RESUMO
OBJECTIVE: Appendicovesicostomy (APV) and Monti ileovesicostomy (Monti) are durable catheterizable channels. While subfascial revision rates vary by channel type, a channel implanted in the anterior (vs posterior) aspect of the bladder may have a lower subfascial revision risk, due to decreased channel mobility and better fascial fixation. The present study aimed to compare long-term durability of anteriorly compared to posteriorly implanted APV and Monti channels in a large international cohort. MATERIALS AND METHODS: A retrospective cohort study was conducted on patients aged ≤21 years and who underwent APV or Monti surgery with an open technique at three high-volume centers (1990-2015). The following were noted: patient demographics, stomal and subfascial revisions, stomal location, channel placement (anterior/posterior), and channel type - APV, spiral Monti to umbilicus (SMU), other Monti channels. Survival analysis and Cox proportional hazards regression were used to separately examine the three channel groups. RESULTS: Of the 675 patients who met inclusion criteria, 387 had an APV (71.3% anterior), 53 had an SMU (13.2% anterior) and 235 had other Monti channels (42.1% anterior). Median age at surgery was 8.8 years for APV (median follow-up: 5.5 years), 9.2 years for other Monti (follow-up: 6.6 years) and 7.9 years for SMU (follow-up: 9.0 years). Patients originated from the USA (67.9%), Argentina (26.4%) and Chile (5.8%). Overall, 76 stomal and 77 subfascial revisions occurred. Risk of stomal revision was 9.3-12.0% at 5 years of follow-up, and was similar between channel types or location (P = 0.57). Risk of subfascial revision at 5 years was 7.4% for APV, 12.7% for all other Monti channels and 25.9% for SMU (P = 0.001). On survival analysis, stomal and subfascial revision rates were similar between anterior and posterior channels for APV (P ≥ 0.16), other Monti channels (P ≥ 0.62) and SMU (P ≥ 0.43) (Summary Fig.). On multivariate regression, channel configuration was not associated with stomal or subfascial revision for APV (P ≥ 0.18) or other Monti channels (P ≥ 0.64). Sex, age, diagnosis, country and stomal location were not associated with revision risk (P ≥ 0.06). DISCUSSION: Contrary to the hypothesis, subfascial revision rates were no different between anterior and posterior channels. Given that many reported outcomes related to genitourinary reconstruction occur rarely and require prolonged follow-up, collaborative research in this area should be encouraged. CONCLUSIONS: The study demonstrated durable long-term results with the APV and Monti techniques in an international cohort. Risks of stomal and subfascial complications were not significantly different between anteriorly and posteriorly implanted channels. As previously reported, Monti channels, particularly SMU, were more prone to undergoing subfascial revisions.
Assuntos
Cistostomia/métodos , Cateterismo Urinário/métodos , Derivação Urinária/métodos , Coletores de Urina , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Fatores Etários , Argentina , Criança , Pré-Escolar , Chile , Estudos de Coortes , Cistostomia/efeitos adversos , Seguimentos , Humanos , Internacionalidade , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Modelos de Riscos Proporcionais , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto JovemRESUMO
Purple urine bag syndrome is an uncommon but particularly striking phenomenon observed in people with urinary catheters and co-existent urinary tract infections. A chemical reaction between plastic and certain bacterial enzymes results in an intense purple urine color. We report a 72 year-old male with a cystostomy. A purple coloration of his urinary drainage bag and tubing was noted in the context of a urinary tract infection caused by Citrobacter freundii.
Assuntos
Idoso , Humanos , Masculino , Citrobacter freundii , Cistostomia/efeitos adversos , Infecções por Enterobacteriaceae/urina , Cateteres Urinários/efeitos adversos , Infecções Urinárias/urina , Cateteres de Demora/efeitos adversos , Citrobacter freundii/enzimologia , Pigmentação , SíndromeRESUMO
INTRODUCTION: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. RESULTS: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. CONCLUSIONS: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.
Assuntos
Cistostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ureterostomia/efeitos adversos , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/cirurgia , Criança , Pré-Escolar , Cistostomia/métodos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Ureterostomia/métodos , Transtornos Urinários/etiologia , Refluxo Vesicoureteral/complicaçõesRESUMO
Introduction To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision ...
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cistostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ureterostomia/efeitos adversos , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/cirurgia , Cistostomia/métodos , Seguimentos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Ureterostomia/métodos , Transtornos Urinários/etiologia , Refluxo Vesicoureteral/complicaçõesRESUMO
Purple urine bag syndrome is an uncommon but particularly striking phenomenon observed in people with urinary catheters and co-existent urinary tract infections. A chemical reaction between plastic and certain bacterial enzymes results in an intense purple urine color. We report a 72 year-old male with a cystostomy. A purple coloration of his urinary drainage bag and tubing was noted in the context of a urinary tract infection caused by Citrobacter freundii.
Assuntos
Citrobacter freundii , Cistostomia/efeitos adversos , Infecções por Enterobacteriaceae/urina , Cateteres Urinários/efeitos adversos , Infecções Urinárias/urina , Idoso , Cateteres de Demora/efeitos adversos , Citrobacter freundii/enzimologia , Humanos , Masculino , Pigmentação , SíndromeRESUMO
Femoral nerve neuropathy as a complication from abdominopelvic surgery was firstly described in 1896, by Gumpertz, in a case report of femoral nerve injury following hysterectomy. The authors report two cases of femoral nerve neuropathy following psoas hitch vesicopexy in ureteral reimplantation, and to discuss the etiology and clinical manifestations of this complication. Femoral nerve neuropathy secondary to psoas hitch is a rare complication, although it should be considered during the surgical procedure, as well as in postoperative care.
Assuntos
Cistostomia/efeitos adversos , Neuropatia Femoral/etiologia , Músculos Psoas/cirurgia , Ureterostomia/efeitos adversos , Adulto , Cistostomia/métodos , Feminino , Humanos , Masculino , Ureterostomia/métodos , Adulto JovemRESUMO
Presentamos a una paciente con colitis ulcerosa y pioderma gangrenoso periestomal. Describimos los hallazgos clinicos, los factores predisponentes, el tratamiento del pioderma gangrenoso y otros problemas cutaneos que suelen surgir alrededor del estoma (AU)
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Humanos , Adulto , Feminino , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/patologia , Colostomia/efeitos adversos , Ileostomia/efeitos adversos , Ureterostomia/efeitos adversos , Cistostomia/efeitos adversos , Colite Ulcerativa/complicações , Doença de Crohn/complicaçõesRESUMO
El síndrome de retención urinaria postoperatorio es una complicación frecuente en la cirugía vaginal y para obviarlo, en muchos centros se propicia el uso de drenaje vesical transuretral por tres a cinco dias, con o sin reeducación vesical. Con el fin de determinar si el tiempo de permanencia del drenaje y la reeducación vesical influyen sobre la ocurrencia de este síndrome, se estudiaron en forma prospectiva y randomizada 106 pacientes sometidas a cirugía vaginal en nuestro servicio, divididas en tres grupos: el primero constituído por 36 pacientes a las que se les retiró el drenaje vesical a las 24 horas; el segundo compuesto por 37 pacientes en las que el drenaje fue retirado a las 72 horas y el tercero que reunió a 33 pacientes en las que la sonda fue retirada a las 72 horas previa reeducación vesical. Nuestros resultados muestran que las pacientes que presentaron con menor frecuencia retención urinaria postoperatoria, fueron aquellas que tuvieron un menor tiempo de drenaje vesical (24,3 por ciento vs 30,7 por ciento y 43 por ciento) por lo que se concluye que el mantener la sonda Foley por más de 24 horas y realizar reeducación vesical, no disminuye la frecuencia del síndrome de retención urinaria y que sólo constituye un mayor riesgo de infección urinaria y de prolongación del tiempo de hospitalización