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UP-03.160 Continent Cutaneous Diversion A.M. Lundiana in 200 Patients: Complications From Reservoir and Outlet
UNMODERATED POSTER SESSIONS
10 women. Patients with ⱕ clinical T2 were 21. Postoperative mean follow-up duration was 10.7 months. In patients for ileal conduit (IC), the 4cm midline infraumbilical skin incision is made and the stoma formation is similar to open technique. In patients for orthotopic neobladder, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in early five cases with redocking (ON-I) and suprapubically in late thirteen cases without redocking (ON-S). Result: All procedures were completed with no intra-operative complications. Mean operative times of IC, ON-I and ON-S groups were 442.5, 646.0 and 531.3 minutes, respectively (p ⫽ 0.001). Mean console and lymph node dissection time were not significant between groups. Mean urinary diversion times in each group were 68.8, 125.0 and 118.8 minutes, respectively (p ⫽ 0.001). In comparison between the ON-I and ON-S group, the operative time was only significant. Three patients required a blood transfusion. We had no intra-abdominal organ injury and open conversion. Nineteen patients (90.5%) were ⱕ pathologic T2, and two patients (9.5%) had node-positive disease. Positive resection margin was shown in one patient (4.8%). Postoperative complications included ileus (n⫽1), stricture in left uretero-ileal junction (n⫽1) and vesicovaginal fistula (n⫽1). Conclusion: Our robotic neobladdersuprapubic incision without redocking is easier and more rapid than that of infraumbilical incision with redocking.
UP-03.160 Continent Cutaneous Diversion A.M. Lundiana in 200 Patients: Complications From Reservoir and Outlet Mansson W1, Davidsson T1, Xu A2, Gudjonsson S1, Liedberg F1 1 Dept. of Urology, Skane University Hospital, Malmö, Sweden, 2Dept. of Urology, Zhujiang Hospital, Guangzhou, China Introduction: The Lundiana Pouch for continent cutaneous diversion is a modification of the Indiana Pouch. In the former the ileocaecal valve is diminished in diameter and fixed against the caecal wall as a flap valve using stapling instruments. The pouch is drained through 2 catheters during the first 4 weeks and thereafter the patient starts intermittent self catheterization, most often using a 16 F Foley catheter.
Materials and Methods: During the years 1991-2007 continent cutaneous diversion a.m. Lundiana was performed in 200 patients. 160 patients underwent cystectomy (144 with bladder cancer and 16 with rectal or anal cancer). In 40 patients there were benign indications for the diversion. In the 114 patients who are alive follow-up is 2.5 – 19.2 years, median 9.2 years. Results: Mortality within 90 days was 2.5%. 46 patients suffered postoperative complications that required open or endoscopic surgery or placement of drainage tubes in 25. Some patients had early tumour recurrence and the catheters draining the pouch were not removed.Evaluation of the functional results is based on 191 patients who started intermittent self catheterization. Revision of the outlet due to incontinence or, in two cases, due to difficult catheterization was performed in 13 patients. Revision of the stoma due to stenosis was done in 14 patients. 14 patients suffered from episodes of difficult catheterization. Pouch stones developed in 22 patients and in 2 patients the pouch had to be augmented due to poor capacity. Rupture/perforation of the pouch occurred in 8 patients. In one patient the pouch was removed and an ileal conduit was fashioned after failed revision of the outlet due to incontinence.Continence was achieved in 177 patients. Continence was achieved less often among patients with benign disorders (33/39 vs 144/152; p⫽0.04) and in that group reoperation was more common (18/39 vs 31/152; p⬍0.001). Conclusions: Continent cutaneous diversion a.m. Lundiana gives excellent functional results. However, complications from the reservoir and the outlet are not uncommon, especially among patients diverted due to benign disorders. Patients who have undergone urinary diversion need lifelong control over their urinary tracts.
UP-03.161 The Diagnostic Role of Transabdominal Ultrasonographic Bladder Wall Thickness in the Female Urinary Incontinence Ozturk H1, Aydur E2, Irkilata H2, Seckin B3, Dayanc M2 1 Military Hospital, Izmir, 2Dept. of Urology, Gulhane Military Medical Academy, Ankara, 3Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya, Turkey Introduction and Objective: Urinary
UROLOGY 78 (Supplement 3A), September 2011
incontinence is the disease that mostly affects women worldwide and impaired quality of life. Initial clinical assessment performed in most patients is usually ineffective and urodynamic examination generally provides definitive diagnosis. However, urodynamics is not practical in all patients. Thus, the diagnosis of urinary incontinence needs useful and practical methods. Materials and Methods: The study was performed at our institution between January 2003 and March 2006. The aim of the study was to determine the diagnostic role of bladder wall thickness measured by transabdominal ultrasonography in the 82 female patients recruited from outpatient clinic. Forty-three patients were diagnosed as genuine stress incontinence (GSI) and 39 had non-neurogenic detrusor overactivity (NNDO) after diagnostic workup including urodynamic assessment, while 31 women patients without lower urinary tract symptoms served as a control group. The bladder wall thickness was measured transabdominally at supine position in three separate places of the bladder with a volume of 200 ml; the anterior wall, the right and the left lateral wall of the bladder. Data from 3 groups was compared statistically. Results: There was no significant correlation between mean bladder wall thickness and age in the whole study group and all subgroups. Examination of the 95% confidence intervals reveals no overlap in all diagnostic subgroups. Mean bladder wall thickness was found to be significantly different in all of the diagnostic groups and whole study group. The positive predictive value of diagnosing NNDO in women with a mean bladder wall thickness ⱖ 4.88mm was 53.9% and negative predictive value was 90%. Using a mean bladder wall thickness greater than 4.88mm. as a cut- off value, sensitivity was 87.1%, and specificity was 60.8% for diagnosis of NNDO. Conclusions: The prospective case-control study assessed the diagnostic role of bladder wall thickness measurement by 2D-transabdominal ultrasonography reveals that bladder wall thickness measurement is a useful and sensitive screening test in the diagnosis of both urge incontinence from NNDO and stress incontinence from GSI.
UP-03.162 Assessment of Effects of Pelvic Floor Muscle Exercises Performed With Music Honda S, Inoue K, Kobara C, Arichi N,
S397
10 women. Patients with ⱕ clinical T2 were 21. Postoperative mean follow-up duration was 10.7 months. In patients for ileal conduit (IC), the 4cm midline infraumbilical skin incision is made and the stoma formation is similar to open technique. In patients for orthotopic neobladder, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in early five cases with redocking (ON-I) and suprapubically in late thirteen cases without redocking (ON-S). Result: All procedures were completed with no intra-operative complications. Mean operative times of IC, ON-I and ON-S groups were 442.5, 646.0 and 531.3 minutes, respectively (p ⫽ 0.001). Mean console and lymph node dissection time were not significant between groups. Mean urinary diversion times in each group were 68.8, 125.0 and 118.8 minutes, respectively (p ⫽ 0.001). In comparison between the ON-I and ON-S group, the operative time was only significant. Three patients required a blood transfusion. We had no intra-abdominal organ injury and open conversion. Nineteen patients (90.5%) were ⱕ pathologic T2, and two patients (9.5%) had node-positive disease. Positive resection margin was shown in one patient (4.8%). Postoperative complications included ileus (n⫽1), stricture in left uretero-ileal junction (n⫽1) and vesicovaginal fistula (n⫽1). Conclusion: Our robotic neobladdersuprapubic incision without redocking is easier and more rapid than that of infraumbilical incision with redocking.
UP-03.160 Continent Cutaneous Diversion A.M. Lundiana in 200 Patients: Complications From Reservoir and Outlet Mansson W1, Davidsson T1, Xu A2, Gudjonsson S1, Liedberg F1 1 Dept. of Urology, Skane University Hospital, Malmö, Sweden, 2Dept. of Urology, Zhujiang Hospital, Guangzhou, China Introduction: The Lundiana Pouch for continent cutaneous diversion is a modification of the Indiana Pouch. In the former the ileocaecal valve is diminished in diameter and fixed against the caecal wall as a flap valve using stapling instruments. The pouch is drained through 2 catheters during the first 4 weeks and thereafter the patient starts intermittent self catheterization, most often using a 16 F Foley catheter.
Materials and Methods: During the years 1991-2007 continent cutaneous diversion a.m. Lundiana was performed in 200 patients. 160 patients underwent cystectomy (144 with bladder cancer and 16 with rectal or anal cancer). In 40 patients there were benign indications for the diversion. In the 114 patients who are alive follow-up is 2.5 – 19.2 years, median 9.2 years. Results: Mortality within 90 days was 2.5%. 46 patients suffered postoperative complications that required open or endoscopic surgery or placement of drainage tubes in 25. Some patients had early tumour recurrence and the catheters draining the pouch were not removed.Evaluation of the functional results is based on 191 patients who started intermittent self catheterization. Revision of the outlet due to incontinence or, in two cases, due to difficult catheterization was performed in 13 patients. Revision of the stoma due to stenosis was done in 14 patients. 14 patients suffered from episodes of difficult catheterization. Pouch stones developed in 22 patients and in 2 patients the pouch had to be augmented due to poor capacity. Rupture/perforation of the pouch occurred in 8 patients. In one patient the pouch was removed and an ileal conduit was fashioned after failed revision of the outlet due to incontinence.Continence was achieved in 177 patients. Continence was achieved less often among patients with benign disorders (33/39 vs 144/152; p⫽0.04) and in that group reoperation was more common (18/39 vs 31/152; p⬍0.001). Conclusions: Continent cutaneous diversion a.m. Lundiana gives excellent functional results. However, complications from the reservoir and the outlet are not uncommon, especially among patients diverted due to benign disorders. Patients who have undergone urinary diversion need lifelong control over their urinary tracts.
UP-03.161 The Diagnostic Role of Transabdominal Ultrasonographic Bladder Wall Thickness in the Female Urinary Incontinence Ozturk H1, Aydur E2, Irkilata H2, Seckin B3, Dayanc M2 1 Military Hospital, Izmir, 2Dept. of Urology, Gulhane Military Medical Academy, Ankara, 3Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya, Turkey Introduction and Objective: Urinary
UROLOGY 78 (Supplement 3A), September 2011
incontinence is the disease that mostly affects women worldwide and impaired quality of life. Initial clinical assessment performed in most patients is usually ineffective and urodynamic examination generally provides definitive diagnosis. However, urodynamics is not practical in all patients. Thus, the diagnosis of urinary incontinence needs useful and practical methods. Materials and Methods: The study was performed at our institution between January 2003 and March 2006. The aim of the study was to determine the diagnostic role of bladder wall thickness measured by transabdominal ultrasonography in the 82 female patients recruited from outpatient clinic. Forty-three patients were diagnosed as genuine stress incontinence (GSI) and 39 had non-neurogenic detrusor overactivity (NNDO) after diagnostic workup including urodynamic assessment, while 31 women patients without lower urinary tract symptoms served as a control group. The bladder wall thickness was measured transabdominally at supine position in three separate places of the bladder with a volume of 200 ml; the anterior wall, the right and the left lateral wall of the bladder. Data from 3 groups was compared statistically. Results: There was no significant correlation between mean bladder wall thickness and age in the whole study group and all subgroups. Examination of the 95% confidence intervals reveals no overlap in all diagnostic subgroups. Mean bladder wall thickness was found to be significantly different in all of the diagnostic groups and whole study group. The positive predictive value of diagnosing NNDO in women with a mean bladder wall thickness ⱖ 4.88mm was 53.9% and negative predictive value was 90%. Using a mean bladder wall thickness greater than 4.88mm. as a cut- off value, sensitivity was 87.1%, and specificity was 60.8% for diagnosis of NNDO. Conclusions: The prospective case-control study assessed the diagnostic role of bladder wall thickness measurement by 2D-transabdominal ultrasonography reveals that bladder wall thickness measurement is a useful and sensitive screening test in the diagnosis of both urge incontinence from NNDO and stress incontinence from GSI.
UP-03.162 Assessment of Effects of Pelvic Floor Muscle Exercises Performed With Music Honda S, Inoue K, Kobara C, Arichi N,
S397