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Inderbir S. Gill - One of the best experts on this subject based on the ideXlab platform.
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Robotic intracorporeal Urinary Diversion: state of the art.
Current opinion in urology, 2019Co-Authors: Giovanni Cacciamani, Nieroshan Rajarubendra, Walter Artibani, Inderbir S. GillAbstract:PURPOSE OF REVIEW We review historical aspects and current status of the emerging approach of robotic Urinary Diversion (rUD). Established surgical principles of constructing a low-pressure, large-capacity reservoir are described and the open surgical literature succinctly reviewed to establish the gold standard. Incontinent and continent rUD types [ileal conduit, orthotopic neobladder (all varieties), continent cutaneous Diversion, cutaneous ureterostomy] and techniques (extra-corporeal, intra-corporeal) are discussed. Outcomes data (intra-operative, perioperative, intermediate-term, long-term), functional outcomes, complications and learning curve are presented. Outcomes data of open versus robotic Urinary Diversion are examined. Critiques, improvements, and pros-cons of rUD are discussed. RECENT FINDINGS Although the majority of centers performing rUD use the extracorporeal technique, use of intra-corporeal rUD is increasing. Although data are yet limited, intra-corporeal rUD may provide some benefits. For rUD, operative times are higher and complication rates comparable with open Urinary Diversion. SUMMARY The entire range of Urinary Diversion surgery has now been replicated robotically. At this writing, extracorporeal Urinary Diversion techniques still predominate following robotic cystectomy. However, all rUD options can now be performed intra-corporeally with success. As experience increases, the field of robotic Urinary Diversion is poised to grow.
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robotic intracorporeal Urinary Diversion practical review of current surgical techniques
The Italian journal of urology and nephrology, 2017Co-Authors: Fabrizio Dal Moro, Inderbir S. Gill, Arnulf Stenzl, Georges Pascal Haber, Peter Wiklund, Abdullah Erdem Canda, Mevlana Derya Balbay, Filiberto Zattoni, Joan Palou, James W F CattoAbstract:In this practical review, we discuss current surgical techniques reported in the literature to perform intracorporeal Urinary Diversion (ICUD) after robotic radical cystectomy (RARC), emphasizing criticisms of single approaches and making comparisons with extracorporeal Urinary Diversion (ECUD). Although almost 97% of all RARCs use an ECUD, ICUD is gaining in popularity, in view of its potential benefits (i.e., decreased bowel exposure, etc.), although there are a few studies comparing ICUD and ECUD. Analyzing single experiences and the data from recent metanalyses, we emphasize the current critiques to ICUD, stressing particular technical details which could reduce operative time, lowering the postoperative complications rate, and improving functional outcomes. Only analysis of long-term follow-up data from large-scale homogeneous series can ascertain whether robotic intracorporeal Urinary Diversion is superior to other approaches.
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Robotic Urinary Diversion: the range of options.
Current opinion in urology, 2016Co-Authors: Sameer Chopra, Andre Luis De Castro Abreu, Inderbir S. GillAbstract:Purpose of reviewTo review current status and controversies on robotic intracorporeal Urinary Diversion (RICUD). We discuss the current status of Urinary Diversion, including complications and current types of RICUD, the available options for RICUD going forward for robotic radical cystectomy (RRC)
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Laparoscopic Urinary Diversion.
World journal of urology, 2000Co-Authors: Amr Fergany, Andrew C. Novick, Inderbir S. GillAbstract:Urinary Diversion, in conjunction with cystectomy or as an isolated procedure, has traditionally been performed using open surgical technique. Laparoscopic Urinary Diversion has only recently been reported. We review the available literature on laparoscopic Urinary Diversion and present some of the experimental and clinical studies that have attempted to overcome the technical difficulties of the procedure. In addition, the indications, results, and future directions of laparoscopic Urinary Diversion are discussed.
Giacomo Passerini Glazel - One of the best experts on this subject based on the ideXlab platform.
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Kidney transplantation into bladder augmentation or Urinary Diversion: long-term results.
Transplantation, 2005Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini GlazelAbstract:We report on a single-institutional experience with renal transplantation in patients with severe lower Urinary tract dysfunction (LUTD) who underwent bladder augmentation or Urinary Diversion, and assess the long-term results. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone bladder augmentation or Urinary Diversion. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with bladder augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent Urinary Diversion were reported. In the first group, surgical complications after kidney transplantation included one Urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent Urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Drainage of transplanted kidneys into an augmented bladder or Urinary Diversion is an appropriate management strategy when the native bladder is unsuitable. Kidney transplantation in patients with bladder augmentation or Urinary Diversion for LUTD let achieve similar results to those obtained in the general population with normal lower Urinary tracts.
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kidney transplantation into bladder augmentation or Urinary Diversion long term results
Transplantation, 2005Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini GlazelAbstract:Background. We report on a single-institutional experience with renal transplantation in patients with severe lower Urinary tract dysfunction (LUTD) who underwent bladder augmentation or Urinary Diversion, and assess the long-term results. Methods. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone bladder augmentation or Urinary Diversion. Results. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with bladder augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent Urinary Diversion were reported. In the first group, surgical complications after kidney transplantation included one Urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent Urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Conclusions. Drainage of transplanted kidneys into an augmented bladder or Urinary Diversion is an appropriate management strategy when the native bladder is unsuitable. Kidney transplantation in patients with bladder augmentation or Urinary Diversion for LUTD let achieve similar results to those obtained in the general population with normal lower Urinary tracts.
Richard E. Hautmann - One of the best experts on this subject based on the ideXlab platform.
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Urinary Diversion how experts divert
Urology, 2015Co-Authors: Richard E. Hautmann, Wiking Mansson, Robert D Mills, Cheryl T. Lee, Urs E. Studer, Hassan Abolenein, David F Penson, Eila C Skinner, Joachim W Thueroff, Bjoern G. VolkmerAbstract:To determine the rates of the available Urinary Diversion options for patients treated with radical cystectomy for bladder cancer in different settings (pioneering institutions, leading urologic oncology centers, and population based).
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Complications associated with Urinary Diversion
Nature Reviews Urology, 2011Co-Authors: Richard E. Hautmann, Stefan H. Hautmann, Oliver HautmannAbstract:Radical cystectomy (RC) and subsequent Urinary Diversion has been assessed to be the most difficult surgical procedure in the field of urology No randomized trials have been performed to compare the outcomes of noncontinent conduit Diversion, neobladder construction and continent cutaneous Diversion Significant disparity in the quality of surgical complication reporting has made it impossible to compare surgical morbidity in patients who have undergone RC; there is a clear case for the standardized reporting of complications Overall, the perioperative surgical morbidity following RC and Urinary Diversion is significant and, when strict reporting guidelines are incorporated, much higher than previously published Complications can occur up to 20 years after surgery, emphasizing the need for close monitoring of these patients and more long-term studies to determine the full morbidity spectrum Evidence suggests an association between volume and outcome in cystectomy procedures; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons Radical cystectomy (RC) with subsequent Urinary Diversion has been assessed to be the most difficult surgical procedure in the field of urology. No randomized trials have been performed to compare the outcomes of noncontinent conduit Diversion, neobladder construction and continent cutaneous Diversion. Almost all studies are of level 3 evidence, meaning the recommendations given in this Review are of grade C only. Until recently, significant disparity in the quality of surgical complication reporting, as well as the lack of universally accepted reporting guidelines, definitions and grading systems, have made it impossible to compare the surgical morbidity and outcomes of RC. There is a clear case for the standardized reporting of complications. The Clavien system is a straightforward and validated instrument that has already been successfully adopted by several urological centers. Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for more long-term studies to determine the full morbidity spectrum. In general, renal function after construction of continent detubularized reservoirs compares favorably with ileal conduit Diversion, although the literature is insufficient to recommend one over the other. The challenge of optimum care for elderly patients with comorbidities is best mastered at a high-volume hospital by a high-volume surgeon. Radical cystectomy with subsequent Urinary Diversion has been assessed the most difficult surgical procedure in the field of urology. In this Review, the authors discuss the need for standardized reporting of complications after Urinary Diversion, and summarize our current knowledge of the complications associated with different Diversion techniques.
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Pregnancy and Urinary Diversion.
The Urologic clinics of North America, 2007Co-Authors: Richard E. Hautmann, Bjoern G. VolkmerAbstract:In most children or premenopausal women who need Urinary Diversion, the underlying disease is benign. After the problems associated with Urinary incontinence have been resolved, and patients have reached puberty, sexuality and fertility become more significant. In women with Urinary Diversion, numerous influencing factors exist, including, but not limited to, the underlying disease and form of Urinary Diversion. The authors' center has a large expertise in Urinary Diversion, although the number of cases with pregnancies is limited. This article uses this prior experience and data from a literature review to provide guidance for urologists, obstetricians, general practitioners, and patients to aid decision making in pregnancies after Urinary Diversion.
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Urinary Diversion.
Urology, 2007Co-Authors: Richard E. Hautmann, Hassan Abol-enein, Khaled Hafez, Isao Haro, Wiking Mansson, Robert D Mills, James D Montie, Arthur I Sagalowsky, John P SteinAbstract:A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) met to critically review reports of Urinary Diversion. The world literature on Urinary Diversion was identified through a Medline search. Evidence-based recommendations for Urinary Diversion were prepared with reference to a 4-point scale. Many level 3 and 4 citations, but very few level 2 and no level 1, were noted. This outcome supported the clinical practice pattern. Findings of >300 reviewed citations are summarized. Published reports on Urinary Diversion rely heavily on expert opinion and single-institution retrospective case series: (1) The frequency distribution of Urinary Diversions performed by the authors of this report in >7000 patients with cystectomy reflects the current status of Urinary Diversion after cystectomy for bladder cancer: neobladder, 47%; conduit, 33%; anal Diversion, 10%; continent cutaneous Diversion, 8%; incontinent cutaneous Diversion, 2%; and others, 0.1%. (2) No randomized controlled studies have investigated quality of life (QOL) after radical cystectomy. Such studies are desirable but are probably difficult to conduct. Published evidence does not support an advantage of one type of reconstruction over the others with regard to QOL. An important proposed reason for this is that patients are subjected preoperatively to method-to-patient matching, and thus are prepared for disadvantages associated with different methods. (3) Simple end-to-side, freely refluxing ureterointestinal anastomosis to an afferent limb of a low-pressure orthotopic reconstruction, in combination with regular voiding and close follow-up, is the procedure that results in the lowest overall complication rate. The potential benefit of "conventional" antireflux procedures in combination with orthotopic reconstruction seems outweighed by the higher complication and reoperation rates. The need to prevent reflux in a continent cutaneous reservoir is not significantly debated, and this should be done. (4) Most reconstructive surgeons have abandoned the continent Kock ileal reservoir largely because of the significant complication rate associated with the intussuscepted nipple valve.
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Urinary Diversion
Urology, 2007Co-Authors: Richard E. Hautmann, Hassan Abol-enein, Khaled Hafez, Isao Haro, Wiking Mansson, Robert D Mills, James D Montie, Arthur I Sagalowsky, John P Stein, Arnulf StenzlAbstract:A consensus conference convened by the World Health Organization (WHO) and the Societe Internationale d'Urologie (SIU) met to critically review reports of Urinary Diversion. The world literature on Urinary Diversion was identified through a Medline search. Evidence-based recommendations for Urinary Diversion were prepared with reference to a 4-point scale. Many level 3 and 4 citations, but very few level 2 and no level 1, were noted. This outcome supported the clinical practice pattern. Findings of > 300 reviewed citations are Summarized. Published reports on Urinary Diversion rely heavily on expert opinion and single-institution retrospective case series: (1) The frequency distribution of Urinary Diversions performed by the authors of this report in > 7000 patients with cystectomy reflects the current status of Urinary Diversion after cystectomy for bladder cancer: ncobladder, 47%; conduit, 33%; anal Diversion, 10%; continent cutaneous Diversion, 8%; incontinent cutaneous Diversion, 2%; and others, 0.1%. (2) No randomized controlled studies have investigated quality of life (QOL) after radical cystectomy. Such studies are desirable but are probably difficult to conduct. Published evidence does not Support an advantage of one type of reconstruction over the others with regard to QOL. An important proposed reason for this is that patients are subjected preoperatively to method-to-patient matching, and thus are prepared for disadvantages associated with different methods. (3) Simple end-to-side, freely refluxing ureterointestinal anastomosis to an afferent limb of a low-pressure orthotopic reconstruction, in combination with regular voiding and close follow-up, is the procedure that results in the lowest overall complication rate. The potential benefit of "conventional" antireflux procedures in combination with orthotopic reconstruction seems outweighed by the higher complication and reoperation rates. The need to prevent reflux in a continent cutaneous reservoir is not significantly debated, and this should be done. (4) Most reconstructive surgeons have abandoned the continent Kock ileal reservoir largely because of the significant complication rate associated with the intussuscepted nipple valve
R. Hohenfellner - One of the best experts on this subject based on the ideXlab platform.
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Quality of life and health in patients with Urinary Diversion: a comparison of incontinent versus continent Urinary Diversion.
European urology, 1997Co-Authors: D. Filipas, Margit Fisch, J. Fichtner, Ulrich T. Egle, Christiane Büdenbender, Sven Olaf Hoffmann, R. HohenfellnerAbstract:Objective: To compare the quality of life and health in patients with incontinent and continent Urinary Diversions, in correlation with the initial diagnosis, Diversion-related symptoms, psychological status and employment status. Materials and Methods: 81 patients (64% male and 36% female) with a mean age of 55 years (18-65 years) were included in this retrospective study. A total of 27 had an incontinent Urinary Diversion (group A) and 54 a continent Diversion (group B). The initial diagnosis was malignant tumor in 75% (n = 61) and nontumor disease in 25% (n = 20). A structured interview and psychometric instrument assessment of the quality of life as well as somatic and psychological symptoms were carried out and analyzed. Results: Patients with nontumor disease, a continent reservoir and employment tended to have the highest level of quality of life. The higher the number and severity of psychological symptoms, such as depression and anxiety, the lower the level of global satisfaction with life, health and Urinary Diversion, and vice versa. No difference was seen between groups A and B concerning Diversion-related symptoms, global satisfaction with life and health and sociodemographic data. Conclusions : The decision for a continent versus an incontinent Urinary Diversion must consider not only the medical factors of each individual patient, but also the initial diagnosis, psychological condition and employment status.
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Appendiceal continence mechanisms in continent Urinary Diversion
World journal of urology, 1996Co-Authors: J. Fichtner, Margit Fisch, R. HohenfellnerAbstract:The creation of a safe, reliable, and easy-to-perform continence mechanism remains one of the most important problems during continent Urinary Diversion. The advent of the use of the appendix as an efferent segment brought through the umbilicus has greatly facilitated surgical procedures with very favorable results. Our experience with the insitu appendix as an efferent segment during continent cutaneous Urinary Diversion using the Mainz-pouch I technique over the past 6 years revealed a markedly decreased complication rate of 3.2% as compared with 7.2% in patients who received an ileocecal intussusception nipple. The routine use of the appendix as a continence mechanism during continent Urinary Diversion has proved to be a most valuable addition to our surgical armentarium.
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Pediatric Urinary Diversion: review and own experience.
European urology, 1992Co-Authors: R. Wammack, Margit Fisch, R. HohenfellnerAbstract:New insights into the diseases of childhood, profound improvements and new developments in surgical techniques as well as the knowledge gained from long-term follow-up have altered the strategies and indications for Urinary Diversion in childhood. Continent Urinary Diversion is generally the method of choice. We are able to construct high capacity, low pressure reservoirs to protect the upper Urinary tract and achieve continence. Nowadays, there is hardly any indication for permanent cutaneous Urinary Diversion. Temporary and intermediate cutaneous Diversion are used only when serious conditions such as renal function deterioration occur. The possibility to convert any incontinent form of Urinary Diversion into a continent form changed the status of intermediate Diversion. The indications for Urinary Diversion, the procedures available, the operative technique, a literature review, our own experience, contemporary strategies and controversies are described and discussed.
Waifro Rigamonti - One of the best experts on this subject based on the ideXlab platform.
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Kidney transplantation into bladder augmentation or Urinary Diversion: long-term results.
Transplantation, 2005Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini GlazelAbstract:We report on a single-institutional experience with renal transplantation in patients with severe lower Urinary tract dysfunction (LUTD) who underwent bladder augmentation or Urinary Diversion, and assess the long-term results. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone bladder augmentation or Urinary Diversion. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with bladder augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent Urinary Diversion were reported. In the first group, surgical complications after kidney transplantation included one Urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent Urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Drainage of transplanted kidneys into an augmented bladder or Urinary Diversion is an appropriate management strategy when the native bladder is unsuitable. Kidney transplantation in patients with bladder augmentation or Urinary Diversion for LUTD let achieve similar results to those obtained in the general population with normal lower Urinary tracts.
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kidney transplantation into bladder augmentation or Urinary Diversion long term results
Transplantation, 2005Co-Authors: Waifro Rigamonti, Alfio Capizzi, Graziella Zacchello, Vincenzo Capizzi, Giovanni Franco Zanon, Giovanni Montini, Luisa Murer, Giacomo Passerini GlazelAbstract:Background. We report on a single-institutional experience with renal transplantation in patients with severe lower Urinary tract dysfunction (LUTD) who underwent bladder augmentation or Urinary Diversion, and assess the long-term results. Methods. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone bladder augmentation or Urinary Diversion. Results. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with bladder augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent Urinary Diversion were reported. In the first group, surgical complications after kidney transplantation included one Urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent Urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Conclusions. Drainage of transplanted kidneys into an augmented bladder or Urinary Diversion is an appropriate management strategy when the native bladder is unsuitable. Kidney transplantation in patients with bladder augmentation or Urinary Diversion for LUTD let achieve similar results to those obtained in the general population with normal lower Urinary tracts.
