had type 2 Diabetes Mellitus. Mean operative time was 180/295 min in G1/G2, respectively (p: 0.003). No patient received transfusions. Postoperative complications were found in 4 of 9 in G1 patients (44%) vs. 2 of 10 (20%) in G2 patients (p: 0.349). Two patients in G1 presented prolonged ileus. Mean time to full oral intake was 7.6/5.8 days (p: 0.369) and mean hospital stay was 23/14 days (p: 0.101) in G1/G2 respectively. After a mean follow-up of 18 months, all patients are continent on intermittent self-catheterization. Conclusions: Laparoscopic enterocystoplasty is feasible and safe. Although operative time is significantly longer, the incidence of ileus is reduced and postsurgical recovery is faster.
UROLOGY 72 (Supplement 5A), November 2008
Table, SCHU-35 Technical Mechanic Manual P
Urinary Infection Yes No 9 (20%) 37 (80%) 14 (19%) 59 (81%) 0.913
changes were found in 24 % of the cases: 18% after SSC, 23% after ON, 24% after IC and 26% after HN (p⬎0.01). For HN, complete daytime (87%) and nighttime continence (75%), was achieved; while the figures were 94%/81% after ON and 94%/ 60% after SSC. The impact on QoL was acceptable for daytime life in all patients. The QLQ-C30 showed a significative better acceptance in the SSC and ON groups (score 2/7, 3/7 respectively), versus HN and IC groups (score 4/7 and 5/7 respectively). Conclusions: Urinary diversion after radical cystectomy is still a surgical procedure with considerable morbidity. The orthotopic diversion has more general complications, but better functional results and a higher approval rate by the patients compared to HN or IC. We found no evidence that age, gender, ASA score, TNM stage (extravesical tumor growth and positive lymph nodes) were a contraindication per se for any type of diversion. SCHU-35 Complications Related to the Use of Intestinal Mechanic Sutures in Urinary Procedures Marchetti P, Go ´ mez R, Catala´n G Service of Urology, Hospital del Trabajador de Santiago, Santiago, Chile Introduction and Objectives: The use of intestinal segments in urology is frequent; in these patients, intestinal continuity is restored with mechanic stapling sutures. This technique is attractive because is fast and prevents intestinal content spillage. However, this anastomosis may not be functional, leading to transit problems. In addition, staples left in the loop used for bladder reconstruction may cause stones. We compared immediate and long-term complications in patients undergoing augmentation enterocystoplasty (with or without an abdominal stoma) or continent urinary diversion using either mechanical or manual intestinal sutures. Materials and Methods: We reviewed the charts of patients submitted to augmentation enterocystoplasty, continent urinary diversion or continent catheterizable urinary channel, between August
S14
Urinary Lithiasis Yes No 21 (47%) 25 (53%) 9 (12%) 64 (88%) ⬍0.001
Intestinal Complications Yes No 15 (33%) 31 (67%) 7 (10%) 66 (90%) 0,002
1986 and March 2008. The type of suture used to restore intestinal continuity, the incidence of bladder stones, urinary tract infection and intestinal complications (defined as prolonged ileus, intestinal anastomotic leakage or intestinal obstruction) were recorded. Results: There were 119 procedures done in 116 patients (101 men and 15 women) with a mean age of 41 years (range 15 to 71). The mean follow-up was 8.4 years (0.1 to 27). Preoperative diagnosis was neurogenic bladder with refractory detrussor overactivity in 86 cases, neurogenic bladder with hypotonic sphincter in 9, urethral damage preventing urethral catheterization in 4, incontinent stomas in 3, invasive bladder cancer in 11, post-prostatectomy incontinence in 4 and interstitial cystitis in 2 cases. A total of 58 patients underwent augmentation enterocystoplasty, 42 underwent augmentation enterocystoplasty with an abdominal stoma, 9 underwent orthotopic urinary diversion, 3 underwent continent supravesical urinary diversion, and 7 underwent continent catheterizable urinary channel. Comparison of the complications found is shown in Table 1. We found a statistically significant difference in the incidence of urinary lithiasis and intestinal complications in the group who received mechanical sutures. Conclusions: The use of mechanical sutures is associated to a higher rate of intestinal complications and bladder stones. SCHU-36 Open vs. Laparoscopic Enterocystoplasty Gomez R1, Castillo O2, Marchetti P1, Catalan G1 1 Department of Urology, Hospital del Trabajador de Santiago, Santiago, Chile; 2 Section of Endourology and Laparoscopic Urology, Clı´nica Santa Marı´a, Santiago, Chile Introduction and Objectives: Laparoscopic enterocystoplasty (LE) is a new treatment alternative for hyperactive neurogenic bladder. Because LE is a minimally invasive procedure, even though requires training and can be more time-consuming, it may be beneficial. We report a prelimi-
Total 46 73 119
nary comparison of LE with the traditional open enterocystoplasty (OE). Materials and Methods: Since 1986, we have performed 65 enterocystoplasties. From November 2002 to March 2008, all enterocystoplasty cases entered a prospective non-randomized protocol comparing OE (G1) with LE (G2). The kind of surgery was chosen by the surgeon. OE is performed through a 14 cm infraumbilical laparotomy; a 30 cm loop of ileum is isolated, preserving at least 15cm of terminal ileum to avoid malabsortion. This isolated loop is opened longitudinally, folded as a U or S patch for detubularization and sutured to the opened bladder. In LE, 5 trocars are used: two 12 mm (one at the umbilicus and the other one at the left paraumbilical area) and three 5mm (right paraumbilical area and in both iliac fossae). The bladder is dissected and opened; a 7 cm periumbilical laparotomy is performed to externalize the loop of ileum, which is isolated and folded just like in OE. The patch of ileum is returned to the abdominal cavity; after incision closure, the procedure is completed suturing the patch to the bladder intracorporeally. Results: Nineteen paraplegic patients underwent surgery: 9 with OE and 10 with LE. In one patient, LE failed because of extensive adhesions from previous peritonitis. All patients were male and underwent a detubularized iliocystoplasty. Mean age was 44/40 years in G1/G2 respectively (p: 0.488). One G1 patient had type 2 Diabetes Mellitus. Mean operative time was 180/295 min in G1/G2, respectively (p: 0.003). No patient received transfusions. Postoperative complications were found in 4 of 9 in G1 patients (44%) vs. 2 of 10 (20%) in G2 patients (p: 0.349). Two patients in G1 presented prolonged ileus. Mean time to full oral intake was 7.6/5.8 days (p: 0.369) and mean hospital stay was 23/14 days (p: 0.101) in G1/G2 respectively. After a mean follow-up of 18 months, all patients are continent on intermittent self-catheterization. Conclusions: Laparoscopic enterocystoplasty is feasible and safe. Although operative time is significantly longer, the incidence of ileus is reduced and postsurgical recovery is faster.
UROLOGY 72 (Supplement 5A), November 2008