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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]

Purpose: Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC. Patients and Methods: The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed. Results: From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications. Conclusions: Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation. [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]

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Radical cystectomy after low anterior resection is rare, and no cases of robotic surgery have been reported. Cystectomy in patients who have undergone a previous pelvic surgery, whether open or endoscopic, requires caution to avoid damaging other organs due to anatomical changes caused by adhesions in a limited space. Additionally, the curative nature of the treatment must be maintained. We describe a 69‐year‐old man with a history of open low anterior resection for rectal cancer who underwent robot‐assisted radical cystectomy with extracorporeal ileal conduit construction. Although this procedure is challenging, it was performed safely with the collaboration of colorectal surgeons. The patient was discharged without perioperative complications and remained recurrence‐free for 5 years. [ABSTRACT FROM AUTHOR]

Purpose: Ileal conduit is commonly employed as a urinary diversion procedure for patients with bladder cancer after radical cystectomy. Studies have reported that ureteroileal anastomotic stricture remains a serious complication following ileal conduit diversion. The aim of this study was to introduce a novel modified technique for ureteroileal anastomosis and evaluate postoperative complications, with a specific focus on the incidence of ureteroileal anastomotic stricture. Methods: A prospective single-center, single-surgeon cohort study was conducted on 29 consecutive patients who underwent laparoscopic radical cystectomy with ileal conduit urinary diversion between February 2017 and April 2021. A descriptive statistical analysis was performed where intraoperative variables and postoperative complications were assessed. Results: All 29 operations were successful with an average operation time of 372.9 ± 94.3 min. The mean follow-up time was 39.62 ± 15.93 months. No cases of UIAS occurred. Three patients (10.3%) had febrile urinary tract infection, three patients (10.3%) had a transient small bowel obstruction, one patient (3.4%) had ileal anastomotic fistula, one patient (3.4%) had ileal conduit leakage, and one patient (3.4%) died 2 months after surgery due to multiple respiratory diseases. One patient (3.4%) had a mild left ureteral obstruction and CT indicated the obstruction site was in front of the iliac vessels where the left ureter had transposed to the right. Conclusion: The modified ureteroileal anastomosis can reduce the incidence of UIAS. [ABSTRACT FROM AUTHOR]

Abstract 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 Objective To evaluate risk factors contributing to side‐specific benign ureteroenteric strictures following radical cystectomy with an ileal conduit. Materials and Methods Data obtained from patients with bladder cancer who underwent radical cystectomy with ileal conduit surgery between 2015 and 2018 were retrospectively analysed. Imaging prior to surgery was analysed, regarding calcifications in the aorta, sarcopenia and postoperatively for length of remaining left ureter. Descriptive analyses were performed on preoperative and perioperative data, comparing patients who developed unilateral left‐ or right‐sided strictures, bilateral strictures, to those who remained free of strictures. COX regression analysis was employed to calculate crude and adjusted hazard ratio for side‐specific strictures. Results The study included 395 patients. Strictures developed in 19% (75/395) of the patients, within a median period of 9 months: 57% (43/75) unilateral left sided, 20% (15/75) unilateral right sided and 23% (17/75) bilateral. Unilateral left‐sided stricture was associated with higher body mass index (p = 0.077) and hypercholesterolemia (p = 0.007). Right‐sided stricture was associated with a history of prior abdominal surgery (p = 0.029) and postoperative leakage (p = 0.004). Bilateral stricture was associated with smoking (p = 0.006) and high BMI (p = 0.015). The adjusted HR comparing patients with and without previous abdominal surgery was only significantly higher for right‐sided ureteroenteric strictures (HR 3.18 [95% CI: 1.11; 9.05]) compared with patients without strictures. No association was identified between strictures and preoperative aortic calcification of the abdominal aorta or sarcopenia as estimated from imaging. Conclusion The aetiology of ureteroenteric strictures appears multifactorial. Our findings suggest that development of left‐sided stricture is influenced by factors associated with metabolic syndrome, indicating a potential role of distal ureteric ischemia. On the other hand, right‐sided stricture was more frequent in patients with previous abdominal surgery and postoperative leakage.

Objective: The aim of the study was to find tools to assess patient characteristics that would help in choosing between orthotopic neobladder and ileal conduit in patients undergoing radical cystectomy. An additional goal was to search for aids that improve preoperative counseling to support patients in the decision-making process. Methods: A systematic review of MEDLINE, Web of Science, and Scopus databases was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, in April 2024. Inclusion criteria were specified in PICO format. Two reviewers independently screened titles/abstracts and full papers. Upon study selection, the results and conclusions from the studies were abstracted and quantitatively summarized in the results section of this article. Results: Seven articles, involving a total 834 patients, were included. One article described frailty, two reviewed cognitive status, one article described functional dexterity, one described personality, two articles reviewed patients' values and goals, and one article reviewed role of patient–physician dialogue in the context of choosing UD after RC. The reviewed articles identified tools and approaches that could be valuable in evaluating the suitability for continent urinary diversion (CUD) or incontinent urinary diversion (ICUD). Conclusions: This is the first systematic review that summarizes the new available methods of patient assessment which improve preoperative counseling and choosing the most suitable UD after RC. Efficient tools for this purpose are still missing, and further studies that will aid in creating a simple aid for patient selection are necessary. [ABSTRACT FROM AUTHOR]

When an ostomy care nurse is not available, bedside nurses must assume responsibility for providing necessary care and educating patients who undergo a urinary diversion. However, staff nurses often lack the necessary knowledge and experience to provide the best care, rehabilitation, and patient education. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery in order to help eliminate gaps in care, increase nurses' and patients' competence and confidence, and optimize patient outcomes and quality of life. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care. [ABSTRACT FROM AUTHOR]

Purpose:We assessed the effect of prophylactic biologic mesh on parastomal hernia (PSH) development in patients undergoing cystectomy and ileal conduit (IC). Materials and Methods: This phase 3, randomized, controlled trial (NCT02439060) included 146 patients who underwent cystectomy and IC at the University of Southern California between 2015 and 2021. Follow-ups were physical exam and CT every 4 to 6 months up to 2 years. Patients were randomized 1:1 to receive FlexHD prophylactic biological mesh using sublay intraperitoneal technique vs standard IC. The primary end point was time to radiological PSH, and secondary outcomes included clinical PSH with/without surgical intervention and mesh-related complications. Results: The 2 arms were similar in terms of baseline clinical features. All surgeries and mesh placements were performed without any intraoperative complications. Median operative time was 31 minutes longer in patients who received mesh, yet with no statistically significant difference (363 vs 332 minutes, P [ .16). With a median follow-up of 24 months, radiological and clinical PSHs were detected in 37 (18 mesh recipients vs 19 controls) and 16 (8 subjects in both arms) patients, with a median time to radiological and clinical PSH of 8.3 and 15.5 months, respectively. No definite mesh-related adverse events were reported. Five patients (3 in the mesh and 2 in the control arm) required surgical PSH repair. Radiological PSH-free survival rates in the mesh and control groups were 74% vs 75% at 1 year and 69% vs 62% at 2 years. Conclusions: Implementation of biologic mesh at the time of IC construction is safe without significant protective effects within 2 years following surgery. [ABSTRACT FROM AUTHOR]

Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the robotic-assisted modified Sugarbaker technique with composite permanent mesh. The study, conducted in a high-volume colon and rectal surgery referral practice, outlines a systematic approach to patient selection, surgical procedures, and postoperative care. Preoperative evaluations include detailed medical and surgical histories, impact assessments of PSH, and oncological history reviews. The surgical technique involves the Da Vinci Xi™ robotic platform for adhesiolysis, hernia content reduction, stoma revision if needed, narrowing of the enlarged stoma trephine, lateralization of the stoma limb of bowel, and securing the mesh to the abdominal wall. Outcomes are reported for 102 patients undergoing robotic parastomal hernia repair from January 2021 to July 2023. Conversion to open surgery occurred in only one case (0.9%). Postoperative complications affected 39.2% of patients, with ileus being the most frequent (24.5%). Recurrence was observed in 5.8% of cases during an average follow-up of 10 months. In conclusion, parastomal hernia, a common complication post-stoma creation, demands surgical intervention. The robotic-assisted modified Sugarbaker repair technique, as outlined in this paper, offers promising results in terms of feasibility and outcomes. [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]

Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy. [ABSTRACT FROM AUTHOR]

Immunonutrition is effective in preventing postoperative infections, but its efficacy in ileal conduit procedures has not been well documented. In this study, the efficacy of immunonutrition was investigated in 86 patients with bladder cancer. Results showed that a reduction in the incidence of SSI was associated with the use of immunonutrition. Background: Radical cystectomy and ileal conduit have a high incidence of surgical site infection. In this study, we evaluated the effects of preoperative immunonutrition on its incidence following these procedures. Materials and Methods: We retrospectively enrolled 86 patients who underwent radical cystectomy and ileal conduit at our hospital between 2014 October and 2021 July. They were sequentially divided into the Immunonutrition group (n = 43) and Control group (n = 43). Patients in the Immunonutrition group drank 4 packs of IMPACT (Nestle, Japan) per day for 5 days before surgery. IMPACT contains arginine and eicosapentaenoic acid. We compared levels of plasma arginine and eicosapentaenoic acid before and after surgery and the rate of surgical site infection between the groups. Factors related to surgical site infection were analyzed using univariate and multivariable logistic regression analysis. Results: No statistically significant differences were observed in patient characteristics between the groups except for surgical operative method (P < .001) and transfusion (P = .009). Levels of plasma arginine and eicosapentaenoic acid were significantly increased the day before surgery in the immunonutrition group (P < .001). However, the levels of plasma arginine on the day after surgery did not vary significantly between the groups. The incidence of surgical site infection was significantly lower in the immunonutrition group (P = .014). Multivariate analyses showed a significant association of surgical site infection with immunonutrition (OR = 0.14, CI 0.03-0.72, P = .019) and with ASA classification (OR = 4.76, CI 1.23-18.40, P = .024). Conclusions: Preoperative immunonutrition significantly reduced the incidence of surgical site infection following radical cystectomy and ileal conduit. [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]

A recent study conducted in Germany analyzed trends in the use of continent urinary diversions (CUDs) and incontinent urinary diversions (IUDs) for patients undergoing extirpative procedures for bladder conditions. The study found that there has been a significant decline in the use of CUDs over the past 17 years, with a decrease from 37% in 2005 to 20% in 2021. This decline was more pronounced in male and elderly patients. The reasons for this trend are not fully understood and require further research. The study highlights the need for unbiased discussions with patients about the risks, benefits, and motivations associated with different urinary diversion types. However, it should be noted that the study has limitations, including reliance on administrative billing data and the lack of consideration for certain patient characteristics and decision-making factors. Further research is needed to determine the potential impact of these trends on patient care. [Extracted from the article]

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien–Dindo (C.D.) complication rates (Minor C.D. I–II, Major C.D. III–V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any—69% vs. 77%; minor—61% vs. 73%; major—46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC. [ABSTRACT FROM AUTHOR]

Cystectomy is the gold standard treatment for muscle invasive bladder cancer. Robotic cystectomy has become increasingly popular owing to quicker post- operative recovery, less blood loss and less post-operative pain. Urinary diversion is increasingly being performed with an intracorporeal technique. Uretero-enteric strictures (UES) cause significant morbidity for patients. UES for open cystectomy is 3–10%, but the range is much wider (0–25%) for robotic surgery. We aim to perform systematic review for studies comparing all 3 techniques, to assess for ureteric stricture rates. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Page et al. in BMJ 29, 2021). PubMed, Scopus and Embase databases were searched for the period January 2003 to June 2023 inclusive for relevant publications.The primary outcome was to identify ureteric stricture rates for studies comparing open cystectomy and urinary diversion, robotic cystectomy with extracorporeal urinary diversion (ECUD) and robotic cystectomy with intracorporeal urinary diversion (ICUD). Three studies were identified and included 2185 patients in total. The open operation had the lowest stricture rate (9.6%), compared to ECUD (12.4%) and ICUD (15%). ICUD had the longest time to stricture (7.55 months), ECUD (4.85 months) and the open operation (4.75 months). Open operation had the shortest operating time. The Bricker anastomoses was the most popular technique. Open surgery has the lowest rates of UES compared to both robotic operations. There is a learning curve involved with performing robotic cystectomy and urinary diversion, this may need to be considered to decide whether the technique is comparable with open cystectomy UES rates. Further research, including Randomised Control Trials (RCT), needs to be undertaken to determine the best surgical option for patients to minimise risks of UES. [ABSTRACT FROM AUTHOR]

Simple Summary: This study, conducted within a large North American cohort from the Surveillance, Epidemiology and End Results (SEER) database (2004–2020), aimed to investigate whether more complex urinary diversion (UD) procedures, such as orthotopic neobladder and abdominal pouch, are associated with higher other-cause mortality (OCM) compared to the conventional ileal conduit in T1-T4aN0M0 bladder cancer patients. Among 3008 patients, 79% underwent ileal conduit, while 21% opted for continent UD. After rigorous analysis, including propensity score matching and multivariable adjustments, the study found that neither continent UD nor its subtypes (orthotopic neobladder and abdominal pouch) were associated with higher 10-year OCM rates relative to ileal conduit. The conclusion suggests that more intricate UD procedures do not seem to elevate OCM risk compared to the simpler ileal conduit. Background: It is unknown whether more complex UD, such as orthotopic neobladder and abdominal pouch, may be associated with higher OCM rates than ileal conduit. We addressed this knowledge gap within the SEER database 2004–2020. Methods: All T1-T4aN0M0 radical cystectomy (RC) patients were identified. After 1:1 propensity score matching (PSM), cumulative incidence plots, univariable and multivariable competing-risks regression (CRR) models were used to test differences in OCM rates according to UD type (orthotopic neobladder vs. abdominal pouch vs. ileal conduit). Results: Of all 3008 RC patients, 2380 (79%) underwent ileal conduit vs. 628 (21%) who underwent continent UD (268 orthotopic neobladder and 360 abdominal pouch). After PSM relative to ileal conduit, neither continent UD (13 vs. 15%; p = 0.1) nor orthotopic neobladder (13 vs. 16%; p = 0.4) nor abdominal pouch (13 vs. 15%; p = 0.2) were associated with higher 10-year OCM rates. After PSM and after adjustment for cancer-specific mortality (CSM), as well as after multivariable adjustments relative to ileal conduit, neither continent UD (Hazard Ratio [HR]:0.73; p = 0.1), nor orthotopic neobladder (HR:0.84; p = 0.5) nor abdominal pouch (HR:0.77; p = 0.2) were associated with higher OCM. Conclusions: It appears that more complex UD types, such as orthotopic neobladder and abdominal pouch are not associated with higher OCM relative to ileal conduit. [ABSTRACT FROM AUTHOR]

Purpose: An abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult. Methods: The indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up. Results: Of 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4). Conclusion: The mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear if robotic radical cystectomy with extracorporeal urinary diversion (eRARC) provides additional benefit when performed along with enhanced recovery after surgery (ERAS). We assessed the additional efficacy of eRARC in terms of perioperative outcomes. Materials and Methods: We retrospectively assessed 143 patients undergoing radical cystectomy with urinary diversion between June 2010 and December 2021 at a single center. The patients were assigned to three groups: open radical cystectomy (ORC) with conventional recovery after surgery (CRAS) [Group A], ORC with ERAS [Group B], and eRARC with ERAS [Group C]. A propensity score-matched analysis was performed to evaluate how ERAS and eRARC affected outcomes respectively. Meanwhile, multivariable analysis was used to detect the predictors of prolonged length of hospital stay (LOS). Results: The median LOS was shorter after ERAS and eRARC. In the propensity score-matched analysis, ERAS was linked to a significantly shorter median LOS (28.0 vs. 20.0 days, P < .001), but eRARC was not associated with a shorter LOS (19.0 vs. 17.5 days, P = .21). Neither ERAS nor eRARC were connected with a reduce in complication rate. Following multivariable analysis, ERAS was found to be independently associated with shorter LOS (OR=0.23, P < .001), but eRARC demonstrated no such correlation (OR=0.29, P = .096). Conclusion: ERAS had strong association with shorter LOS, although eRARC did not contribute to additional efficacy. Neither ERAS nor eRARC decreased the complication rate. [ABSTRACT FROM AUTHOR]

Background: Urinary diversion in bladder cancer treatment has been a distinguished topic of interest due to varying approaches available. Amongst them, ileal conduit (IC) and transuretero-ureterostomy (TUU) have been popular options in clinical practice. This study would like to compare the long-term outcomes of IC and TUU in patients undergoing RC procedures. Materials and methods: Literature searches were conducted in MEDLINE, CENTRAL, and EMBASE. Duration of hospitalization, complication rate, quality of life, and survival rate were selected as outcomes. Risk of bias was assessed using the ROBINS-I tool. Outcome measure was pooled using forest plot in Review Manager V.5 for Macintosh. Heterogeneity was measured using the DerSimonian and Laird random-effects model. Results: Eighteen matching interventional studies were included, 3 were prospective studies. The total number of included samples was 3,689; 1,172 patients of the TUU and 2,517 of IC group. The IC procedure associates with longer hospitalization [mean difference 3.80 [95% confidence interval (CI): 2.27-5.32), p < 0.001, I2 = 92%]. Duration of intensive care did not differ significantly. There were no differences in major complication rates [odds ratio (OR) = 1.45, 95% CI: 0.74-2.84, p = 0.27, I2 = 54%]: stone formation (OR = 1.07, 95% CI: 0.51-2.23, p = 0.48, I2 = 0%), and renal function deterioration (OR = 0.81, 95% CI: 0.39-1.68, p = 0.57, I2 = 0%) between the TUU and IC groups. Quality of life decreased in both groups, and only occurred in the early days after the stoma placement phase. Survival rates were not different among the groups. Conclusion: TUU is a better UD option as it offers shorter time of hospitalization, with the similar major complications, quality of life, and survival rate compared to IC. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). Methods Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality‐of‐life scores and postoperative clinical parameters. Results Spearman correlation analysis showed that postoperative BMI, late complications and catheter‐free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter‐free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table 2, p

Introduction Venous hemorrhage from ectopic varices is potentially fatal. This report describes a rare case in which bleeding from mesenteric varices in an ileal conduit was treated successfully by embolization therapy. Case presentation The patient was an 82‐year‐old man who had previously undergone total pelvic exenteration for colon cancer with creation of an ileal conduit for urinary diversion. He subsequently developed liver cirrhosis and underwent partial hepatectomy for hepatocellular carcinoma. 9 years after his colon surgery, he was admitted with gross hematuria. Computed tomography revealed subcutaneous mesenteric varices in the ileal conduit and hemorrhage as a result of rupture of the varices. The bleeding continued despite repeated manual compression but was eventually stopped by embolization therapy. Conclusion Embolization therapy may be helpful for hemostasis in the event of intractable bleeding from mesenteric varices in an ileal conduit.

Objective: We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (IC) and neobladder (NB) urinary diversion. Methods: Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai, New York, NY, USA were indexed. Baseline demographics, clinical characteristics, perioperative, and oncologic outcomes were analyzed. Survival was estimated with Kaplan-Meier plots. Results: Of 261 patients (206 [78.9%] male), 190 (72.8%) received IC while 71 (27.2%) received NB diversion. Median age was greater in the IC group (71 [interquartile range, IQR 65–78] years vs. 64 [IQR 59–67] years, p

Objective: To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). Methods: Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality‐of‐life scores and postoperative clinical parameters. Results: Spearman correlation analysis showed that postoperative BMI, late complications and catheter‐free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter‐free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table 2, p<0.05). Patients in Group 2 with significant weight loss had a better Global QoL, a lower rate of stomal stricture and a higher catheter‐free state compared with those in Group 1 in both IC and MSSCU patients. MSSCU patients in Group 2 could achieve a comparable Global QoL as to IC patients in Group 1. Conclusion: Controlling the substantial increase in body weight after surgery contributes to improving QoL, reducing the occurrence of stomal stricture, and ensuring a postoperative catheter‐free state in BCa patients undergoing MSSCU. [ABSTRACT FROM AUTHOR]

Ureteroenteric anastomotic strictures (UEAS) are typical complications after creating an ileal conduit for total pelvic exenteration (TPE) of rectal tumors. We report the ileal conduit for reconstruction in three patients, in the age-range of 47–73 years. Case 1 was when a left-sided UEAS had sufficient length of ureter for anastomosis, Case 2 was a right-sided UEAS with sufficient length of ureter for anastomosis, and Case 3 was a left-sided UEAS with insufficient length of ureter for anastomosis. There were no complications after operation and no recurrence of UEAS. It is important to learn the open surgical procedures for repair of a benign UEAS after TPE of rectal cancers. This has fewer complications and is safe in the long term. [ABSTRACT FROM AUTHOR]

Introduction: Radical cystectomy with dissection of pelvic lymph nodes and urethral diversion is the standard surgical treatment for muscle-invasive nonmetastatic bladder cancer. In rare cases where patients with bladder cancer without distant metastasis have pelvic multi-organ invasion, the cancer compresses or invades the ureter and, in severe cases, leads to bilateral upper urinary tract obstruction and renal damage. The treatment recommended by guidelines often cannot improve the patients' clinical symptoms immediately, and patients cannot complete the treatment owing to severe side effects, resulting in poor survival benefits. Case presentation: A 69-year-old woman with facial edema was treated at the First Affiliated Hospital of Jinan University. The serum creatinine and potassium values were 1244 umol/L and 5.86 mmol/L, respectively. Pelvic magnetic resonance and abdominal computed tomography revealed that the bladder tumor had infiltrated the uterus, anterior vaginal wall, rectum, right ureter, right fallopian tube, and right ovary and metastasized to multiple pelvic lymph nodes. Tumor invasion of the right ureter resulted in severe hydronephrosis of the right kidney and loss of function and obstructive symptoms in the left kidney. Four days later, the patient's creatinine level decreased to 98 u mol/L, the general condition significantly improved, and the patient and family members strongly desired surgical treatment of the tumor. Through a comprehensive preoperative discussion, possible intraoperative and postoperative complications were evaluated. Right nephrectomy, right ureterectomy, total pelvic organ resection, extended pelvic lymph node dissection, and bowel and urinary diversion were conducted under 3D laparoscopy-assisted treatment. The patient was followed-up for 1.5 years and showed good tumor control, selfcare, and mental status. Conclusion: Minimally invasive surgery is a curative option for patients with bladder cancer with pelvic multi-organ invasion without distant metastasis. Surgeons should strictly control the indications for surgery and warn patients about the occurrence of related post-surgical complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate long-term outcomes in patients homogenously treated with radical cystectomy and ileal conduit for muscle invasive bladder cancer. Method: The retrospective study was conducted at the Urology Department of Pakistan Kidney and Liver Institute and Research Centerm, Lahore, Pakistan, and comprised data from December 25, 2017, to January 16, 2023, related to patients who underwent radical cystectomy with ileal conduit with or without neo-adjuvant and adjuvant radiation, chemotherapy, or immunotherapy for papillary urothelial carcinom of the bladder. Clinical trajectory, histopathological characteristics and long-term clinical outcomes were noted. Data was analysed using SPSS 20. Results: In our study of 40 patients with muscle invasive bladder cancer, males predominated (32, 80%), with a median age of 57.4 years (IQR: 29-80). Diagnosis was early in 5 patients (12.5%) with varying hematuria durations, while 34 patients (85%) had a smoking history. Comorbidities included hypertension in 17 patients (42.5%), diabetes in 1 patient (2.5%), both hypertension and diabetes in 9 patients (22.5%), and a combination of hypertension, diabetes, and ischemic heart disease in 3 patients (7.5%). Transurethral resection was performed once in 13 patients (32.5%) and multiple times in 27 patients (67.5%). Additionally, 5 patients (12.5%) received immunotherapy, 11 patients (27.5%) underwent non-adjuvant radiation, and 14 patients (35%) received non-adjuvant chemotherapy. Papillary urothelial carcinoma was the predominant histological subtype among 37 (92.5%) patients. Patients receiving chemotherapy had significantly better overall survival (p=0.02).No significant differences were noted in recurrence or survival by therapy modality (p>0.05). These findings highlight the significance of early diagnosis, tailored treatments, and comorbidity management in muscle invasive bladder cancer patients. Age stratification revealed significant survival differences across groups (X² = 10.923, df = 3, p = 0.012). Analysis by complications did not show age-related survival variations (X² = 3.978, df = 3, p = 0.264). Conclusion: Achieving excellent long-term survival in MIBC patients requires a multidisciplinary approach, emphasizing early diagnosis, tailored treatment, and adherence to guidelines and protocols. Key Words: Radical cystectomy, Ileal conduit, Management, Muscle invasive bladder cancer, Papillary urothelial carcinoma.

Background: Approximately 10 000 patients undergo cystectomy/ileal conduit annually in the USA, of whom over 70% subsequently develop a parastomal hernia (PSH). Still, no well-established “best” practice for stoma creation to prevent a PSH exists. Objective: To measure the relationship between incision size/type/material and axial tension force (ATF) as a surrogate for herniation force, using several models to mimic abdominal fascia. Design, setting, and participants: Abdominal fascia models included silicone membrane, ex vivo porcine, and embalmed human cadaveric fascia. A dynamometer pulled a Foley catheter (20 mm/min) with the balloon inflated to 125% incision (linear, cruciate, and circular) diameter using a motorized positioning system. The maximum ATF before herniation was recorded. The study was repeated in unused silicone/tissue for suture reinforcement. We evaluated silicone, ex vivo porcine, and human abdominal fascia. Intervention: Incision sizes (1–3 cm) in 0.5-cm increments were evaluated in silicone. A 3-cm incision was used in porcine/human tissue. Outcome measurements and statistical analysis: ATF for herniation was recorded/compared across incision types/sizes using Mann-Whitney U and Kruskal-Wallis tests as appropriate, with α = 0.05. Results and limitations: Linear incision ATF was significantly greater than cruciate and circular incisions. A cruciate incision had significantly greater ATF than a circular incision. In cadaveric tissue, incisions were significantly greater for linear (34.5 ± 12.8 N) versus cruciate (15.3 ± 2.9 N, p = 0.004) and for cruciate versus circular (p = 0.023) incisions. Results were similar in ex vivo porcine fascia and silicone. Reinforcement with a suture significantly increased ATF in all materials/incision sizes/types. The ex vivo nature is this study’s main limitation. Conclusions: This study suggests that urostomy fascial incision type may influence ATF required for herniation. Linear incisions may be preferable. Urostomy reinforcement may significantly increase ATF required for a PSH. These data may help establish best practices for PSH risk reduction. Patient summary: The results of this study illustrate that urostomy fascia incision type may influence the force required to create a parastomal hernia. Linear incisions may be preferable.

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders.

Objective: The aim of the study was to find tools to assess patient characteristics that would help in choosing between orthotopic neobladder and ileal conduit in patients undergoing radical cystectomy. An additional goal was to search for aids that improve preoperative counseling to support patients in the decision-making process. Methods: A systematic review of MEDLINE, Web of Science, and Scopus databases was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, in April 2024. Inclusion criteria were specified in PICO format. Two reviewers independently screened titles/abstracts and full papers. Upon study selection, the results and conclusions from the studies were abstracted and quantitatively summarized in the results section of this article. Results: Seven articles, involving a total 834 patients, were included. One article described frailty, two reviewed cognitive status, one article described functional dexterity, one described personality, two articles reviewed patients’ values and goals, and one article reviewed role of patient–physician dialogue in the context of choosing UD after RC. The reviewed articles identified tools and approaches that could be valuable in evaluating the suitability for continent urinary diversion (CUD) or incontinent urinary diversion (ICUD). Conclusions: This is the first systematic review that summarizes the new available methods of patient assessment which improve preoperative counseling and choosing the most suitable UD after RC. Efficient tools for this purpose are still missing, and further studies that will aid in creating a simple aid for patient selection are necessary.

Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.

BackgroundAnatomic complications of the ureteroenteric anastomosis in ileal conduit (IC) cause significant morbidity in patients post-cystectomy and cystoprostatectomy. The Bricker technique has a perceived disadvantage of increased risk for stricture, whereas the Wallace technique runs the risk for ureteral malignancy affecting both ureteric ends, and bilateral ureteric obstruction from a stone lodged at the anastomosis. We aimed to evaluate the safety, efficacy, and stricture rate of a novel hybrid ureteroenteric anastomosis technique. We compared these outcomes to the Bricker and Wallace anastomosis techniques for IC urinary diversion (ICUD). MethodsWe performed a retrospective chart review of patients who had undergone ICUD after cystectomy for bladder cancer from 2011 to 2016. Patients were categorized into groups undergoing the Bricker, Wallace, and hybrid ureteroanastomosic techniques. Strictures were identified during clinical follow-up or hospital presentations with complications. ResultsWe identified 68 patients suitable for inclusion. They were separated by Bricker, Wallace, and hybrid anastomosis techniques, with 19 (27.9%), 20 (29.4%), and 29 (42.6%) patients, respectively. Ureteroenteric anastomotic strictures occurred in 9 patients (5 Bricker, 3 Wallace, 1 hybrid). This difference in stricture rates for Bricker versus hybrid (26.3% vs. 3.4%; OR, 10 [95% CI, 1.1 to 121.1]; P = 0.02) was significant but was comparable for Wallace versus hybrid (15.0% vs. 3.4%; OR, 4.9 [0.7 to 66.0]; P = 0.15) and for Bricker versus Wallace (26.3% vs. 15.0%; OR, 2 [0.4 to 8.6]; P = 0.87). 15 patients (51%) in the hybrid group required oral antibiotics for a symptomatic urinary tract infection compared with 4 (21%) with Bricker and 8 (40%) with Wallace (P = 0.10). Median post-cystectomy follow-up and stricture formation time were 16 months (IQR, 4–36) and 9 months (7–32), respectively. ConclusionThe hybrid technique is a safe and efficacious alternative to the Bricker and Wallace anastomoses. It carries with it a risk for urinary tract infection that is eclipsed by substantially lowered rates of ureteric strictures requiring intervention while maintaining the advantage of separating the two ureters.

Background: Head-to-head comparisons between ileal conduit (IC) and orthotopic neobladder (ONB) in terms of peri- and postoperative outcomes and complications, in the specific setting of robot-assisted radical cystectomy (RARC), are not available. Objective: To address the impact of the type of urinary diversion (UD, IC vs ONB) on RARC morbidity, as well as operative time (OT), length of stay (LOS), and readmissions. Design, setting, and participants: Urothelial bladder cancer patients treated with RARC at nine high-volume European institutions between 2008 and 2020 were identified. Intervention: RARC with either IC or ONB. Outcome measurements and statistical analysis: Intra- and postoperative complications were collected and reported according to the Intraoperative Complications Assessment and Reporting with Universal Standards recommendations and European Association of Urology guidelines, respectively. Multivariable logistic regression models tested the impact of UD on outcomes, after adjustment for clustering at single hospital level. Results and limitations: Overall, 555 nonmetastatic RARC patients were identified. In 280 (51%) and 275 (49%) patients, an IC and an ONB were performed, respectively. Eighteen intraoperative complications were recorded. The rates of intraoperative complications were 4% in IC patients and 3% in ONB patients (p = 0.4). The median LOS and readmission rates were 10 versus 12 d (p

Purpose: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. Patients and methods: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient’s record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. Results: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. Conclusions: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.

Fistula formation between the iliac artery and an ileal conduit is a rare pathology. A 39-year-old female patient presented with intermittent hematuria from her ileal conduit for 4 days, which progressed to massive hemorrhage on the ward. Her background includes stage 4A squamous cell carcinoma of the cervix treated with pelvic chemoradiotherapy and brachytherapy, recurrent obstructive uropathy requiring bilateral nephrostomies and bilateral ureteral stenting. Twelve months before this presentation, she had been treated for an iliac artery–ileal conduit fistula with a covered stent to the left common iliac artery. After initial fluid resuscitation, the bleeding was managed with endovascular placement of a covered stent. She subsequently underwent definitive vascular reconstruction with removal of the common iliac artery stents, an aortoiliac bypass using a vein graft, and repair of the ileal conduit electively. This case demonstrates the management of a rare clinical pathology and highlights the importance of close surveillance after endovascular procedures.

Introduction: Assessing ileal conduit for double J stents removal after radical cystectomy is not always a straightforward task as navigation inside the ileal loop can be challenging to manage due to the difficulty to maintain a waterfilled environment and its long and tortuous aspect. Methods: We present a novel technique using a flexible ureteroscope that aims to ease this common demand with simple and readily available tools. Results: This technique has been successfully utilized in 2 patients now. No complications were documented Conclusion: We propose a novel surgical technique to improve endoscopic navigation in incontinent ileal loop urinary diversion.

Simple Summary: Post-radiation prostate cancer patients are at an increased risk for developing a multitude of long-term complications, notably, a nonfunctional bladder with associated fistulae, bleeding, and infection. In its advanced stages, this can be difficult for the clinician to effectively manage. Our review discusses the role of cystectomy in patients with a radiation-induced end-stage bladder and the challenges that an irradiated surgical field poses to the surgeon. In summary, the literature supports cystectomy in select patients as an option for definitive treatment, which can drastically improve the quality of life in these patients. Men with prostate cancer have the daunting task of selecting from multiple modalities of treatment. The long-term effects of radiation therapy are only now being recognized. For both patients and surgeons, the end-stage irradiated bladder poses numerous problems and challenges. Specifically, irradiated bladders with urosymphyseal fistula, radiation cystitis, and rectourethral fistula are challenging to manage and treat. This review outlines the presentation, workup, and management including cystectomy for these three devastating late complications of radiation therapy. There are special considerations when performing benign cystectomy that are not typically considered during oncologic cystectomy. We discuss an overview of the current literature regarding the "end-stage bladder" resulting from radiation therapy and the important considerations that must be acknowledged when managing these patients. It is shown that many of the less invasive and conservative options ultimately lead to cystectomy. Indeed, our review concludes that cystectomy with urinary diversion is a safe and viable option in select irradiated patients with the goal to improve quality of life. [ABSTRACT FROM AUTHOR]

IntroductionRadical cystectomy with dissection of pelvic lymph nodes and urethral diversion is the standard surgical treatment for muscle-invasive non-metastatic bladder cancer. In rare cases where patients with bladder cancer without distant metastasis have pelvic multi-organ invasion, the cancer compresses or invades the ureter and, in severe cases, leads to bilateral upper urinary tract obstruction and renal damage. The treatment recommended by guidelines often cannot improve the patients’ clinical symptoms immediately, and patients cannot complete the treatment owing to severe side effects, resulting in poor survival benefits.Case presentationA 69-year-old woman with facial edema was treated at the First Affiliated Hospital of Jinan University. The serum creatinine and potassium values were 1244 umol/L and 5.86 mmol/L, respectively. Pelvic magnetic resonance and abdominal computed tomography revealed that the bladder tumor had infiltrated the uterus, anterior vaginal wall, rectum, right ureter, right fallopian tube, and right ovary and metastasized to multiple pelvic lymph nodes. Tumor invasion of the right ureter resulted in severe hydronephrosis of the right kidney and loss of function and obstructive symptoms in the left kidney. Four days later, the patient’s creatinine level decreased to 98 u mol/L, the general condition significantly improved, and the patient and family members strongly desired surgical treatment of the tumor. Through a comprehensive preoperative discussion, possible intraoperative and postoperative complications were evaluated. Right nephrectomy, right ureterectomy, total pelvic organ resection, extended pelvic lymph node dissection, and bowel and urinary diversion were conducted under 3D laparoscopy-assisted treatment. The patient was followed-up for 1.5 years and showed good tumor control, self-care, and mental status.ConclusionMinimally invasive surgery is a curative option for patients with bladder cancer with pelvic multi-organ invasion without distant metastasis. Surgeons should strictly control the indications for surgery and warn patients about the occurrence of related post-surgical complications.