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Urogenital involvement in neurofibromatosis is extremely rare and thus is less documented. Herein, we discuss a 11-year-old boy who was referred with a diagnosis of neurofibroma bladder on bilateral flank ureterostomy with mild renal failure. A diagnosis of neurofibroma of the bladder with ureterohydronephrosis had been made and partial excision had been attempted, followed by bilateral ureterostomy because of increasing ureterohydronephrosis. He was 13 years and wanted to be dry as he wanted to go to school. With the plan of attaining dryness with stable upper tracts, he was posted for surgery. Near-total excision followed by a sigmoid conduit was performed. The biopsy was reported as plexiform neurofibroma and is on regular follow-up, dry on a stoma bag with stable renal parameters.

Objective To describe the incidence, complications, and trends associated with ureteral surgeries on a gynecologic oncology service in the context of a fellowship training program over a 24-year period. Methods We conducted a retrospective cohort analysis of ureteral surgeries by gynecologic oncologists at either Moffitt Cancer Center or Tampa General Hospital from 1997 to 2020. Patient characteristics, predisposing factors, location and type of injury, repair method, postoperative management and complications were abstracted from the medical record. The recent cohort (2005–2020) was compared to our prior series (1997–2004). Results Eighty-eight cases were included. The average number of ureteral surgeries per year decreased from 5.75 (1997–2004) to 2.63 (2005–2020). Of 46 iatrogenic injuries, 45 were recognized and repaired intraoperatively. Ureteral transection was the most common type (85% [39 of 46]) and the distal 5 cm was the most common location of injury (63% [29 of 46]). Ureteroneocystostomy was the most common method of repair (83% [73 of 88]). Postoperative management, including stenting and imaging, has not changed significantly. Length of urinary catheter usage decreased in the recent cohort without associated complications. Five patients had major postoperative complications and 4 involved the urinary tract. Of those with follow-up, 96% (66 of 69) of ureteroneocystostomies and 75% (9 of 12) of ureteroureterostomies had radiologically normal urinary tracts. Conclusions Ureteral surgery is necessary in the case of injury or involvement with invasive disease. There has been a decrease in number of procedures. Ureteroneocystostomy has remained the most common method of reconstruction for both injury and resection with acceptable postoperative complication rates.

Objective: To compare the first 30-day outcomes of Trans-peritoneal and Extra-peritoneal Radical cysto-prostatectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2015 to Mar 2019.Methodology: A total of 100 patients who underwent Radical cystoprostatectomy were observed in two groups either by extra or trans-peritoneal approach. Patients diagnosed with carcinoma urinary bladder (both muscle and non-muscle invasive) vetted through multidisciplinary meeting, with or without neo-adjuvant chemotherapy were included. Patients undergoing salvage cystectomy or any previous open abdomino-pelvic surgery were excluded. The standard techniques were used for both approaches. Variables under study were recorded for first 30-day-followup period. Results: The mean age was 59.9 ± 7.231 years (range=34-80). In extra-peritoneal group the mean duration of surgery was 5.6 ± 1.16 hours comparing to 7.2 ± 1.34 hours in the trans-peritoneal group. Statistically significant trend was also noted in the favour of extra-peritoneal group for stay in Intensive care in post-operative period (3.00 ± 1.19 days/4.77 ± 1.20, p

Peristomal skin problems are a common complication in ostomy patients (1,2,3). This complication can impact treatment, increase healthcare costs and decrease the patient’s quality of life (4,5). The use of a valid, reliable and user-friendly measurement tool helps healthcare providers with objective follow-up and targeted treatment of peristomal skin problems. Several assessment tools have already been developed to assess peristomal skin problems, among which assessment tools Studio Alterazioni Cutanee Stomali (SACS) and Ostomy Skin Tool (OST) are the most common in the literature. A clear overview of the measurement properties of assessment tools SACS and OST can help health care providers in making an appropriate choice based on the follow-up and treatment of peristomal skin and provides a new incentive for the development of a ‘gold standard’ in assessment tools for peristomal skin in ostomy patients. (1) Malik, T., Lee, M. J., Harikrishnan, A. B. (2018). The incidence of stoma related morbidity – a systematic review of randomised controlled trials. Ann R Coll Surg Engl, 100, 501-508. (2) LeBlanc, K., Whiteley, I., McNichol, L., et al. (2019). Peristomal Medical Adhesive-Related Skin Injury: Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs, 46(2), 125-136. (3) Bafford, A. C., Irani, J. L. (2013). Management and Complications of Stomas. Surgical Clinics of North America, 93(1), 145-166. (4) Schiergens, T. S., Hoffmann, V., Schobel, T. N., et al. (2017). Long-term Quality of Life of Patients With Permanent End Ileostomy: Results of a Nationwide Cross-Sectional Survey. Dis Colon Rectum, 60(1), 51-60. (5) Meisner, S., Lehur, P. A., Moran, B., et al. (2012). Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. PLoS One, 7(5), 1-8.

Background Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are less invasive than conventional procedures. However, for older patients, cutaneous ureterostomy (CUS) may be preferred because urinary diversion using the intestine has a high incidence of perioperative complications and is highly invasive. The purpose of this study was to demonstrate the safety and efficacy of intracorporeal ileal conduit (ICIC) compared with CUS in patients aged 75 years or older who underwent RARC. Methods From October 2014 to December 2021, 82 patients aged 75 years or older who underwent RARC at Tokushima University Hospital, Tokushima Prefectural Central Hospital, or Ehime Prefectural Central Hospital were retrospectively reviewed. Of these, 52 and 25 patients who underwent ICIC and CUS, respectively, were included. After adjusting the patients’ characteristics using propensity score-matching, surgical results and prognoses were retrospectively compared. The propensity score was based on age, Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PS), American Society of Anesthesiologists physical status classification (ASA-PS), clinical tumor stage, and neoadjuvant chemotherapy. Results The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30–90 days after surgery, 2-year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group. Conclusion In older patients, the ICIC group showed non-inferior surgical and oncological outcomes compared with the CUS group. Urinary diversion following RARC in older patients should be carefully selected by considering not only the age but also the general condition (including comorbidities) of the patient.

The patient was an 82-year-old woman with localized muscle-invasive bladder cancer, who underwent robot-assisted radical cystectomy and cutaneous ureterostomy. On the 3rd day after the operation, she suddenly complained of abdominal pain. Abdominal computed tomographic scans revealed parastomal hernia. The patient underwent manual reduction of hernia, but had repeated recurrences of parastomal hernia within a few days. On the 14th day we performed a laparoscopic hernia repair. Observation of the stoma site revealed a laceration of the peritoneum and fascia, and the small intestine was prolapsed. We pulled the small intestine out and ligated the laceration with Mediflex® Suture Grasper Closure Device. After re-operation, there was no recurrence of bladder cancer and parastomal hernia, and the stoma appliances could be put on without any trouble.

Megaureter je deskriptivni pojam koji označuje dilatirani mokraćovod. Definira se kao svaki retrovezikalni promjer uretera jednak ili veći od 7 milimetara, od 30.tjedna trudnoće na dalje. Klasifikacija se temelji na prisutnosti opstrukcije ili refluksa te prema uzroku. Četiri su kategorije megauretera: refluksni, opstruktivni, refluksni s opstrukcijom i nerefluksni/neopstruktivni, a svaki od njih s obzirom na uzrok može biti primarni i sekundarni. Megaureter se javlja nešto češće kod dječaka i to više na lijevoj strani. Primarni megaureter je drugi najčešći uzrok hidronefroze. Megaureter se obično detektira prenatalno kao slučajan nalaz. Djeca obično nemaju simptoma, a ako oni postoje onda su to obično rekurentne urinarne infekcije, bolovi u trbuhu, neobjašnjive temperature itd. Dijagnoza se obično potvrđuje ultrazvukom, a danas postoji i novija UZV metoda nazvana ceVUS koja je slična MCUG samo ne koristi ionizirajuće zračenje. Ako je potrebna daljnja obrada onda se rade još također i dinamička scintigrafija bubrega, MRU i fMRU. Inicijalno liječenje svih vrsta megauretera je konzervativno. Indikacije za kirurško liječenje su masivna hidroureteronefroza, progresivni gubitak bubrežne funkcije i neuspješno konzervativno liječenje. Postoje brojne metode kirurškog liječenja. Kod djece starije od jedne godine, reimplantacija uretera je metoda izbora liječenja. U početku se ona radila otvorenim pristupom koji je tehnički bio teško izvediv. S vremenom se razvijaju manje invazivne metode s boljim postoperativnim ishodima i smanjenom stopom komplikacija. Te metode uključuju laparoskopsku reimplantaciju uretera transvezikalnim pristupom i endoskopsku dilataciju balon kateterom. Od privremenih kirurških metoda tu su insercija dvostruke J-proteze, refluksna reimplantacija i postavljanje ureterostome. Megaureter is a descriptive term denoting dilated ureter. It is defined as any retrovesical diameter of the ureter equal to or greater than 7 millimeters, from the 30th week of pregnancy onwards. Classification is based on the cause and presence of obstruction or reflux. There are four categories of megaureters: reflux, obstructive, obstructive with reflux, and non-reflux / non-obstructive, and each of them can be primary or secondary, depending on the cause. Megaureter occurs more often in boys and is more commonly located on the left side. The primary megaureter is the second most common cause of hydronephrosis. Megaureter is usually detected prenatally as a random finding. Children are usually asymptomatic, and if symptoms exist, the patients usually present with recurrent urinary tract infections, abdominal pain, unexplained fever etc. The diagnosis is usually confirmed by ultrasound. Today there is a newer ultrasound method called ceVUS, which is similar to MCUG, but it does not use ionizing radiation. If further diagnosis is needed, then dynamic renal scintigraphy, MRU and fMRU are also performed. Initial treatment of all types of megaureters is conservative. Indications for surgical treatment are massive ureterohydronephrosis , progressive loss of renal function, and unsuccessful conservative treatment. There are numerous methods of surgical treatment. In children older than one year, ureteral reimplantation is the method of choice. Initially, it was done with an open approach that was technically difficult to perform. Over time, less invasive methods were developed with better postoperative outcomes and a reduced complication rate. These methods include laparoscopic reimplantation of the ureter by transvesical approach and endoscopic balloon dilatation. Temporary surgical methods include double J-stent insertion, reflux reimplantation, and ureterostomy placement.

A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851.A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020.The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed.CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.

INTRODUCTION: The prognosis of patients with persistent or recurrent cervical cancer (CC) is poor, and patient selection for exenterative surgery is challenging. The aim of this study was to determine the outcomes of patients undergoing pelvic exenteration (PE) for persistent or recurrent CC after treatment with radiotherapy in Belarus. METHODS: A retrospective study was performed of 22 patients with persistent and recurrent CC who underwent supralevator PE from 2006 to 2012 at NN Alexandrov National Cancer Centre. Anterior PE was performed in 16 (72.7%) patients, posterior PE in 2 (9.1%) and total PE in 4 (18.2%) patients. RESULTS: The mean surgical procedure time was 289.1 minutes. Urinary diversion was performed in 20 patients: 5 (25.0%) underwent ureterostomy and 15 (75.0%) underwent neobladder formation. Fecal diversion with end colostomy (Hartman’s procedure) was performed in 5 patients and in one patient a rectosigmoid resection with anastomosis was performed. The median follow-up time was 87 months (range, 4.4–146.0 months). To date, 16 (72.7%) patients have died of cervical cancer and there were no deaths due to other causes. The median survival was 17 months with a 5-year survival rate of 31.8% (SE 9.9%). Cox regression analysis showed that surgical margin status and pelvic lymph node involvement were independent risk factors for survival. CONCLUSIONS: PE was found to be a safe and feasible option for patients with persistent or recurrent cervical cancer who do not have other potentially curative treatment options. Careful patient selection is needed to determine which patients will benefit from this treatment. HIGHLIGHTS: Treatment options are limited for patients with persistent or recurrent cervical cancer Pelvic exenteration is a safe and feasible option for women in Belarus Positive surgical margins and positive lymph node status are risk factors affecting survival

Megaureter je deskriptivni pojam koji označuje dilatirani mokraćovod. Definira se kao svaki retrovezikalni promjer uretera jednak ili veći od 7 milimetara, od 30.tjedna trudnoće na dalje. Klasifikacija se temelji na prisutnosti opstrukcije ili refluksa te prema uzroku. Četiri su kategorije megauretera: refluksni, opstruktivni, refluksni s opstrukcijom i nerefluksni/neopstruktivni, a svaki od njih s obzirom na uzrok može biti primarni i sekundarni. Megaureter se javlja nešto češće kod dječaka i to više na lijevoj strani. Primarni megaureter je drugi najčešći uzrok hidronefroze. Megaureter se obično detektira prenatalno kao slučajan nalaz. Djeca obično nemaju simptoma, a ako oni postoje onda su to obično rekurentne urinarne infekcije, bolovi u trbuhu, neobjašnjive temperature itd. Dijagnoza se obično potvrđuje ultrazvukom, a danas postoji i novija UZV metoda nazvana ceVUS koja je slična MCUG samo ne koristi ionizirajuće zračenje. Ako je potrebna daljnja obrada onda se rade još također i dinamička scintigrafija bubrega, MRU i fMRU. Inicijalno liječenje svih vrsta megauretera je konzervativno. Indikacije za kirurško liječenje su masivna hidroureteronefroza, progresivni gubitak bubrežne funkcije i neuspješno konzervativno liječenje. Postoje brojne metode kirurškog liječenja. Kod djece starije od jedne godine, reimplantacija uretera je metoda izbora liječenja. U početku se ona radila otvorenim pristupom koji je tehnički bio teško izvediv. S vremenom se razvijaju manje invazivne metode s boljim postoperativnim ishodima i smanjenom stopom komplikacija. Te metode uključuju laparoskopsku reimplantaciju uretera transvezikalnim pristupom i endoskopsku dilataciju balon kateterom. Od privremenih kirurških metoda tu su insercija dvostruke J-proteze, refluksna reimplantacija i postavljanje ureterostome., Megaureter is a descriptive term denoting dilated ureter. It is defined as any retrovesical diameter of the ureter equal to or greater than 7 millimeters, from the 30th week of pregnancy onwards. Classification is based on the cause and presence of obstruction or reflux. There are four categories of megaureters: reflux, obstructive, obstructive with reflux, and non-reflux / non-obstructive, and each of them can be primary or secondary, depending on the cause. Megaureter occurs more often in boys and is more commonly located on the left side. The primary megaureter is the second most common cause of hydronephrosis. Megaureter is usually detected prenatally as a random finding. Children are usually asymptomatic, and if symptoms exist, the patients usually present with recurrent urinary tract infections, abdominal pain, unexplained fever etc. The diagnosis is usually confirmed by ultrasound. Today there is a newer ultrasound method called ceVUS, which is similar to MCUG, but it does not use ionizing radiation. If further diagnosis is needed, then dynamic renal scintigraphy, MRU and fMRU are also performed. Initial treatment of all types of megaureters is conservative. Indications for surgical treatment are massive ureterohydronephrosis , progressive loss of renal function, and unsuccessful conservative treatment. There are numerous methods of surgical treatment. In children older than one year, ureteral reimplantation is the method of choice. Initially, it was done with an open approach that was technically difficult to perform. Over time, less invasive methods were developed with better postoperative outcomes and a reduced complication rate. These methods include laparoscopic reimplantation of the ureter by transvesical approach and endoscopic balloon dilatation. Temporary surgical methods include double J-stent insertion, reflux reimplantation, and ureterostomy placement.

Introduction We validated a Japanese version of the Bladder Cancer Index (BCI) as a tool for measuring health-related quality of life (HRQOL) in bladder cancer patients treated with various surgical procedures. Methods The reliability and validity of the Japanese BCI were examined in 397 Japanese patients with bladder cancer via cross-sectional analysis. The patients simultaneously completed the Short Form (SF)-12, EQ-5D, and the Functional Assessment of Cancer Therapy-General and Bladder (FACT-G and FACT-BL). The differences in BCI subscales among various treatment groups were analyzed. Results This study involved 397 patients (301 males and 96 females), with a mean age of 70 years and a median disease duration of 29 months (IQR: 12–66 months). Of these patients, 221 underwent transurethral resection of a bladder tumor, and 176 patients underwent radical cystectomy (ileal conduit: 101 patients, ileal neobladder: 49, and ureterostomy: 26). Cronbach’s alpha coefficient was ≥ 0.78 for all subscales, except the bowel bother subscale. Despite moderate correlations being detected between the function and bother score in urinary and bowel domains, the sexual function score was inversely correlated with the sexual bother score (r = − 0.19). A missing value percentage of > 15% was associated with old age (p Conclusions Although revisions are needed to make it easier for elderly patients to comprehend, we confirmed the reliability and validity of the Japanese BCI. The Japanese BCI could be used for cross-cultural assessments of HRQOL in bladder cancer patients.

Summary Objective. - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC). Methods. - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. Results. - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS 60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. Conclusion. - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.

Highlights • Encrusted cystitis and pyelitis are rare chronic inflammatory diseases. • Commonly caused by the Corynebacterium spp. type D2, which is a gram positive, aerobic, slow-growing, with a multi-antibiotic resistant profile. • Glycopeptides are the most effective antibiotics used as a first choice treatment. • In some complication as urosepsis, bladder rupture and acute peritonitis could lead to higher mortality. • Surgical cystectomy associated with the glycopeptide can be the only relevant cure in those condition., Introduction Encrusted cystitis and Encrusted pyelitis are rare chronic inflammatory diseases. Those conditions are commonly caused by the Corynebacterium spp. especially the type D2 which is a gram positive, aerobic, slow-growing, and urea-sliting bacteria with a multi-antibiotic resistant profile. Presentation of case We report the case of a 62-year-old man with a past history of chronic obstructive pulmonary disease. He was referred to the department of urology for urosepsis. Bacterial culture results were positive to Corynebacterium urealyticum. The diagnosis of encrusted cystitis and pyelitis were highly considered. An adapted antibiotherapy was undertaken using vancomycin during 3 weeks. The patient presented two acute peritonitis : the first was caused by a spontaneous bladder dome rupture which was surgically repaired and the second was caused by a total bladder rupture which required cysto-prostatectomy and bilateral ureterostomy. The post operative outcomes were uneventful. Bacterial urinalysis was negative and total recovery was obtained. Discussion In the majority of the reported cases, there were no sepsis or peritonitis conditions. Medical treatment by the glycopeptides and urine acidification was sufficient. However in this case, the sepsis condition and the bladder rupture with acute peritonitis made exclusively medical treatment by antibiotics insufficient. Therefore cystectomy associated to conventional antibiotics were able to limit the systemic dissemination of the bacteria and save the patient’s life. Conclusion Glycopeptides antibiotics are currently the preferential treatment of encrusted cystitis. In some complicated conditions such as bladder rupture and urosepsis as in this case, radical surgical treatment by cystectomy must be realized early to avoid peritonea and septic shock.

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015–2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0–29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28–30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts.

Objective To compare the outcomes of patients who underwent early repair (≤7 days) of iatrogenic ureteral injury with ureteroneocystostomy and compare them to those repaired in a delayed fashion (>7 days). Methods A retrospective review of billing data between 2012 and 2018 identified patients who underwent ureteroneocystostomy for a benign ureteral disease. Inclusion criteria included all ureteral injuries related to a laparoscopic, robotic, or open surgical injury. Patients with ureteral injury related to radiation, stones, or reconstructive surgery were excluded. Patients undergoing reconstruction during the initial injury or within ≤7 days were designated as having undergone early repair, while the remaining were considered delayed repair. Demographics, as well as inpatient and postdischarge data were acquired, and statistical analysis was performed comparing the 2 groups. Results Sixty-seven patients met inclusion criteria. Early repair was performed on 12 patients, while 55 underwent delayed repair. No significant difference in age, gender, Charlson Comorbidity Score, laterality, stricture location, or history of pelvic/abdominal radiation was noted. Inpatient complications were significantly higher in the immediate group (58 vs 18%, P =.004). Thirty- and 90-day complications were similar. Two patients in the delayed group and none in the immediate group demonstrated stricture recurrence (P =.710). A higher rate of Boari flap ureteral reconstruction was performed in the delayed cohort (P =.001). Conclusion In this cohort, there was no detectable difference in outcomes when comparing early and delayed ureteroneocystostomy for iatrogenic ureteral injuries.

The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, ≥ pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.

Objectives. To investigate the clinical diagnostic value of differential flora as biomarkers in patients with symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) undergoing cutaneous ureterostomy based on metagenomic next-generation sequencing and construct predictive models to provide a scientific reference for clinical diagnosis and treatment. Material and Methods. According to standard procedures, samples were taken from each patient for routine tests (urine, ureteral stent, and skin swab around the stoma). Cytokine levels in the blood were also detected. Urinary microflora were measured by mNGS, and potential biomarkers for distinguishing UTI and ASB were identified by differential flora. Finally, we generated the predictive models for ASB and UTI using the Lasso method and cytokine levels. Results. Urine culture was performed for 50 patients with cutaneous ureterostomy; 44 of these patients developed bacteriuria. The incidence of symptomatic bacteriuria was 54.55%. Biomarker analysis showed that Propionimicrobium lymphophilum, Staphylococcus haemolyticus, Stenotrophomonas maltophilia, Ralstonia insidiosa, and Aspergillus sydowii all had good predictive performance and were combined in a single model. The predictive model exhibited good prediction performance (area under the curve AUC = 0.8729 , sensitivity = 80 % , specificity = 83.3 % , and cutoff = 1.855 ). We also identified a significant negative correlation between the weight sum of the abundance for these five characteristic pathogens (Sum_weighted_Reads) and levels of the cytokine IL-6 and IL-1β ( P < 0.05 ). Conclusion. mNGS had a higher positive detection rate for pathogens in urine samples. The selected differential bacteria can be used as biomarkers of ASB and UTI, and the prediction model has good predictive performance. Analysis also showed that the occurrence of symptoms was related to individual immunity. Combined with the Sum_weighted_Reads cutoff and cytokine levels (IL-6 and IL-1β) of differential flora, it was possible to judge the severity of symptoms in cutaneous ureterostomy patients with bacteriuria and provide new insights for the treatment and intervention of ASB and UTI.

Mucin-producing urothelial-type adenocarcinoma of the prostate (MPUAP) is a very rare disease. MPUAP has been reported to progress faster than the rate at which normal prostate cancer progresses. We report a case of MPUAP with long-term survival. The patient was a 65-year-old man. Computed tomography and magnetic resonance imaging showed a cystic lesion extending from the prostate to the urethra. We performed transrectal prostate biopsy and transurethral resection of the tumor, and the pathological diagnosis was adenocarcinoma. Subsequently, we performed total cystectomy, ureterostomy, and pelvic lymphadenectomy. Based on the pathological and immunostaining findings (prostate-specific antigen negativity, CDX-2 positivity, cytokeratin 20 positivity, 34β-E12 positivity), the patient was diagnosed with MPUAP. Four years after the surgery, recurrence or metastasis was not observed.

Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be a choice, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy.This was a case-series study conducted from April 2016 to Dec 2017. Seventeen male patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in a teaching center mainly by senior residents.The mean age of patients was 68.6 ± 6.41 years. The mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had a PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed a fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia dehiscence.It seems that this technique is suitable for high-risk patients with acceptable operating time, surgical complications, and fast recovery after the operation and one ureterostomy bag instead of two one's comparing to bilateral cutaneous ureterostomy.

We report a 66-year-old male patient with severe right lower extremity swelling resulting from diffuse pelvic mass with compression on right external iliac vein. The patient had papillary urothelial carcinoma of bladder seven years ago and radical cystectomy and ureterostomy was performed. Recurrence of malignancy had occurred five years after the operation. The patient had also bilateral diffuse lung metastasis. The external iliac vein had severe stenosis and invasion of pelvic mass into the vein was evident on venography. Venoplasty of external iliac vein was performed throughout the stenosis. A venous stent of 80 mm length and 12 mm diameter was introduced over the guidewire and deployed in the external iliac vein. Dramatic clinical response was evident since postoperative day two. Swelling of right lower extremity was resolved dramatically on three-month and six-month follow-up visits. We believe that endovascular venous recanalization of iliac veins is feasible and safe in patients with unresectable and diffuse pelvic masses.

Background: The recurrence of urothelial carcinoma in orthotopic ileal neobladder is an extremely rare entity. We present a case of a patient who developed urothelial carcinoma in a robotically formed ileal neobladder (Studer), 10 years after primary surgery, who was managed with robotic neocystectomy. Case Presentation: A 56 year-old patient presented with gross hematuria 10 years after robotic cystoprostatectomy, lymphadenectomy, and intracorporeal formation of Studer ileal neobladder. After surgery the patient was closely followed up using cytology testing, cystoscopy, and imaging at regular intervals. Ten years later the patient presented gross hematuria. Cystoscopic examination with biopsies was performed, revealing the presence of high-grade urothelial carcinoma. The patient under general anesthesia was placed in a position similar to robotic prostatectomy and robotic neocystectomy with bilateral ureterostomy was performed. Conclusion: Although urothelial carcinoma in an orthotopic neobladder is unusual, recurrence should be considered in patients with hematuria who underwent radical cystoprostatectomy and orthotopic ileal neobladder formation. However, those patients can be managed safely and effectively, performing robotic neocystectomy.

To evaluate the residual cancer rate after cystoprostatectomy (CPT) in patients with a history of radiation therapy for prostate cancer and the postoperative complication rates. We conducted a retrospective study involving 21 patients who had a CPT over 7 years and who had a history of radiotherapy for prostate cancer. To compare results, two additional groups were created: a group of patients without a history of radiotherapy in whom a CPT was performed, and a group without a history of radiotherapy and in whom was accidentally discovered a prostate cancer after CPT on histology specimens. The median age at the time of radiotherapy was 69 years. The median age at the time of cystoprostatectomy was 78 years. The median PSA at the time of the intervention was 0.6 ng/ml in the group with a history of radiotherapy. The residual cancer rate was 24%. No patients had criteria for biological recurrence. There were no additional surgical complications in the radiotherapy group (p = 0.2). The rate of cutaneous ureterostomy was higher (p = 0.0006) due to increased surgical difficulties (p = 0.0009). The residual cancer rate was 24% after radiotherapy for prostate cancer. PSA alone does not appear to be sufficient to detect the persistence of residual prostate cancer after radiotherapy. There were no more surgical complications after prostate radiotherapy.

Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of RCU in children. A retrospective review of data from patients treated for RCU between 2002 and 2018 in our institution was performed. All patients were positioned in a flank position and underwent a three-port (5-mm optical trocar and two 3-mm trocars) laparoscopic retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted. Five patients with a median age of 94 months (5–152) were operated on and followed up for a median time of 103 months (46–201). Median operating time was 200 min (160–270). No conversion and no transfusion occurred. Median hospital stay was 2 days (1–4). Ureteral stent was removed after 52 days (47–82). Complications included pyelonephretis (N = 1). In all cases, hydronephrosis decreased postoperatively. Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different patients with specific surgical details to show how to manage these children. The global vision of the upper tract by laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.

Robotic-assisted laparoscopic (RAL) surgery has gained momentum in pediatric urology. Technological adaptations such as the development of 5 mm instruments have led to robotic procedures being performed on younger children and those having smaller body habitus, with improved cosmesis. However, concerns have been raised regarding decreased intra-abdominal working space and the absence of monopolar curved scissors (hot endoshears®) when using 5 mm instruments. The aim of this study is to examine the overall experience at a single pediatric urology center using 5 mm instruments with no planned additional assistant ports during common robotic procedures. We hypothesized this approach is safe and feasible for a variety of pediatric urologic reconstructive procedures. We retrospectively reviewed all major robotic procedures entered into an IRB approved data registry. The analysis was performed only for procedures in which 5 mm instruments were used exclusively with hook diathermy. Procedures that utilized 8 mm instrumentation were excluded from the study. Data were abstracted according to patient age, weight and robotic surgery performed. Outcomes included post-operative complications (Clavien–Dindo classification), operative time, operative blood loss, need for assistant port placement and conversion rates to open or pure laparoscopic surgery. From 2012 to 2016, 220 consecutive pediatric RAL urological surgical cases were performed on 201 patients. These comprised pyeloplasty (n = 102) 46.4%, ureteral reimplants (n = 84) 38.2% and ipsilateral ureteroureterostomy (n = 34) 15.5%. Median age at surgery was 4 years (3 months to 18 years). There were no conversions to open or laparoscopic surgery. Placement of an additional Assist port was documented in seven cases. Severe (Clavien grade 4) complications occurred in two patients requiring ICU admission: one for sepsis and one ventilator-dependent patient having increased work of breathing post-op. Intra-operative blood loss was minimal (

Cutaneous ureterostomy is a well-established surgical technique of incontinent urinary diversion treatment. However, stoma stenosis limits widespread utilization of this technique. We present our modification of constructing single-site tubeless cutaneous ureterostomy aiming to reduce stomal complications and improve catheter-free rate of those patients. In 2016–2017, 30 patients with 60 renal units underwent modified and 30 patients with 60 renal units standard technique. The main differences of our method from previously described techniques were the preservation of parietal peritoneum and fixation of ureteral orifices one to another. Catheter-free rate was calculated in all patients with a minimum follow-up period of 12 months. In total, 52 patients, 26 from the modified cutaneous ureterostomy group, and 26 from the standard cutaneous ureterostomy group were available for the final analysis. The patients’ mean age was 63.1 years. The median follow-up period was 25.8 months (ranging from 1–37 months). The catheter-free rate was achieved 76.9% (20 patients) in the modified group compared to 42.3% (11 patients) in the standard group (P value = 0.013). No statistically significant differences were observed between two groups for late complications and readmission rates. Our technique of single-site-modified cutaneous ureterostomy is a safe and simple surgical technique with similar postoperative complications rate and better catheter-free rate compared to standard cutaneous ureterostomy. We believe that this technique could be a method of choice not only for candidates for cutaneous ureterostomy but also for selected patients for ileal conduit.

Purpose We present surgical techniques and operative results of laparoscopic reconstruction for patients with retrocaval ureter (RCU) and review similar papers. Materials and methods Ten patients with RCU were enrolled in this study from April 2005 to January 2017. The mean age of 7 males and 3 females was 40.5 years old. The chief complaint was flank pain in 6 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Five patients showed obstructed patterns on the renal scans. Two surgeons performed laparoscopic ureteroureterostomies with transperitoneal approaches including excision of the compressed ureter. Double-J ureteral stents were inserted intraoperatively. The operative and follow-up results were checked and compared with published papers. Results All laparoscopic reconstructions were successfully completed without conversion to open surgery. The mean operative time was 199.6 minutes. The estimated blood loss was 154.4 mL. No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 40.7 months. We found 7 papers from PubMed, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters. Conclusions Our results show that transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it.

Introduction: Unilateral robot-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR) has demonstrated previously to be effective and safe in patie...

To describe the use of robotic-assisted transplant ureteral repair (RATUR) for treating transplant ureteral stricture (TUS) in 3 patients who had undergone robot assisted kidney transplant (RAKT).We reviewed the medical records of 3 patients who experienced TUS after RAKT and who underwent RATUR between 2017 and 2020. The patients' RAKT, post-transplant clinical course, endourological interventions, reoperation, and recovery were assessed.All patients diagnosed with TUS presented with deterioration of kidney function after RAKT. Method of diagnosis included ultrasound, antegrade ureterogram, and CT scan. All 3 patients had a short (1 cm) area of TUS and underwent RATUR. For 2 patients, distal strictures were bypassed with modified Lich-Gregoir ureteroneocystostomy reimplantation. One patient was treated with pyelo-ureterostomy to the contralateral native ureter. No intraoperative complications, conversions to open surgery, or significant operative blood loss requiring blood transfusion for any patient were observed. Also, no patients had urine leaks in the immediate or late postoperative period. After RATUR, 2 patients developed Clavien grade II complications with rectus hematoma or urinary tract infection.RATUR is a technically feasible operation for kidney transplant patients with TUS after RAKT. This procedure may provide the same benefits of open operation without promoting certain comorbidities that may occur from open surgical procedures.

To compare improvement/change of hydronephrosis and hydroureter in patients with complete ureteral duplications that underwent upper and lower robotic-assisted laparoscopic uretero-ureterostomies. The hypothesis being that improvement of hydronephrosis and hydroureter between the two groups was similar.35 subjects met inclusion criteria and were reviewed retrospectively. 'Upper' anastomoses were defined as those being done below the lower pole of the kidney (Group 1), while 'lower' anastomoses were those done below the iliac vessels (Group 2). Primary variables analyzed were antero-posterior and diameter measurements of the renal pelvis and ureter, respectively, before and after surgery. Secondary variables included operative time, length of hospital stay, and complication rates.Group 1 consisted of 20 subjects while Group 2 consisted of 15 subjects. Presenting diagnoses were hydronephrosis in 31 subjects and incontinence in 4 subjects. Group 1 mean AP renal diameters decreased by 62.9% (P.05), while Group 2 decreased by 65.4% (P.05). Group 1 mean hydroureter diameter measurements decreased by 80.3% (P.05), while Group 2 decreased by 83% (P.05). The improvement in hydronephrosis and hydroureter between the two groups was not statistically different. Group 1 median operative time (271 minutes) was longer than Group 2 (201 minutes) (P.05). There was no significant difference in hospital stay between the groups and there were no significant complications within the cohort.The improvement rate of hydronephrosis and hydroureter is similar in upper versus lower RAL UU. Operative time was significantly shorter in the lower anastomosis group.

Resumen Introducción. Cerca del 15 % de los pacientes con insuficiencia renal crónica terminal tienen alteraciones de las vías urinarias inferiores. Estas anomalías eran consideradas una contraindicación para el trasplante renal. Por lo anterior, el objetivo del presente trabajo es describir el comportamiento sociodemográfico y clínico de los pacientes trasplantados renales con ureterostomía cutánea como técnica de derivación definitiva de las vías urinarias. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes trasplantados renales con vejiga anormal y ureterostomía cutánea, entre enero de 1973 y octubre de 2012. Resultados. En 4.294 trasplantes renales, se practicaron 24 (0,55 %) ureterostomías, 19 (79,1 %) como técnica inicial y 5 por falla de la ureteroneocistostomía. Diez (41,7 %) ureterostomías fallaron, la mayoría (8 casos) por estenosis. Se presentó infección urinaria en 20 pacientes y la mortalidad fue del 8,3 % (2/24). El 50 % (12/24) de los pacientes con trasplante de riñón estuvieron libres de infección urinaria durante el primer año. La supervivencia del riñón trasplantado fue de 93,8 % (23/24) a los 18 meses, de 85,9 % (20/24) a los 36 meses y de 66,7 % (16/24) a los 50 meses de seguimiento. La supervivencia de los injertos con ureterostomía sin infección fue del 100 % durante el periodo de seguimiento, mientras que la supervivencia de los riñones con infección urinaria fue de 93 % (23/24) a los 18 meses, de 76 % (18/24) a los 36 meses y de 54 % (13/24) a los 50 meses (p=0,235). Conclusiones. La ureterostomía cutánea es una alternativa segura para la derivación urinaria en pacientes trasplantados renales con alteraciones de la vejiga que no permite su uso o preparación antes del trasplante. Abstract Introduction. About 15% of patients with end-stage chronic renal failure have lower urinary tract abnormalities. These abnormalities were considered a contraindication for kidney transplantation. Therefore, the objective of the present work is to describe the sociodemographic and clinical behavior of renal transplant patients with skin ureterostomy as a definitive urinary tract bypass technique. Methods. A descriptive, longitudinal and retrospective study of renal transplant patients with abnormal bladder and skin ureterostomy was conducted between January 1973 and October 2012. Results. We performed 24 (0.55%) ureterostomies in 4.294 kidney transplants. Nineteen (79.1%) were used as first and definitive urinary diversion, and five were ureteroneocystostomies that failed and required ureterostomy as alternative diversion. Ten (41.7%) ureterostomies failed, most (eight cases) from stenosis. Urinary tract infection (UTI) were present in 20 patients and mortality was 8.3% (2/24); 50% (12/24) of kidney transplants were free of urinary tract infection during the first year. The survival of the transplanted kidney was 93.8% (23/24) at 18 months, 85.9% (20/24) at 36 months, and 66.8% (16/24) at 50 months of follow up. The survival of grafts with ureterostomy without urinary tract infection were 100% during the follow-up period, while the survival of the kidneys with UTI was 93% (23/24) at 18 months, 76% (18/24) at 36 months, and 54% (13/24) at 50 months (p=0.235). Conclusions. Cutaneous ureterostomy is a safe alternative for urinary diversion in transplanted renal patients with bladder abnormalities that cannot be prepared or used for a routine diversion before transplantation.

RESUMEN: Los cánceres de colon y recto son una de las principales causas de colocación de un estoma. Cuando la neoplasia se sitúa en el intestino se aboca una porción del mismo a la pared abdominal a través de una abertura llamada estoma. También se puede colocar por enfermedades inflamatorias intestinales como la enfermedad de Crohn o Colitis ulcerosa. Cuando el problema deriva de las vías del sistema urinario se aboca desde los uréteres, riñón o vejiga al exterior utilizando también un tipo de estoma, en todos los casos se coloca una bolsa colectora para recoger los desechos del organismo. El proceso de adaptación al estoma y a la bolsa colectora es bastante largo- aunque varía de unas personas a otras- los pacientes han de asimilar que padecen un cáncer, pasar por una intervención quirúrgica, adaptarse a una alteración en su imagen corporal, aprender el manejo de su ostomía y volver a realizar una vida familiar, social y laboral lo más parecida posible a su vida anterior. Para ello, ha de afrontar cada problema con estrategias dirigidas a su resolución, a controlar sus emociones y a reorganizar su vida. Para tener una buena reinserción hacia una vida plena, es necesaria la figura de la enfermera estomaterapeuta que, con sus cuidados basados en la evidencia y sus expertos conocimientos le ofrece ayuda de calidad, le enseña el manejo del estoma, prevé problemas propios derivados de la intervención quirúrgica, le ayuda emocionalmente, crea y fortalece una relación basada en la confianza mutua, tanto con el paciente como su familia o allegados, de manera que, se sientan siempre amparados, con recursos suficientes para afrontar este nuevo episodio tan negativo y duro de sus vidas. ABSTRACT: Colon and rectum cancers are one of the main causes of stoma placement. When a neoplasm is located in the intestine, part of it is carried to the abdominal wall through an opening called stoma. It can also be used for inflammatory bowel diseases such as Crohn’s Disease or ulcerative colitis. When the problems comes from the urinary tract, it goes from the ureters, kidney or bladder to the outside, also through a kind of stoma, in all cases a collection bag is placed to collect body waste. The process of adapting to the stoma and the collection bag is quite long- although it varies from person to person- the patient has to be trained that he suffers from cancer and will have to undergo a surgical intervention, for which he will have to adapt to an alteration in body image, learn how to manage his ostomy and return to a family, social and professional life as similar as possible to your previous life. For this he has to face each problem with the strategy aimed at solving it, controlling his emotions and reorganizing his life. For a good reintegration towards a full life, it is necessary the figure of the stomatherapist nurse who, with her evidence-based care and her specialized Knowledge, offers quality help, teaches stoma management, foresees his previous problems arising from surgical intervention helps the patient emotionally, creates and strengthens a relationship of mutual trust, both with the patient and with his family or relatives, so that they always feel protected, with sufficient resources to face this new and difficult episode of their lives. Grado en Enfermería

The University of Texas MD Anderson Cancer Center performs over a thousand cystoscopies annually. Cystoscopy is indicated in patients with history of bladder cancer or any other which has involved the bladder.

Renal and ureteric surgical anatomies are presented for the general surgeon. A review of anatomy inclusive of the musculature, fascia, lymphatics, and vasculature are provided as background. As we considered development of the chapter, we thought the most instructive approach would be to review classic open incision techniques such as the lumbar/flank and the anterior abdominal, transperitoneal approaches. An understanding of the ability to access the kidney electively or in an urgent capacity will always require proficiency in one of the aforementioned methods. The most common procedure for a general surgeon to perform in the urinary tract is a nephrectomy, and therefore a step-by-step outline is provided.

Objective: To review and compare robotic ipsilateral uretero-ureterostomy (RIUU) and laparoscopic ipsilateral uretero-ureterostomy (LIUU) in terms of safety, efficacy, and outcomes. Materials and methods: A retrospective chart review, including all pediatric patients who underwent RIUU and LIUU at 5 different medical centers, between 2015 and 2019, was performed. Patient's demographics, perioperative data, surgical techniques, complications, and results were compared. Results: The study included 66 pediatric patients, 22 RIUU and 44 LIUU. Median age at surgery was 12 month (IQR 7–52) and median weight was 12 kg (IQR 9–16). Upper to lower IUU was performed in 55 cases and lower to upper IUU in 11 cases. Median operative times for RIUU and LIUU were 90 min (IQR 75–97.5) and 112.5 min (IQR 81.5–121.25), respectively (p = 0.034). Clavien-Dindo grade 3 postoperative complications occurred in two LIUU patients. One patient underwent an ancillary procedure with laparoscopic distal ureteral stump removal. All patients had resolution of symptoms and improvement in hydronephrosis or a non-obstructed curve on MAG3 diuretic renal scan. Conclusion: RIUU and LIUU are both safe and effective minimally invasive approaches for duplex upper urinary tract anomalies in the pediatric population. RIUU demonstrated shorter operating times .

Objective To determine the efficacy of pelvic exenteration (PE) in patients with locally advanced, persistent and recurrent cervical cancer (CC). Methods A retrospective study was performed of 30 patients with locally advanced, persistent and recurrent CC who underwent PE in 2006–2012. Anterior PE was performed in 24 (80%) patients, posterior PE in 2 (7%) and total PE in 4 (13%). Results The mean operation time was 279.5 min. Urine derivation in 28 patients was performed in the following ways: 7 (25%) patients were subjected to ureterostomy, 21 (75%) had plastic interventions for neocyst formation. Fecal diversion performed in 5 patients by end colostomy (Hartman’s procedure) and in one patient rectum resection was performed. Radical surgery was performed in 70% (21 of 30) of the patients. The median follow-up time of the 28 patients was 76.3 months. During the follow-up period, 19 (68%) patients died of the underlying disease with no deaths of other causes. The median survival was 15.5 months, 5-year survival – 32% (SE 8.8%). The median survival after radical surgery was 37.9 months vs 5.5 months after nonradical one. Five-year cause-specific survival after radical surgery was 74% (SE 10.1%; 95% CI 49–91%), after nonradical one – 33% (SE 15.7%). Conclusion Surgical radicality has been established to be a clinically and statistically significant factor of death risk: the radical surgery enables to reduce the death risk 3.5-fold (95% CI 1.4–9.0; p=0.009), to increase the median survival 6.9-fold, 5-year survival from 11% (SE 10.5%) to 42% (SE 11.3%, 95% CI 20–67%).

Background CAKUT are the most common cause of end-stage renal failure in children (Pediatr Nephrol. 24, 2009, 1719). Many children with CAKUT have poor urinary drainage which can compromise post-transplant outcome. Identifying safe ways to manage anatomical abnormalities and provide effective urinary drainage is key to transplant success. Much debate exists regarding optimum urinary diversion techniques. The definitive formation of a continent urinary diversion is always preferable but may not always be possible. We explore the role of ureterostomy formation at transplantation in a complex pediatric group. Methods We report six pediatric patients who had ureterostomy formation at the time of transplantation at the National Paediatric Transplant Centre in Dublin, Ireland. We compared renal function and burden of urinary tract infection to a group with alternative urinary diversion procedures and a group with normal bladders over a 5-year period. Results There was no demonstrable difference in estimated glomerular filtration rate between the groups at 5-year follow-up. The overall burden of UTI was low and similar in frequency between the three groups. Conclusions Ureterostomy formation is a safe and effective option for temporary urinary diversion in children with complex abdominal anatomy facilitating transplantation; it is, however, important to consider the implications and risk of ureterostomy for definitive surgery after transplantation.

We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

Although bladder injury is a rare complication during cesarean delivery (CD), its incidence is increasing due to the growing trend in elective CD. Herein, we report a case of a 28-year-old woman, who presented during labor. An emergency CD and hysterectomy were done to control bleeding. The case was complicated by and inadvertent cystectomy. Urine was diverted immediately by ureterostomy. After five months, augmentation ileocytoplasty, bilateral ureteral re-implantation, and abdominal catheterizable stoma formation were carried out. This case highlights the surgical management of inadvertent cystectomy during CD.

Objective: To report the outcomes of percutaneous nephroureterostomies performed in a single center a period of ten years. Materials and methods: We retrospectively collected and analyzed data for 52 nephroureterostomy procedures that were performed from September 2008 to August 2018. We present patient’s demographics, indications for the procedure, type of anesthesia, technical difficulties, length of stay in hospital and complications. Results: A total of 52 procedures including 13 bilateral nephroureterostomies were performed on 39 patients. Taking into account the need for replacement of nephroureterostomy procedures during the study period, total number of procedures was 168. Out of a total 39 patients, 32 (84%) of patients had advanced cancer. All procedures were performed as day cases using sedation and had no immediate or early complications. Ten patients or 16% (27 nephroureterostomies out of total 168 procedures) had minor complications. Conclusions: To the best of author’s knowledge, this is the largest case series reporting the outcome of percutaneous nephroureterostomies. We can therefore conclude that percutaneous nephroureterostomy is a useful palliative procedure to relieve ureteric obstruction, when other measures are not possible, and it has low incidence of complications. However, further studies are warranted to compare different procedures used to relieve ureteric obstruction.

To compare the clinical outcomes and patients’ health-related quality of life (HR-QoL) with modified single stoma cutaneous ureterostomy (MCU), bilateral standard cutaneous ureterostomy (SCU) and ileal conduit (IC) using validated diversion-specific HR-QoL instrument. The study included 70 patients who underwent open radical cystectomy with either MCU, SCU, or IC from May 2017 to May 2018. In total 23, 25 and 22 patients were included in each group, respectively, after applying the following exclusion criteria: female, pre- and postoperative radio and chemotherapy, palliative surgery. HR-QoL was evaluated using the European Association of Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30) and Functional Assessment of Cancer Therapy for patients undergoing radical cystectomy (FACT-Bl-Cys). Global health status per EORTC-QLQ-C30 was the only domain that was found to be statistically better in the IC group compared to MCU (p = 0.007). Higher scores in additional concerns (p = 0.008), functional health domains (p = 0.002), satisfaction from urinary diversion (p = 0.004), and total score (p = 0.027) per FACT-Bl-Cys questionnaire, global health status (p

Background The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction. Methods This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications. Results All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients. Conclusion Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.

INTRODUCTION Urinary diversion in pediatric renal transplant candidates with bladders not amenable to primary reconstruction can be achieved by pre-transplant ileal conduit creation. We performed cutaneous ureterostomies to limit pre-transplant surgery, protect the peritoneum for dialysis, transplant patients sooner, and preserve ureter length for future surgical reconstruction. METHODS We compared four pediatric transplant recipients with ureterostomies to four recipients with ileal conduits from 2009 to 2017. RESULTS All patients with ileal conduits developed at least one urinary tract infection (UTI) within 1 year of transplant and three of four patients had recurrent UTIs within the first year. Two patients required ileal conduit revisions for redundant conduits and recurrent UTIs. Of the four ureterostomy patients, two patients had UTIs within one year of transplant. Two patients developed ureterostomy strictures requiring revision at the fascial level; one was associated with a UTI. CONCLUSION In our small case series, ureterostomy allowed for a single operative intervention with preservation of ureter length for later reconstruction. Ureterostomy is safe and recurrent UTI may be lower in the ureterostomy group. Long-term evaluation of ureterostomy for urinary diversion in pediatric kidney transplant is warranted.

The term "megaureter" is used to describe a markedly dilated ureter, irrespective of its underlying anatomic abnormality. Primary megaureters categorised as type I and II according to the Pfister-Hendren classification resolve spontaneously during the first years of life, whereas severely dilated type III megaureters have no potential to resolve on conservative management. Regarding this small group of very severely dilated type III megaureters, we recommend a two-step surgical approach: in a first step, we place a temporary splint-free ureterocutaneostomy for early disobstruction. In a second step, we perform the actual corrective surgery with closure of the incontinent urinary diversion when the patient is approximately one year old, a point in time when bladder function is more mature. With this strategy, ultrasound imaging provides all important information until the corrective surgery is performed. A voiding cystourethrogram (VCUG) to rule out reflux and a MAG-3 diuretic renography can supplement the diagnostic work-up before the ureterocutaneostomy is closed.Der Begriff des Megaureters bedeutet, dass ein Harnleiter eine Erweiterung aufweist, unabhängig von der zugrundeliegenden anatomischen Pathologie. Erweiterte Ureteren vom Typ I und II gemäß der Klassifikation nach Pfister und Hendren normalisieren sich im Verlauf der ersten Lebensjahre spontan, während stark dilatierte Systeme des Pfister Hendren Typ III keine Maturationsfähigkeit haben. Bezogen auf diese besondere Gruppe der Typ III Megaureteren empfehlen wir ein 2-zeitiges operatives Vorgehen: Erstens legen wir in einer frühzeitigen Operation eine splintfreie temporäre Ureterocutaneostomie zur Desobstruktion an und zweitens führen wir den eigentlichen Korrektureingriff mit zeitgleicher Aufhebung des inkontinenten Harnleiterhautstomas um den ersten Geburtstag durch, ein Zeitpunkt, zu dem die Blasenfunktion gereift ist. Durch dieses Vorgehen sind sonografische Verlaufskontrollen bis zum 1. Lebensjahr ausreichend und werden vor der definitiven Korrekturoperation mit Stomaverschluss durch eine Miktionszysturethrografie (MCU) zum Refluxausschluss und ggf. eine MAG-3-Szintigrafie ergänzt.

CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.

Aggressive angiomyxoma (AA) is a distinctive soft tissue tumor with a high risk of local recurrence. Clinicians must be aware of this rare tumor pre-operatively. Excision is the preferred method of AA treatment. The case report presents a case of a 36-year-old woman who was difficulty in walking due to a non-painful tumor in the abdomen and perineum. She was misdiagnosed as abdomen neurofibroma for more than 10 years, and an operation was performed in 1997. However, the tumor was incompletely resected because its huge volume accompanies with extensive infiltration and bleeding. The tumors in her abdomen and perineum were growing gradually, and the latter became a large lump which impeded her daily life. In 2008, the perineal tumor was incompletely resected, which weighed 10725 g. The severe hemorrhage had been ceased by Gonadotropin-Releasing Hormone treatment. She is alive till now. Details of the history and operative procedures are presented. An AA diagnosis was made by microscopy immunohistochemically. Long-time misdiagnosis and improper treatment are the important reasons for making it impossible to be radically resected. Pathological and immunohistochemical examination are important for avoiding misdiagnosis. For this case, there is a remaining tumor in her abdomen. A special project including further follow-up and treatment will be taken out.