Functional evaluation of a spiral neobladder with an angled chimney; A prospective randomized comparative study.

Autor: Moeen AM; Department of Urology, Assiut University, Asyut, Egypt. Electronic address: moeen3@yahoo.com., Behnsawy HM; Department of Urology, Assiut University, Asyut, Egypt., Faragallah MA; Department of Urology, Assiut University, Asyut, Egypt., Gadelkareem RA; Department of Urology, Assiut University, Asyut, Egypt., Osman MM; Department of Urology, Assiut University, Asyut, Egypt., Moeen SM; Department of Anesthesia and Intensive Care Unit, Assiut University, Asyut, Egypt., Hameed DA; Department of Urology, Assiut University, Asyut, Egypt., Zarzour MA; Department of Urology, Assiut University, Asyut, Egypt.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2023 Feb; Vol. 49 (2), pp. 491-496. Date of Electronic Publication: 2022 Oct 07.
DOI: 10.1016/j.ejso.2022.09.021
Abstrakt: Objectives: to assess the functional outcome of performing ureteric re-implantation to an angled short chimney in a modified spiral orthotopic ileal neobladder.
Patients and Methods: From January 2018 to December 2020, 90 male patients with bladder cancer underwent radical cystectomy and spiral ileal neobladder reconstruction with a chimney. Patients were randomly divided in two groups according to the position of the chimney [straight and angled] to which the ureters will be implanted. Postoperative evaluation included clinical, laboratory, radiographic and urodynamic studies.
Results: There were no perioperative deaths. The mean operative time for the procedure was 4.7 ± 1.2 h in group I and 4.9 ± 1.3 h in group II (p 0.456). No intraoperative complications occurred. Early postoperative complications occurred in 8 patients. In group I, according to the modified Clavien system, GII complication occurred in 2 (5%) patients in the form of DVT in 1 (2.5%) and surgical site infection in 1 (2.5%). GIIIa occurred in 3 (7.5%) patients in the form of wound dehiscence. In group II, GII occurred in 2 (4.8%) patients in the form of prolonged urinary leakage and myocardial infarction, each occurred in one patient. GIIIb occurred in 1 (2.4%) patient in the form of intestinal leak. Poucho-ureteral reflux occurred in 10 patients [3 (7.5%) in group I and 7 (16.8%) in group II (p 0.001)].
Conclusions: The preliminary results of the right sided angled chimney during neobladder reconstruction are safe, acceptable, without an extra time to develop an anti-reflux technique and without an increased incidence of reflux.
Competing Interests: Declaration of Competing Interest None declared.
(Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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