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To outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. We identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate 2 years after surgery. Additionally, we present the 30-day postoperative complication rate. Fifty underwent transoblique conduits and we matched them to 190 transrectus patients. Sixty-seven percent were men with a median age of 62. Exactly 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The 2-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least 1 postoperative complication. A transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates. [ABSTRACT FROM AUTHOR]

Purpose: To describe and evaluate safety and feasibility of the robotic modified Sugarbaker technique with intraperitoneal underlay mesh (IPUM) for repairing parastomal hernias associated with ileal conduits (ICPSH). Methods: This retrospective, single-center cohort study analyzed data from 15 adult patients who underwent robotic ICPSH repair using the modified Sugarbaker IPUM technique between July 2021 and July 2023. The primary endpoints were hernia recurrence rates and 30-day morbidity. Secondary endpoints included length of stay, conversion to open surgery, 30-day readmission, and 30-day reoperation. Results: The mean patient age was 69.1 years, and 53.3% were female. Most patients (86.6%) had undergone radical cystectomy as the index surgery. The mean operative time was 249 min, with no conversions to open surgery. The 30-day complication rate was 26.7%, and the mean hospital stay was 3.6 days. No hernia recurrences, hydronephrosis, rise in creatinine or distended conduit on imaging suggesting poor drainage were observed during a mean follow-up of 15.2 months. Conclusions: The robotic modified Sugarbaker IPUM technique appears safe and feasible for PSH repair in IC patients, with promising short-term outcomes. Further studies with larger cohorts and longer follow-up are needed to confirm its long-term efficacy and establish its role in ICPSH management. [ABSTRACT FROM AUTHOR]

Background: The incidence of urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD), the typical pathogens, and associated patient risk factors have not been well documented. In this study, we examined the incidence of post-op UTIs after RC to identify associated risk factors. Methods: Single-center, retrospective case series of 386 patients with bladder cancer who underwent RC with UD between 2012 and 2024. The primary objective was UTI incidence, defined by the frequency of patients with urine culture with >105 colony-forming units per high-powered field, spanning from post-op day 0 (POD0) to 90 days after discharge. Isolated pathogens were reported. Risk factors for UTIs were assessed. Results: The average age was 69 years old at surgery, and patients were predominantly male (80%). The cumulative incidence of post-op UTIs was 14%, among which 12 patients had more than one UTI. The UTI incidence was 2%, 8%, and 7% during the immediate post-op period, within 30 days, and within 31–90 days, respectively. Isolated pathogens included Escherichia coli (26%), Enterococcus faecalis (24%), Klebsiella pneumoniae (21%), and Pseudomonas species (21%). In the immediate post-op period, female sex was the only significant risk factor. At 31 to 90 days, cutaneous ureterostomy UD was the predominant risk factor for UTIs. For ileal conduit patients, those with a Wallace ureteral anastomosis were associated with UTI 31–90 days from discharge for RC. Conclusions: Our retrospective data suggests the incidence of UTIs and their causative pathogens after RC differ based on post-operative time points and vary according to different patient risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder. Methods: From a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs. Results: The study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively. Conclusions: Robot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether preoperative body morphometry analysis can identify patients at risk of parastomal hernia (PH), which is a common complication after radical cystectomy (RC). Patients and Methods: All patients who underwent RC between 2010 and 2020 with available cross‐sectional imaging preoperatively and at 1 and 2 years postoperatively were included. Skeletal muscle mass and total fat mass (FM) were determined from preoperative axial computed tomography images obtained at the level of the L3 vertebral body using Aquarius Intuition software. Sarcopenia and obesity were assigned based on consensus definitions of skeletal muscle index (SMI) and FM index (FMI). PH were graded using both the Moreno‐Matias and European Hernia Society criteria. Binary logistic regression and recursive partitioning were used to identify patients at risk of PH. The Kaplan–Meier method with log‐rank and Cox proportional hazards models included clinical and image‐based parameters to identify predictors of PH‐free survival. Results: A total of 367 patients were included in the final analysis, with 159 (43%) developing a PH. When utilising binary logistic regression, high FMI (odds ratio [OR] 1.63, P < 0.001) and low SMI (OR 0.96, P = 0.039) were primary drivers of risk of PH. A simplified model that only relied upon FMI, SMI, and preoperative albumin improved the classification of patients at risk of PH. On Kaplan–Meier analysis, patients who were obese or obese and sarcopenic had significantly worse PH‐free survival (P < 0.001). Conclusion: Body morphometry analysis identified FMI and SMI to be the most consistent predictors of PH after RC. [ABSTRACT FROM AUTHOR]

Background: Radical cystectomy (RC) with the formation of an ileal orthotopic neobladder (ONB) may adversely affect long-term health-related quality of life (HRQOL). An advanced age at the time of ONB construction could further exacerbate the decline in HRQOL. This study aims to establish an evidence-based age threshold at the time of RC with ONB, beyond which a significant deterioration in HRQOL is observed. Methods: We retrospectively analyzed all bladder cancer patients in our department between 2013 and 2022 that fulfilled the EORTC-QLQ-C30 questionnaire preoperatively, as well as at 3 and 12 months after RC with ONB. Patients receiving neoadjuvant or adjuvant chemotherapy or benign/palliative RC were excluded. Results: Overall, 120 patients (81% males) with a mean age of 66 ± 9.6 years underwent RC with ONB and fulfilled the selection criteria. The Global Health Status (GHS) of the EORTC-QLQ-C30 was 64 ± 23 preoperatively, was 64 ± 20 three months postoperatively, and was 68 ± 23 twelve months postoperatively. Overall, 80 (67%) patients presented an increase in GHS at twelve months compared to their preoperative values. The perioperative complications did not differ between patients with decreased and increased GHS. Patients with increased GHS had values of 58 ± 24 preoperatively, 67 ± 19 at 3 months, and 77 ± 16 at 12 months. Patients with decreased GHS had values of 76 ± 16 preoperatively, 57 ± 21 at 3 months, and 50 ± 25 at 12 months. Using ROC analyses with Youden's index, we defined a threshold of 70 years, after which RC with ONB may lead to worse GHS twelve months postoperatively. Worse continence outcomes were the only perioperative and long-term parameters that predicted worse HRQOL in elderly patients. Conclusions: Based on HRQOL, we suggest that RC with an ileal conduit as a urinary diversion should be recommended in patients older than 70 years. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES). Methods: The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates. Results: We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2–5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3 cm, p = 0.007). Conclusion: In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis. [ABSTRACT FROM AUTHOR]

Introduction: Peritonitis due to Hollow viscus perforation is the commonest cause for the acute abdomen next to Acute appendicitis. It is the most common emergency surgery done for a case of acute abdomen. Among the cases of hollow viscus perforation Duodenal and Gastric perforations are the commonest, followed by Ileal, Appendicular, and large bowel. The incidence of Gastric perforation is on the rise followed by the Ileal perforation accounting for about 20% of total hollow viscus perforation. Among the causes for Enteric perforation, Typhoid ileal perforation is common. Aim: To study the Enteric Perforation due to Typhoid. Objectives: 1. To study the incidence of Ileal perforation in relation to age and sex. 2. To evaluate the mode of clinical presentation in patients with ileal perforation due to typhoid. 3. To study the management and outcome of patients with ileal perforation due to typhoid. Study Design: Prospective observational study. Study Population: All patients presenting to emergency and surgical OPD with symptoms of peritonitis (hollow viscus perforation). Materials And Methods: This study was done in the Department of General Surgery, SVRRGGH, Tirupathi. The materials for the study were collected from patients presenting to the surgical outpatient department and emergency with features of hollow viscus perforation during the period of December, 2020- December 2021 were included in the study. Inclusion Criteria: 1. Patients with age above 18 years present with features of hollow viscus perforation. 2. Patients with intraoperative findings of ileal perforation. 3. Patient who gave consent for emergency exploratory laparotomy. Exclusion Criteria: 1. Patients with the intraoperative finding of hollow viscus perforation other than ileal perforation. 2. Patients with cardiovascular, pulmonary disease. Observation And Results: This study shows the common etiology of Ileal perforation was Typhoid (Enteric fever) accounting for 83% followed by Tuberculosis 8%. The average age of presentation was between 20 and 40 years. There was a male preponderance with 70%. The majority of the cases accounting for 53% were seen during the 3rd and 4th week of the typhoid fever. The predominant symptoms were abdominal pain and vomiting. The most common sign elicited was guarding and rigidity in all cases 100%. The most reliable test that identified perforation was x-ray 100%. The biopsy culture of the perforated ulcer edge had yielded positive results of 73% when compared to blood culture and serum widal tests. All the perforations in the present study were found within 50cm of the terminal ileum. None were noted beyond 50 cm from the ileocecal junction, due to the presence of more Peyer’s patches in the terminal ileum. 77% of ileal perforations were single in number. The primary closure and peritoneal lavage were the procedure done in 70% of cases. Postoperative complications were seen in 37%. The most common complication encountered was the Wound infection accounting for 30% overall. The re-exploration rate was 6% done in 2 cases. The mortality in the present study was 6.66%. [ABSTRACT FROM AUTHOR]

Introduction: Parastomal hernias are a challenging complication of digestive ostomies. Ileal‐conduit parastomal hernias after cystectomy have specific aspects. The aim of this study was to describe the incidence and natural history of ileal‐conduit parastomal hernias in order to guide their management, as well as to identify risk factors to prevent them. Patients and methods: All consecutive patients undergoing cystectomy with a Bricker's ileal conduit in 3 academic centers were retrospectively identified. Data were collected regarding their medical history prior to cystectomy, the operation, the postoperative period, imaging results within 5 years of follow‐up, and the onset and timing of clinically or radiologically diagnosed ICPH. Results: Among 577 patients included in the study, 115 (20.6%) developed an ICPH during the study period. Most patients did not present any symptom and the diagnosis was made at imaging in 74.8% of them. Most hernias were detected between 1 and 2 years after the cystectomy, with a mean time to diagnosis of 12.4 months. At multivariate analysis, overweight and obesity were independent risk factors for developing an ICPH (adjusted hazard ratio [aHR] 1.96; p = 0.046), while a trans‐rectus position of the ostomy was a significant protective factor (aHR 0.45; p = 0.011). Conclusions: A PH develops in almost 20% of patients after ileal conduit urinary diversion, with a mean time of onset of 12.4 months. It is often a subclinical condition detected at medical imaging. Obesity increases the risk, while passing the ileal‐conduit through the rectus muscle can help to prevent it. [ABSTRACT FROM AUTHOR]

Purpose: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. Methods: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. Results: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25–38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. Conclusion: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate. [ABSTRACT FROM AUTHOR]

This article describes the surgical technique of robotic appendiceal ureteric interposition or replacement for the management of extensive ureteric strictures. The appendix is used as a substitute for the ureter in cases where other methods are not feasible. The surgical procedure involves excision of the diseased ureteric segment, harvest of the appendix, and anastomosis of the appendix to the ureter or bladder. The study reports successful outcomes in four patients who underwent this procedure. However, further research and longer follow-up are needed to validate the long-term efficacy of this technique. [Extracted from the article]

This study aimed to determine the ileal digestible energy (IDE), apparent metabolizable energy (AME), and nitrogen-corrected AME (AMEn) of three typical cereals for quail chicks with two age periods (day 15–21 and 22–28). The experimental diets comprised a corn–soybean meal reference diet (RD), and three test diets (TD) that were fed to quail chicks in a completely randomized design with five replicates per diet and 15 birds each. The TD comprised corn, wheat, and barley that partly replaced the RD at 300 g/kg (70% reference diet + 30% test ingredient). Age did not influence the IDE, AME, and AMEn values, while the effect of ingredient type was highly significant on the energy estimates (p < 0.001). The IDE values of corn, wheat, and barley were estimated as 2924, 3440, and 3184 kcal/kg, respectively. The AME values of corn, wheat, and barley were 3519, 2979, and 2710 kcal/kg, respectively. The estimated AMEn values of corn, wheat, and barley were 3255, 2676, and 2281 kcal/kg, respectively. These findings are crucial for optimizing diet formulations to support quail growth and performance effectively, as they provide valuable insights into the energy content of different cereals for quail production. Notably, the high IDE and AME values of wheat suggest its potential as a valuable energy source for quail diets. Understanding these values can aid in formulating diets that meet the energy requirements of quail chicks, leading to improved growth rates, feed efficiency, and overall productivity in quail production systems. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Assessing the cumulative degree of bowel injury in ileal Crohn's disease (CD) is difficult. We aimed to develop machine learning (ML) methodologies for automated estimation of cumulative ileal injury on computed tomography-enterography (CTE) to help predict future bowel surgery. METHODS: Adults with ileal CD using biologic therapy at a tertiary care center underwent ML analysis of CTE scans. Two fellowship-trained radiologists graded bowel injury severity at granular spatial increments along the ileum (1 cm), called mini-segments. ML segmentation methods were trained on radiologist grading with predicted severity and then spatially mapped to the ileum. Cumulative injury was calculated as the sum (S-CIDSS) and mean of severity grades along the ileum. Multivariate models of future small bowel resection were compared with cumulative ileum injury metrics and traditional bowel measures, adjusting for laboratory values, medications, and prior surgery at the time of CTE. RESULTS: In 229 CTE scans, 8,424 mini-segments underwent analysis. Agreement between ML and radiologists injury grading was strong (κ = 0.80, 95% confidence interval 0.79-0.81) and similar to inter-radiologist agreement (κ = 0.87, 95% confidence interval 0.85-0.88). S-CIDSS (46.6 vs 30.4, P = 0.0007) and mean cumulative injury grade scores (1.80 vs 1.42, P < 0.0001) were greater in CD biologic users that went to future surgery. Models using cumulative spatial metrics (area under the curve = 0.76) outperformed models using conventional bowel measures, laboratory values, and medical history (area under the curve = 0.62) for predicting future surgery in biologic users. DISCUSSION: Automated cumulative ileal injury scores show promise for improving prediction of outcomes in small bowel CD. Beyond replicating expert judgment, spatial enterography analysis can augment the personalization of bowel assessment in CD. [ABSTRACT FROM AUTHOR]

Introduction: This randomized clinical trial evaluated the clinical outcomes of two surgical interventions for obesity treatment: single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI) and biliopancreatic diversion with duodenal switch (BPD/DS). The SADI procedure was developed as a response to the challenges posed by the BPD/DS procedure, aiming to enhance surgical efficiency, minimize postoperative risks, and maintain therapeutic efficacy. The present study primarily focused on early complications and short-term results. Methods: Fifty-six patients with a body mass index (BMI) ranging from 42 to 72 kg/m2 were randomly assigned to either the SADI or BPD/DS procedure. Parameters compared included % excess weight loss (%EWL), % total weight loss (%TWL), length of hospital stay (LOS), re-admission rates, and complications. Results: Both groups had similar demographics and baseline characteristics. SADI had a mean operating time of 109 min, significantly shorter than BPD/DS at 139 min (p < 0.001). Early complications occurred in five patients in the SADI group and in four patients in the BPD/DS group with no mortality. Median LOS was 2 days for both SADI and BPD/DS. Within 30 days, one SADI patient and three BPD/DS patients required re-admission. Serious late complications necessitating reoperation were observed in three SADI and two BPD/DS patients. After 1 year, %EWL and %TWL were similar: SADI (81.8% ± 13.6% and 40.1% ± 5.9%) and BPD/DS (84.2% ± 14.0% and 41.6% ± 6.4%). Conclusion: This trial suggests that both the SADI and BPD/DS yield comparable weight loss outcomes after 1 year, with a notable risk profile. Trial Registration: NCT 03938571 (http://www.clinicaltrials.gov) [ABSTRACT FROM AUTHOR]

Objective: Radical cystectomy with ileal conduit is the current mainstay of treatment for muscle-invasive bladder cancer and is also a high-risk procedure. Existing studies have limited targeted assessment of the efficacy and safety of this procedure, and the patient population appropriate for this procedure is still poorly defined. We sought to longitudinally analyze differences in the efficacy and safety of radical cystectomy with ileal conduit by age subgroups to assess whether the age factor should be used as an exclusion criterion when selecting this procedure. Materials and methods: We retrospectively examined the clinicopathological data of patients with MIBC treated with RC with IC at the Cancer Hospital of Harbin Medical University between February 2014 and October 2023. Additionally, we utilized clinical and pathological data from the SEER database (2000-2020) for external validation of our findings. Patients were categorized into elderly (≥70 years at diagnosis) and non-elderly (<70 years) groups. Statistical analyses included t-tests, non-parametric tests for continuous data, chi-square tests for categorical data, and Kaplan-Meier survival analysis. Results: In this study, 152 patients were included: 119 were categorized as nonelderly and 33 as elderly. For external validation, data from 416 patients in the SEER database were analyzed, with 172 classified as non-elderly and 244 as elderly. The results indicated that elderly patients were more likely to require ICU transfer postoperatively but exhibited a lower incidence of stoma inflammation. Additionally, both the data from our center and the external validation from the SEER database showed a concordance in cancer-specific survival (CSS) between the elderly and non-elderly groups. The efficacy of RC with IC was comparable in both elderly and non-elderly patients. Conclusion: For longitudinal age subgroups, RC with IC for both elderly and non-elderly MIBC had good efficacy and safety, and good quality of life after surgery. Although there are surgical and perioperative risks in elderly patients, there is no significant difference compared with non-elderly patients. In elderly patients requiring RC for bladder cancer, IC should remain the preferred mode of urinary diversion, and old age should not be used as an absolute exclusion criterion for IC. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. Methods: In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. Results: 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p < 0.001). After propensity-matching, the median OS of the NAC and non-NAC cohorts were 51.6 months and 31.3 months, respectively (p<0.001). Similarly, the median OS of responders and non-responders were 89.4 months and 26.5 months, respectively(p < 0.0001). Conclusion: In our study, we observed that NAC with RC for MIBC may help to improve OS among healthy octogenarians. Similarly, responders had better OS than non-responders. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the learning curve (LC) on perioperative and long‐term functional outcomes of a consecutive single‐centre series of robot‐assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. Patients and Methods: Patients treated between 2013 and 2022 were included, with ≥1 year of follow‐up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1‐year day‐ and night‐time continence. Uni‐ and multivariable Cox regression analyses identified predictors of day‐ and night‐time continence recovery. Day‐time continence was defined as 'totally dry' (no pads), night‐time continence as pad wetness ≤50 mL (one safety pad). Results: Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30‐day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1‐year day‐ and night‐time continence probabilities displayed a significant improving trend (day‐time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night‐time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day‐ (hazard ratio [HR] 1.008; P < 0.001) and night‐time continence (HR 1.004; P = 0.03) over time. Conclusion: Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10‐year analyses, we observed a significant improving trend for both the 1‐year day‐ and night‐time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day‐ and night‐time continence rates. [ABSTRACT FROM AUTHOR]

There is no optimal reconstruction after radical distal esophagectomy for cancers of the esophagogastric junction. We designed a novel reconstruction technique using pedicled ileocolic interposition with intrathoracic anastomosis between the esophagus and the elevated ileum. Two patients underwent the surgery. Case 1 was a 70‐year‐old man with esophagogastric junction adenocarcinoma with 3 cm of esophageal invasion. Case 2 was a 70‐year‐old man with squamous cell carcinoma of the esophagogastric junction; the epicenter of which was located just at the junction. These two patients underwent radical distal esophagectomy and pedicled ileocolic interposition with intrathoracic anastomosis. They were discharged on postoperative days 17 and 14, respectively, with no major complication. Pedicled ileocolic interposition is characterized by sufficient elevation and perfusion of the ileum, which is fed by the ileocolic artery and vein. As a result, we can generally adapt this reconstruction method to most curable esophagogastric junction cancers. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the clinical outcomes of radical cystectomy without cisplatin‐based neoadjuvant chemotherapy (NAC) and identified factors affecting the effectiveness of cisplatin‐based adjuvant chemotherapy (AC). Methods: Between September 2002 and February 2020, 288 bladder cancer patients who did not receive NAC underwent radical cystectomy. We retrospectively analyzed the recurrence rates, primary recurrence sites, recurrence‐free survival (RFS), and overall survival (OS) of 115 advanced bladder cancer patients (pT3–4 or pN1–3) who were divided into the AC and observation groups. Subgroup analysis was performed, focusing on pathological stage. Results: In total, 51 patients received AC, and 64 patients were observed. The median follow‐up duration was 95 months. The recurrence rate was lower in the AC group than in the observation group (35.3% vs. 54.7%, p = 0.041). The rate of recurrences in the lymph node area (dissection site and proximal lymph nodes) was lower in the AC group (9.8% vs. 26.6%; p = 0.031). In the subgroup analysis of patients with pN1, the probability of RFS and OS was higher in the AC group than in the observation group. The hazard ratio for RFS and OS was 0.243 (95% confidence interval [CI]: 0.077–0.768) and 0.259 (95% CI: 0.082–0.816), respectively. The 5‐year RFS and OS were significantly higher in the AC group (80.0% and 79.4%) than in the observation group (35.7% and 42.9%; p < 0.008 and p < 0.012, respectively). Conclusions: AC improved RFS and OS in patients with pN1 disease who did not receive NAC and should be considered for this population. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to describe the surgical outcome of robot‐assisted radical cystectomy and predictive factors for major complications in real‐world clinical practice at a single institution in Japan. Methods: We retrospectively analyzed 208 consecutive patients undergoing robot‐assisted radical cystectomy at our institution between 2019 and 2023. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed. Postoperative complications were defined as minor complications (Clavien–Dindo grades 1–2) or major complications (grades 3–5). Predictors of complications were examined using multivariable logistic analysis. Results: Overall, 147 men and 61 women, median age 70 years (interquartile range, 62–77), were included in this study. Median operative time and estimated blood loss were 8.4 h and 185 mL, respectively; 11 patients (5%) received intraoperative blood transfusions. For urinary diversions, ileal conduit, neobladder, and cutaneous ureterostomy were performed in 153 (74%), 49 (24%), and 6 (3%) patients, respectively. Urinary diversions were primarily performed with extracorporeal urinary diversion. In total, 140 complications occurred in 111 patients (53%) within 30 days. Of these patients, 31 major complications occurred in 28 patients, and one perioperative death (0.5%) with a postoperative cardiovascular event. Multivariable analysis showed only prolonged operative time (odds ratio: 4.34, 95% confidence interval: 1.82–10.35, p < 0.01) was the independent risk factor for major complications. Conclusions: This study reports surgical outcomes at our single institution. Prolonged operative time was a significant prognostic factor for major complications. As far as we know, this study reports the largest number of robot‐assisted radical cystectomy cases at a single center in Japan. [ABSTRACT FROM AUTHOR]

To identify the impact of the duration of peri-operative antibiotics on infectious complications following radical cystectomy. The National Surgical Quality Improvement Project (NSQIP) targeted database was queried for patients undergoing radical cystectomy from 2019 to 2021. Baseline patient characteristics were collected. Antibiotic duration was classified as <24 hours (short), 24-72 hours (intermediate) or >72 hours (long). Infectious complication data were collected including surgical site infection (SSI), urinary tract infection (UTI), organ space infection, pneumonia, sepsis, and clostridium difficile infection up to 30 days after surgery. Univariate and multivariable analyses were performed to compare duration of antibiotic therapy to infectious outcomes. Of the 4363 patients who underwent radical cystectomy, 3250 (74%), 827 (19%) and 286 (6.6%) received short, intermediate, and long duration of peri-operative antibiotics, respectively. Infectious complication occurred in 954 (22%) patients, including 227 (5.2%) SSI, 280 (6.4%) UTI, 268(6.1%) organ space infection, 87 (2%) pneumonia, and 378 (8.7%) sepsis. Clostridium difficile infection occurred in 89 (2%) patients. On multivariable analysis, there was no significant difference in overall infectious complication rates with long-duration antibiotics. However, intermediate duration of antibiotics in open surgery was associated with a decreased risk of SSI (OR 0.58; 95%CI 0.37-0.91) compared to those treated with short-term antibiotics. Despite guideline recommendations, 26% of patients in this database received >24 hours of peri-operative antibiotics without decreased risk of overall infectious complication. An intermediate course of antibiotics decreased risk of SSI in open surgery compared to the guideline recommend <24-hour course. Greater education regarding antibiotic stewardship and further studies investigating infectious complications are warranted. [ABSTRACT FROM AUTHOR]

Background: Studies of transcatheter pulmonary valve replacement (TPVR) with the Melody valve have demonstrated good clinical and hemodynamic outcomes. Our study analyzes the midterm clinical and hemodynamic outcomes for patients who underwent Melody valve implantation in Southeast Asia. Methods: Patients with circumferential conduits or bioprosthetic valves and experiencing post-operative right ventricular outflow tract (RVOT) dysfunction were recruited for Melody TPVR. Results: Our cohort (n = 14) was evenly divided between pediatric and adult patients. The median age was 19 years (8–38 years), a male-to-female ratio of 6:1 with a median follow-up period of 48 months (16–79 months), and the smallest patient was an 8-year-old boy weighing 18 kg. All TPVR procedures were uneventful and successful with no immediate mortality or conduit rupture. The primary implant indication was combined stenosis and regurgitation. The average conduit diameter was 21 ± 2.3 mm. Concomitant pre-stenting was done in 71.4% of the patients without Melody valve stent fractures (MSFs). Implanted valve size included 22-mm (64.3%), 20-mm (14.3%), and 18-mm (21.4%). After TPVR, the mean gradient across the RVOT was significantly reduced from 41 mmHg (10–48 mmHg) to 16 mmHg (6–35 mmHg) at discharge, p < 0.01. Late follow-up infective endocarditis (IE) was diagnosed in 2 patients (14.3%). Overall freedom from IE was 86% at 79 months follow-up. Three patients (21.4%) developed progressive RVOT gradients. Conclusion: For patients in Southeast Asia with RVOT dysfunction, Melody TPVR outcomes are similar to those reported for patients in the US in terms of hemodynamic and clinical improvements. A pre-stenting strategy was adopted and no MSFs were observed. Post-implantation residual stenosis and progressive stenosis of the RVOT require long term monitoring and reintervention. Lastly, IE remained a concern despite vigorous prevention and peri-procedural bacterial endocarditis prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures. Patients and methods: From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared. Results: The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC. Conclusion: IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prognostic value of T1 substaging in patients treated with bacillus Calmette‐Guérin (BCG) or immediate radical cystectomy (iRC). Materials and Methods: We performed an institutional review board‐approved retrospective study analysing non‐muscle‐invasive bladder cancer (NMIBC) patients with pT1 disease treated with either BCG or iRC between 2000 and 2020. Lamina propria (LP) invasion characteristics were extracted from the pathology report. The Kaplan–Meier method was used to calculate overall survival (OS), cancer‐specific survival (CSS) and metastasis‐free survival (MFS). Multivariable Cox models were used to determine the association between progression‐free survival (PFS) and characteristics in the BCG cohort. A logistic regression model explored the relationship between T1 substaging and upstaging to >pT2 at iRC. Results: A total of 411 T1 high‐grade patients were identified. LP invasion characteristics were as follows: not specified: 115 (28%); focal/superficial (F/S): 147 (35.8%); and extensive/multifocal (E/M): 149 (36.2%). Overall, 303 patients (73.7%) received BCG, and 108 patients (26.3%) underwent iRC. The median (interquartile range) follow‐up was 53 (32–96) months. Patients with E/M LP invasion were significantly more likely to undergo iRC (34% vs. 19%; P = 0.003). Patients with E/M LP invasion showed poorer MFS and CSS compared to those with F/S LP invasion when treated with BCG but not when treated with iRC. Among BCG‐treated patients, progression occurred in 41 patients and E/M LP invasion was independently associated with progression after BCG (hazard ratio 5.3, 95% confidence interval [CI] 2.2–13.1; P < 0.001). T1 substaging was not associated with upstaging at RC (odds ratio 3.15, 95% CI 0.82–12.12; P = 0.095). Conclusions: Extensive/multifocal LP invasion was associated with poor PFS, MFS and CSS in patients treated with BCG. T1 substaging provides valuable prognostic information and should be reported in pathology reports. [ABSTRACT FROM AUTHOR]

A study published in BJU International examined the complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction. The study analyzed data from 858 patients who underwent the procedure at 16 European centers between 2003 and 2022. The results showed a high overall rate of complications, with urinary tract infection (UTI) being the most common complication. The study highlighted the need for improvements in surgical technique and peri-operative management to reduce complications. The findings also suggested the importance of careful management of the urinary device and consideration of neoadjuvant therapy in patient care. [Extracted from the article]

Purpose: To compare the prognosis and quality of life between radical cystectomy and bladder conservative treatment for muscle invasive bladder cancer in the real world. Materials and Methods: Patients treated for muscle invasive bladder cancer without metastases were retrospectively evaluated for overall survival, progression‐free survival, and rehospitalization. Results: Of the 141 patients, 62 underwent bladder conservative treatment and 79 underwent radical cystectomy. Patients who underwent radical cystectomy had significantly better progression‐free survival (HR: 1.83, 95% CI: 1.12–3.00; p < 0.01) and overall survival (HR: 1.82, 95% CI: 0.99–3.34; p = 0.03) than those who underwent conservative treatment. However, there was no significant difference in prognosis between patients who refused to undergo radical cystectomy and those who underwent. In addition, rehospitalization rates for complications and additional treatment were significantly higher in patients who received conservative treatment (69.3% vs. 34.2%; p < 0.01), and the length of hospital stay was also prolonged compared to patients who received radical cystectomy (26 vs. 9 days; p = 0.03). Conclusions: Overall, conservative treatment had a significantly poorer prognosis than radical cystectomy, but there was no significant difference in prognosis when comparing patients who refused radical cystectomy and received conservative treatment with those who received radical cystectomy. However, hospitalization rates and length of stay were significantly worse for patients who chose conservative treatment, which may lead to a decline in quality of life. [ABSTRACT FROM AUTHOR]

To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, Boari flap, buccal ureteroplasty, and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option. We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for changes in renal function. Demographic data were analyzed and Cox proportional hazard models were performed. One hundred and fifty-eight patients were identified with median follow-up time of 40 months. Eighty-one percent had a unilateral ileal ureter creation. Fifty percent were female, median age was 53.3. Twenty-seven percent of patients had radiation-induced strictures. Preoperatively, 56.3% of patients were chronic kidney disease stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex (biologically male or female). Seventy-seven percent had no 30-day complications. Clavien complications included grade 1 (18), grade 2 (4), grade 3 (9), and grade 4 (5). Long-term complications included worsening renal function (3%), incisional hernia (8.2%), and small bowel obstruction (6.9%). Five (3.1%) patients ultimately required dialysis and 5 (3.1%) patients developed metabolic acidosis. Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis. [ABSTRACT FROM AUTHOR]

Objective: The Cancer of the Bladder Risk Assessment (COBRA) score is a practical method that can be used to predict survival in patients who have undergone radical cystectomy (RC). We aimed to evaluate COBRA scores in our patient group. Materials and Methods: Patients were classified according to tumor stage and lymph node (TLN) involvement; mortality rates and survival were analyzed according to both the TLN classification and COBRA score from the Turkish Urooncology Association database. The chi-square test and Fisher-Freeman-Halton Exact chi-square test were used to compare qualitative data as well as descriptive statistical methods. Cox regression analysis was used for multivariate analysis. KaplanMeier and log-rank tests were used for survival analysis. Results: There was a statistically significant difference between the COBRA scores and survival rates in terms of cancer-specific mortality according to TLN classification (p=0.000; p<0.05). A COBRA score of 6 was associated with a lower mortality rate than a COBRA score of 5. In the Cox regression analysis of cancer-related death, a one-unit increase in the COBRA score increased the cancer-related death rate 1.54-fold [hazard ratio (HR)=1.540; 95% confidence interval (CI)=1.402-1.691] (p<0.05). When the COBRA score was compared to 0, the highest risk was observed for COBRA 5. If the COBRA score was 5, the risk of cancerrelated death increased 14.63 times (HR=14.627; 95% CI=7.041-30.385) (p<0.05). If the COBRA score was 6, the risk of cancer-related death increased by 11.54 times (HR=11.547; 95% CI=5.270-25.278) (p<0.05). Conclusion: The COBRA score increased, the prognosis worsened, and our results are consistent with the first validated study. [ABSTRACT FROM AUTHOR]

Background: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. Methods: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. Results: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. Conclusion: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs. [ABSTRACT FROM AUTHOR]

Objectives: Our previous study suggested that the operative procedure is critical for the development of parastomal hernia. We developed a novel procedure for the creation of an ileal conduit stoma to prevent parastomal hernia. Herein we evaluate the efficacy and safety of the procedure. Methods: A total of 113 Japanese patients underwent radical cystectomy and ileal conduit diversion for bladder cancer from January 2017 through December 2021 at our institution. After excluding those with incomplete data, 103 patients consisting of 46 (44.7%) with the conventional procedure and 57 (55.3%) with the novel procedure were consecutively enrolled. The main points of the novel procedure are as follows: (1) the passage of the ileal conduit is ≤2.4 cm in diameter in principle; (2) the posterior rectus sheath and peritoneum are vertically incised 2 cm laterally from the middle of the stoma site to make an oblique passage for the ileal conduit; and (3) the anterior rectus sheath and posterior rectus sheath with peritoneum are fixed to the ileal conduit separately. Results: Radiography‐based parastomal hernia was observed in 11 patients (10.7%) with a median follow‐up of 22.0 months. The incidences of parastomal hernia were 3.5% and 19.6% in the novel and the conventional procedure groups, respectively (p = 0.011). The former had a significantly lower cumulative incidence of parastomal hernia (p = 0.008, log‐rank test). No specific complications associated with the procedure were observed. Conclusions: The results of the preliminary cohort study suggest that the novel procedure is safe and effective for the prevention of parastomal hernia. [ABSTRACT FROM AUTHOR]

To evaluate a cohort of patients diagnosed with benign ureteroenteric stricture (UES) after radical cystectomy with ileal conduits using a strict predefined definition of strictures. Additionally, we want to illustrate the UES debut, regarding symptoms and clinical findings. UES is a well-known long-term complication after radical cystectomy, affecting up to 20% of all patients. In the literature, different incidence rates are reported. However, these are based on various definitions of strictures. We used strict predefined criteria to evaluate UES incidence including symptoms, timing, diagnostic methods, treatment, and outcome in all patients who underwent radical cystectomy with an ileal conduit between 2012 and 2018 at a single high-volume center. Of a total of 693 patients who underwent radical cystectomy with ileal conduit, we found 109 patients with 135 UES in total, corresponding to 15.7% of patients (CI: 13.2-18.6) and 10% of all included ureteroenteric anastomosis (CI: 8.5-11.6) after radical cystectomy. Median follow-up was 24 months (interquartile range (IQR): 12-31), and postoperatively UES was diagnosed after a median of 6 months (IQR: 3-16). A total of 56% was diagnosed with elevated creatinine. Every UES underwent a median of two (IQR: 1-2) treatment attempts and 122 UES were treated successfully. Benign UES is a significant cause of morbidity following radical cystectomy. Our findings contribute to the knowledge of timing, incidence, and recommended treatment of strictures. We argue the importance of establishing a clear gold standard when defining UES to ensure accurate reporting in future research. [ABSTRACT FROM AUTHOR]

Background: Women's sexual health after radical cystectomy is an important but poorly understood aspect of bladder cancer survivorship. Dedicated investigation is needed to elucidate patient perceptions on sexual function and dysfunction in this setting. Aims: In this study we sought to qualitatively examine women's perceptions and experiences of sexual health following radical cystectomy for bladder cancer. Methods: We conducted one-on-one qualitative telephone interviews with 40 women who underwent radical cystectomy in the past 6 months to 5 years and signed a research consent form to be contacted for future studies. We examined women's experiences of engaging in sexual activity after surgery and their attitudes toward sex and body image. We audio recorded, transcribed, and coded the interviews using ATLAS.ti software and applied grounded theory methods for analysis. Outcomes: For data that emerged during the qualitative interviews that was related to lack of knowledge about how physical and psychological sexual health would be affected after surgery, we reviewed and discussed transcripts that enabled coding of the data into emerging topic areas. Results: Our analysis yielded 4 main themes. (1) Women reported receiving little to no information from providers about female sexual dysfunction prior to or after radical cystectomy. Women wished they had been provided more information about female sexual dysfunction from their clinicians, including strategies for postoperative self-pleasure and nonintercourse methods of sexual pleasure with partners. (2) Women shared that they were not sexually active following surgery due to physical and mental barriers. (3) When women did try to engage in sex, they described feeling disappointed that it did not feel the same as prior to surgery. (4) Some women found that physical therapy helped them to physically and mentally recover their strength to engage in sexual activity again. Clinical Implications: Clinicians must directly address sexual health concerns with patients who undergo radical cystectomy. Strengths and Limitations: This study has several key strengths. Investigation into women's sexual function and dysfunction addresses a gap in understanding of this component of women's health-related quality of life after radical cystectomy, which represents an unmet need. The large number of interviews conducted as well as the in-depth information obtained through one-on-one interviews are additional strengths. This study also has limitations, including possible shortcomings of telephone interviews compared with in-person interviews. However, telephone interviews were beneficial because the interviews took place during the COVID-19 pandemic and spared patients from extra visits or from having to travel long distances to the respective medical centers. Other possible limitations were that patients may have been reluctant to share all of their experiences and that patients who underwent urostomies, also termed ileal conduits, were overrepresented in this study compared with women who underwent continent urine diversions, which allow greater control over urine output. Conclusion: Broadening the understanding of sexual health beyond sexual intercourse to encompass sexuality and self-pleasure can provide clinicians, patients, and their families with more effective preparation and strategies to care for an essential aspect of their wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies. Materials and methods: This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement. Results: A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months. Conclusion: Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach. [ABSTRACT FROM AUTHOR]

• Prostate-capsule sparing radical cystectomy with orthotopic neobladder may improve continence and erectile function in appropriate patients. • We demonstrate similar oncologic outcomes with higher rates of clean intermittent catheterization in this patient population. • Standardized techniques and prostate cancer screening are needed for further study. Radical cystectomy (RC) is the gold standard treatment for patients with organ-confined bladder cancer. However, despite the success of this treatment, many men who undergo orthotopic neobladder substitution develop significant erectile dysfunction and urinary symptoms, including daytime and nighttime urinary incontinence. Prostate-capsule-sparing radical cystectomy (PCS-RC) with orthotopic neobladder (ONB) has been described in the literature as a surgical technique to improve functional outcomes in appropriately selected patients. We performed a systematic review and meta-analysis of manuscripts on PCS-RC with ONB published after 2000. We included retrospective and prospective studies with more than 25 patients and compared PCS-RC with nerve-sparing or conventional RC. Studies in which the entire prostate was spared (including the transitional zone) were excluded. Comparative studies were analyzed to assess rates of daytime continence, nighttime continence, and satisfactory erectile function in patients undergoing PCS-RC compared with those undergoing conventional RC. Fourteen reports were included in the final review. Our data identify high rates of daytime (83%–97%) and nighttime continence (60%–80%) in patients undergoing PCS-RC with ONB. In comparative studies, meta-analysis results demonstrate no difference in daytime continence (RR:1.12; 95% CI: 0.72–1.73) in those undergoing PCS-RC compared to those undergoing conventional RC. Similarly, nighttime continence was similar between the 2 groups (RR:1.85; 95% CI: 0.57–6.00. Erectile function was improved in those undergoing PCS-RC (RR 5.35; 95% CI: 1.82–15.74) in the PCS-RC series. Bladder cancer margin positivity and recurrence rates were similar to those reported in the literature with conventional RC with an average weighted follow-up of 52.2 months. While several studies utilized different prostate cancer (CaP) screening techniques, the rates of CaP were low (incidence 0.02; 95% CI:0.01–0.04), and oncologic outcomes were similar to standard RC. PCS-RC is associated with improved nighttime continence and erectile function compared to conventional RC techniques. Further work is needed to standardize CaP screening before surgery, but the data suggest low rates of CaP with similar oncologic outcomes when compared to RC. [ABSTRACT FROM AUTHOR]

Purpose: To compare 90-day perioperative complications and pathological outcomes between laparoscopic radical cystectomy (LRC) and extraperitoneal radical cystectomy (EORC) approaches. Materials and Methods: All operations were performed in a single high-volume tertiary referral center by the same surgical team. Males ≥ 18 years with pre-cystectomy clinical T1-T3 disease and having undergone an ileal conduit were included. Exclusion criteria included patients with inflammatory bowel disease, previous pelvic and/or abdominal irradiation, neo-adjuvant chemotherapy, and/or clinical T4 disease. Perioperative outcomes such as operative time, estimated blood loss, transfusion rate, hospital stay, and 90-day complications were evaluated. The recovery duration of regular bowel activity, mean stool passage and ileus rates were recorded. Results: A total of 221 patients met the inclusion criteria(81 LRC and 130 EORC). Demographics and preoperative parameters were comparable. Intraoperative estimated blood loss favored LRC by a median of 450 mL (200-900) (P = .021) vs. a median of 700 mL (300-2900) for EORC. The transfusion rate did not differ between the two groups; %14.8 (N = 12) for the LRC and %20.8 (N = 27) for EORC (P = .37). The median hospital stay was 9 (4-49) days for EORC and 8 (4-29) days for LRC (P = .011). The need for analgesics to control pain through an epidural catheter was higher for EORC (P = .042). There was no difference in overall complication rates (P = .47). Conclusion: Although LRC appears to have a slight advantage over EORC, both techniques yield satisfactory results in regard to ileus rates and 90-day perioperative complications. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the risk factors associated with failure to complete gemcitabine-cisplatin (GP) neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC). Materials and Methods: In total, 231 patients with MIBC treated with NAC before undergoing radical cystectomy between 2013 and 2022 participated in this study. Logistic regression analysis was performed to assess the relationship between the likelihood of incomplete NAC and clinical and demographic variables, including age, sex, hypertension (HTN), diabetes mellitus (DM), prechemotherapy glomerular filtration rate, clinical T stage, clinical N stage, and body mass index (BMI). Results: Of 231 patients, 209 (90.5%) and 22 (9.5%) completed and discontinued the NAC course, respectively. The mean age was 66.13±9.15, 65.63±9.07, and 70.86±8.66 years for the total sample, continuation, and discontinuation groups, respectively (p=0.010). No significant inter-group differences in sex, HTN, height, weight, BMI, pre-chemotherapy glomerular filtration rate, clinical T stage, or clinical N stage were observed. According to the results of the multivariable analysis, age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.013-1.143, p=0.018) and the presence of DM (OR 2.541, 95% CI 1.028-6.281, p=0.043) were significantly associated with NAC discontinuation. Conclusions: Thus, older age and presence of DM are potential risk factors for GP NAC discontinuation in patients with MIBC. Further studies are required to validate our findings and develop strategies to minimize the rate of GP NAC discontinuation in this population. [ABSTRACT FROM AUTHOR]

Objective: To report the incidence of malignancy in gynaecological organs removed during radical cystectomy (RC). Patients and Methods: A retrospective multicentre study of 1600 RCs at three high‐volume institutions between January 2009 and March 2022 was performed. Pathological findings in gynaecological organs in female RC specimens were reviewed. Multivariable logistic regression analyses were used to identify predictors of malignant gynaecological organ involvement (GOI) at time of RC. Results: Overall, 302 females with a median (interquartile range) age of 68 (61–75) years underwent RC for clinical (c)Ta–T4 bladder cancer. In all, 56 patients (18.5%) received neoadjuvant chemotherapy. Malignant GOI was seen in 20 patients (6.6%); the most common single sites of GOI were the uterus (five patients) and vaginal wall (four), followed by cervix (one), and ovaries (one). Nine patients had involvement of more than one gynaecological organ. No females had a primary gynaecological malignancy detected incidentally at RC. Patients with GOI were more likely to have cT3/T4 stage (P < 0.001), preoperative hydronephrosis (P = 0.004), lymphovascular invasion (P = 0.002), and squamous cell carcinoma (P = 0.005) than those without GOI. On multivariable analysis, cT4 stage was an independent predictor of malignant GOI (odds ratio 88.3, 95% confidence interval 10.1–1214; P < 0.001). Conclusion: To our knowledge, we present the largest multi‐institutional study examining malignant GOI in females with bladder cancer undergoing RC. The rate of GOI at the time of RC is low and associated with higher clinical stage. In the absence of clinical or radiological evidence of sexual organ involvement, our results do not support their routine removal at the time of RC. [ABSTRACT FROM AUTHOR]

Background: Neutrophil-to-lymphocyte ratio (NLR), a widely assessed biomarker in most common diseases, is typically evaluated before treatment initiation. However, data on NLR in the post-treatment setting is limited. Therefore, we assessed the NLR calculated after neoadjuvant chemotherapy (NAC) initiation in patients with bladder cancer (BC). We hypothesised that changes in blood cells after NAC could be a marker of tumour response and long-term survival. Materials and Methods: Our study included 214 patients who underwent NAC followed by radical cystectomy (RC) in two urological departments, wherein post-NAC NLR was used to categorize patients into the low (NLR ≤ 1.75) and high (NLR > 1.75) groups. Results: Logistic regression analysis indicated that a post-NAC NLR ≥ 1.75 is a good biomarker for pathologic response (odds ratio (OR), 0.045; p <0.001), emphasizing its ability to predict patient survival. The HRs for overall survival and cancer-specific survival were 2.387 (p = 0.048) and 2.342 (p < 0.001), respectively. Conclusions: We believe that post-NAC NLR can be used for patient stratification after NAC. Consequently, the post-NAC NLR may serve as a guide for the decision-making process regarding RC versus bladder-preserving strategies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of robot‐assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients. Methods: We retrospectively analyzed 122 patients who underwent robot‐assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence‐free survival, cancer‐specific survival, and overall survival were compared between the cohorts. Results: The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30‐day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence‐free survival, cancer‐specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer‐specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high‐grade complications and cancer‐specific survival. Conclusions: Robot‐assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to present the surgical technique and clinical outcomes of modified ileal conduit for pelvic lipomatosis (PL). Methods: From 2020 to 2022, we prospectively enrolled 9 patients with PL undergoing modified ileal conduit. The patient characteristics, perioperative variables, and follow-up outcomes as well as the description of surgical technique were reported. Results: All 9 patients successfully completed the operation. Two patients had perioperative complications of Clavien-Dindo grade I. The mean operation time and bleeding volumes were 253 ± 51.4 min and 238.9 ± 196.9 mL, with a mean postoperative follow-up time of 13.0 ± 5.6 months. The postoperative 3-month and 1-year creatinine values were significantly decreased versus the preoperative (p = 0.006 and p = 0.024). The postoperative 3-month and 1-year estimated glomerular filtration rate values were significantly increased compared with those before operation (p = 0.0002 and p = 0.018). The separation value of left renal pelvis collection system after operation was significantly reduced compared with preoperative evaluation (p = 0.023 at 3 months and p = 0.042 at 1 year) and so was the right side (p = 0.019 and p = 0.023). Conclusion: Modified ileal conduit is safe and feasible for PL. A large sample cohort with long-term follow-up is needed to evaluate the clinical outcomes of PL. [ABSTRACT FROM AUTHOR]

Several techniques are described for intracorporeal neobladder during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted orthotopic neobladder reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others. [ABSTRACT FROM AUTHOR]

Introduction Robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (LS) are the main options for ileal ureteral replacement (IUR). It is not clear which option is superior. The purpose of this study is to compare RALS and LS for IUR. Material and methods We searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Central, and Google Scholar for studies comparing RALS and LS for IUR. The outcomes of interest are operative time, blood loss, postoperative stay, and Clavien-Dindo complications. Meta-analysis was performed with Rev Man version 5.4. Results We included 36 patients from 3 studies. The mean age was 44 years, with 53% male patients. Blood loss (MD -89.13 cc, CI -129.03 to -49.22, I² = 0%) was significantly lower in patients undergoing RALS when comparing with LS. No differences were observed when comparing operative time (MD -10.99 minutes, CI -85.66 to 63.59, p = 0.77, I² = 64%), postoperative stay (MD -2.56 days, CI -8.24 to 3.13, p = 0.38, I² = 30%), and postoperative complications (OR 1.63, CI 0.27 to 10.02, p = 0.60, I² = 0%). Conclusions Overall, we conclude that the robot-assisted technique showed less bleeding compared to the laparoscopic technique. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to examine the impact of the COVID-19 pandemic on the structure of patients who had undergone operative treatment for oncological indications at the Urology Clinic of the University Clinical Center Niš in the period from March 2018 to June 2022. The following operations were included: nephrectomy for kidney cancer, nephroureterectomy for upper urothelial cancer, prostatectomy for prostate cancer, cystectomy for bladder cancer, orchiectomy for testicular cancer and penectomy for penile cancer. Data were taken on the number of operations, patients' age and gender and postoperative histopathological findings. Depending on the time the surgery was performed, patients were divided into two groups: the preCOVID group - procedures carried out before the start of the pandemic (March 1, 2018 − March 1, 2020) and the COVID group - procedures carried out after the start of the pandemic (June 2020 − June 2022). A total of 569 investigated operations were performed, 320 before and 249 after the beginning of the pandemic. Nephrectomies were the most frequently performed procedures in both study groups. During the pandemic, a significant decrease in number of prostatectomies and nephrectomies was registered. The proportion of prostatectomies was significantly lower in the COVID group, while the proportion of cystectomies significantly increased. The frequency of stage T4 bladder cancer was significantly higher during the pandemic, while the frequency of stage T3a was significantly lower. When we consider the results of tumor stages after all operative procedures in our study, significantly more patients with T4 stage were registered during the pandemic, the majority with bladder cancer. [ABSTRACT FROM AUTHOR]

Objectives: To investigate preoperative patient factors that may predict the occurrence of perioperative complications following robot‐assisted radical cystectomy at a single center in Japan. Methods: From 2013 to 2022, 103 patients underwent RARC at our institution. Complications within 90 days after surgery were assessed using the Clavien–Dindo classification. Preoperative characteristics and surgical outcomes were compared between cohorts with and without complications ≥grade 3. Logistic regression analysis was used to identify the risk factors associated with perioperative complications. Results: Overall, 27% of patients (27/103) experienced grade 3 or higher complications. The cohort that developed complications ≥grade 3 exhibited significantly higher Charlson comorbidity index (p = 0.046) and significantly lower estimated glomerular filtration rate (p = 0.048). Charlson comorbidity index ≥2 (p = 0.037) and estimated glomerular filtration rate <53 (p = 0.008) were independent predictors for the occurrence of complications ≥grade 3. The incidence of complications ≥grade 3 was 61.5% in the group possessing both factors, which was significantly higher than those in the groups possessing neither factor nor only one of the two factors. Conclusions: Our results suggest that the Charlson comorbidity index and preoperative estimated glomerular filtration rate may be predictors of perioperative complications. It is important to evaluate the patient's preoperative characteristics and choose the surgical procedure accordingly. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the safety and feasibility of a novel stent‐assisted ileal bypass for rectal cancer patients who received sphincter‐preserving surgery. Methods: Patients who were diagnosed with rectal cancer and received sphincter‐preserving surgery plus a novel stent‐assisted ileal bypass were respectively included from January 2022 to January 2023. Biofragmentable ileal stent with diaphragm sheet in the cavity was placed in the terminal ileum using absorbable sutures after anastomosis. At the proximal end of the stent, an intestinal diversion tube was placed in the prefabricated purse‐string, through which faeces were drained. The stent completely disintegrated in the body after 3–4 weeks, which protected the anastomosis after surgery and avoided protective stoma. Clinical characteristics and surgical outcomes were collected. Results: Eleven patients who successfully received surgery were included. There were seven (63.6%) males and four (36.4%) females. The tumour size was 3.2 ± 1.7 cm and the lower verge of tumour to anal verge was 6.8 ± 1.3 cm. As for surgical outcomes, operation time was 216.4 ± 54.1 min, blood loss was 43.6 ± 64.6 mL, time to first flatus via intestinal diversion tube was 3.2 ± 1.1 days, time to discharge stent was 22.8 ± 3.0 days, and postoperative hospital stay was 21.0 ± 5.4 days. Two patients suffered from postoperative complications including pneumonia and incision infection. Conclusion: This novel stent‐assisted ileal bypass is safe and feasible, it provides a new choice for rectal cancer patients to avoid protective stoma and secondary surgery. In this work, we reported a novel stent‐assisted ileal bypass in eleven rectal cancer patients and found that there was no anastomotic leakage or mortality during the follow‐up. Therefore, we demonstrated that this novel stent‐assisted ileal bypass is a safe and feasible way to prevent postoperative anastomotic leakage for patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Objective: To acknowledge that minimally invasive pelvic exenteration is a feasible alternative to open surgery and potentially identify prediction factors for patient outcome. Methods: The study was designed as a retrospective single team analysis of 12 consecutive cases, set between January 2008 and January 2022. Results: Six anterior and 6 total pelvic exenterations were performed. A 75% of cases were treated using a robotic approach. In 4 cases, an ileal conduit was used for urinary reconstruction. Mean operative time was 360±30.7 minutes. for anterior pelvic exenterations and 440±40.7 minutes. for total pelvic exenterations and mean blood loss was 350±35 mL. An R0 resection was performed in 9 cases (75%) and peri-operative morbidity was 16.6%, with no deaths recorded. Median disease-free survival was 12 months (10-14) and overall survival (OS) was 20 months (1-127). In terms of OS, 50% of patients were still alive 24 months after surgery. Taking into consideration the follow up period, 16.6% of females under 50 or above 70 years old did not reach the cut off and 4 out of 6 patients that failed to reach it were diagnosed with distant metastases or local recurrence (p=0.169). Conclusion: Our experience is very much consistent with literature in regard to primary site of cancer, post-operative complications, R0 resection and survival rates. On the other hand, minimally invasive approach and urinary reconstruction type were in contrast with cited publications. Minimally invasive pelvic exenteration is indeed a safe and feasible procedure, providing patients selection is appropriately performed. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic radical cystectomy (LRC) with ileal orthotopic neobladder (IONB) reconstruction is one of the most promising methods for bladder cancer treatment; its advantages include a small incision size, less blood loss, improved perioperative outcome and tumor prognosis, and a positive self-image postoperatively. The short-term benefits of various IONB reconstruction procedures reported thus far include a simple process, short operative time, less intraoperative bleeding, few postoperative complications, and good postoperative neobladder function; in the long term, these benefits engender good quality of life of the patients. Here, we explored and summarized the more novel and available IONB reconstruction procedures to identify the safest, most efficient, and simplest IONB reconstruction techniques for patients with bladder cancer. Summary: LRC with IONB reconstruction is technically feasible; however, most of the relevant studies have been short, employing a small sample size and a retrospective design. However, long-term, large-scale, prospective studies identifying the most appropriate bowel segments for IONB reconstruction, comparing intracorporeal and extracorporeal IONB reconstruction, assessing currently available IONBs, and resolving relevant postoperative complications further, with a focus on patients with bladder cancer, are warranted. Key Message: Several procedures for LRC with IONB reconstruction have been reported thus far. However, there is no consensus regarding the IONB reconstruction procedures most beneficial to patients with bladder cancer. Our review may aid researchers in developing a simple, safe, and efficient LRC with IONB reconstruction procedure for patients with bladder cancer. [ABSTRACT FROM AUTHOR]

Background: Ileal perforations have a diverse etiology and often present with perforative peritonitis in the surgical emergency. This study is based on the scenario of management of ileal perforation encountered in a tertiary teaching hospital in West Bengal. Aims and Objectives: The aim and objective of this study is to document and evaluate the post-operative outcome based on the diverse etiopathology, clinical presentation, and surgical management performed in patients having ileal perforation. Materials and Methods: A prospective crosssectional observational study was conducted in the Deben Mahata Government Medical College, Purulia, West Bengal, for a period of 2 years from February 2020 to January 2022 with 60 patients introperatively diagnosed with ileal perforation. Emergency exploratory laparotomy was done in all the cases presenting with perforative peritonitis. Ileal perforation was identified and an edge biopsy was taken. Appropriate surgical treatment in the forms of primary repair/resection-anastomosis/resection-ileostomy was done. The histopathological report was reviewed following surgery. The patients were evaluated in the post-operative period for post-operative morbidity and mortality. Results: Typhoid fever (68.33%) was the predominant cause in our study. The most common symptoms were abdominal pain (93%), fever (85%), and abdominal distension (75%). Widal test was performed preoperatively and was positive in 41 cases (68.33%). In our study, primary repair (58.33%), resectionanastomosis (15%), and resection-ileostomy (26.67%) were the main surgical treatment performed. Sepsis, surgical site infections (SSIs), fecal fistula, and wound dehiscence were the common post-operative complications found. Among them, SSI (51.67%) was the most common post-operative complication (P<0.0001) found and fecal fistula was the most dreaded post-operative complication with 50% mortality. Histopathological reports following surgery showed cases were mainly due to enteric fever (51.67%) and tuberculosis (25%). Conclusion: Early surgical intervention was the mainstay of treatment of ileal perforation. Delayed presentation of perforation is responsible for the development of surgical site infections (SSIs). Uncontrolled generalized sepsis, wound dehiscence, and fecal fistula were the main causes of post-operative mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE: To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS: Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS: Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ 2 test = 8.245; df = 1; P = 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ 2 test = 4.447; df = 1; P = 0.034). CONCLUSION: Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders. [ABSTRACT FROM AUTHOR]

Background: Duodenal stump leakage is a serious post-gastrectomy complication, and there have been no reports on endoscopic drainage. Case presentation: We report a case of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction in a 68-year-old man. First-line conservative management was ineffective. Reoperation was performed because of severe abdominal pain and increased ascites. After reoperation, duodenal stump leakage recurred with bleeding from the anterior superior pancreaticoduodenal artery. Coil embolization and pigtail catheter insertion were performed. Furthermore, we retrogradely inserted an ileal tube for tube decompression near the duodenal stump using double-balloon endoscopy for effective drainage. After tube insertion, duodenal stump leakage decreased; on the 47th primary postoperative day, the patient was discharged. The primary postoperative course was uneventful after 1 year and 9 months of follow-up. Conclusions: This is the first successful case of duodenal stump leakage treated with retrograde decompression tube insertion near the duodenal stump using double-balloon endoscopy. [ABSTRACT FROM AUTHOR]