Search

Background: The aim of this study was to evaluate the differences in perioperative outcomes between transperitoneal and retroperitoneal techniques in cutaneous ureterostomy (CUS). Methods: Between 2018 and 2023, 55 patients underwent CUS following robot-assisted radical cystectomy. Among the 55 patients, we compared 33 patients who underwent transperitoneal CUS (t-CUS) and 22 who underwent retroperitoneal CUS (r-CUS). Results: Compared with the r-CUS group, the t-CUS group had significantly shorter operative times (p < 0.001); significantly less estimated blood loss (p < 0.001); and significantly lower incidence of complications (Clavien–Dindo classification grade ≤ 2) within 30 days (p = 0.005). Unexpectedly, the incidence of ileus within 30 days was lower, though the difference was not statistically significant (p = 0.064). During the median follow-up period of 24.3 months, no ileus was observed in either group after 30 days postoperatively. There was no significant difference in the stent-free rate between the groups (p = 0.449). There were also no significant differences in the rates of change in estimated glomerular filtration rate from preoperatively at 3, 6, 12, and 24 months postoperatively between the groups (p = 0.590, p = 0.627, p = 0.741, and p = 0.778, respectively). Conclusions: Compared with r-CUS, t-CUS was associated with a shorter operative time and lower incidence of perioperative complications, including gastrointestinal complications. We believe that t-CUS can be performed safely and effectively. [ABSTRACT FROM AUTHOR]

Robot‐assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient‐side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques. [ABSTRACT FROM AUTHOR]

Objectives: To compare the postoperative outcomes of robot‐assisted partial nephrectomy when only the inner layer is sutured (single‐layer technique with soft coagulation) with those when sutures are placed in the inner and outer layers (double‐layer technique) in patients with and without complex renal tumors. Methods: This retrospective three‐institution study included 371 patients with renal tumors who underwent robot‐assisted partial nephrectomy with a double‐layer technique or a single‐layer technique with soft coagulation. Tumors that were cT1b, completely embedded, located in the renal portal, or had a RENAL score of ≥10 were considered complex. Relevant data were collected from hospital records. Propensity score matching was performed to minimize selection bias. Results: Propensity score matching created 83 patient pairs with non‐complex tumors and 32 with complex tumors. Regardless of tumor complexity, there was no significant difference in operation time, console time, warm ischemia time, positive surgical margin rate, or length of hospital stay between the double‐layer and single‐layer groups. Although Clavien–Dindo grade I–II urinomas not requiring intervention were significantly more common in the single‐layer group regardless of tumor complexity, there was no significant between‐group difference in the rate of decline in renal function or grade III–IV complications. Conclusion: Single‐layer suturing with soft coagulation achieves renal function and perioperative outcomes comparable to those of double‐layer suturing regardless of complexity. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes‐Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes‐Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. Methods: Twenty‐six patients who underwent vaginal reconstruction following robot‐assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes‐Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. Results: There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes‐Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p = 0.102). No complications associated with vaginal reconstruction were identified. Conclusion: The surgical outcomes were comparable between Mercedes‐Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes‐Benz closure is a valuable alternative technique. [ABSTRACT FROM AUTHOR]

Therefore, a similar procedure can be performed with the rigid cystoscope sheath without this device at initial ureteric stenting.[3] This device is primarily used for ureteral stent replacement. In this case, if you apply force during ureteric stenting, the catheter loops between the external urethral orifice and ureteral orifice, making ureteric stenting more difficult. [Extracted from the article]

Introduction Methods Results Conclusions The aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot‐assisted surgery (robot‐assisted radical cystectomy, RARC), including the stent‐free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function.Between 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups.The patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high‐risk cases with ASA‐PS ≥3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent‐free rate were comparable between the ORC and RARC groups. Throughout a median follow‐up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3‐year survival rates were similar across both groups.CUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent‐free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities. [ABSTRACT FROM AUTHOR]

The complications of ileal conduit urinary diversion were reported to be urinary tract infections, bowel obstruction, and delayed wound healing, but ileal conduit-enteric fistula is rare. We report a case of ileal conduit-enteric fistula after robotic intracorporeal ileal conduit urinary diversion. An 81-year-old man with muscle-invasive bladder cancer underwent robot-assisted radical cystectomy and intracorporeal ileal conduit urinary diversion. Twenty-two days after the surgery, we identified the presence of fecaluria. Loopography revealed an ileal conduit-enteric fistula. He underwent conservative treatment with fasting and intravenous hyperalimentation. Loopography was performed 48 days after the surgery. However, the fistula remained. Therefore, fistula closure surgery was performed 51 days after the surgery. Here we review the characteristics of 4 ileal conduit-enteric fistula cases reported in Japan.

Emphysematous cystitis is a rare disease involving infection caused by gas-producing bacteria is characterized by air storage in the bladder wall and lumen. Approximately 90% of the affected cases are treated using medical therapy alone, and approximately 10% require combined surgical treatment. Here we report a case of emphysematous cystitis with septic shock that could be treated using multimodal therapy with retroperitoneal drainage. A 76-year-old woman was hospitalized at a nearby hospital owing to lumbar compression fracture. She was transferred to our hospital owing to altered consciousness and low blood pressure. She was diagnosed with emphysematous cystitis, and conservative treatment was performed using an indwelling bladder catheter and by administering antibiotics or vasopressors. The patient had septic shock; hence, retroperitoneal drainage was performed. After surgery, the patient's general condition improved. In this study, we review the characteristics of five cases of emphysematous cystitis requiring surgical treatment in Japan.

(Objectives) While robot assisted radical cystectomy (RARC) has been associated with improved perioperative outcomes such as blood loss, hospital stay, and improved convalescence, much of the criticism has been attributable to the longer operative time. Opinions are divided regarding whether intracorporeal urinary diversion (ICUD) or extracorporeal urinary diversion (ECUD) should be performed. The aim of this study is to evaluate the utility of RARC and ICUD by comparing with the conventional method. (Patients and methods) From December 2014 to July 2018, 14 patients underwent laparoscopic radical cystectomy (LRC) and 16 patients underwent RARC at our institution. Among the 30 patients, 23 underwent ileal conduit or orthotopic bladder; these patients were divided into two groups: an ICUD patient group (n=10) and an ECUD patient group (n=13). Treatment outcomes were compared between groups. (Results) Compared to patients who underwent LRC those treated with RARC had older (75 vs. 67, P=0.031). There was a trend of high-risk cases (American Society of Anesthesiologists' physical status classification ≥3) more frequently (31.3% vs. 7.1%, P=0.176). Patient treated with RARC had less blood loss (150 vs. 544 ml, P=0.003). There was no significant difference in the intra- and postoperative complication rates (12.5% vs. 21.4%, P=0.642). Compared to patients who underwent ECUD, those treated with ICUD included a longer operative time for urinary diversion (222 vs. 181 minutes, P=0.007) but less maximal incision length without perineal incision (3.0 vs. 6.0 cm, P=0.002). (Conclusions) Our data suggests that RARC is a safe procedure with potential advantages in terms of reduced blood loss. ICUD has longer operative time but is a procedure with excellent cosmetic results.

Although patients on long-term hemodialysis frequently develop renal cell carcinoma, mucinous tubular and spindle cell carcinoma (MTSCC) is rare in incidence. Here, we report a case of MTSCC occurring in a patient under hemodialysis. The patient was a 72-year-old man with end stage renal failure due to diabetic nephropathy. Hemodialysis was initiated in 2003. He presented with macrohematuria. Contrastenhanced computed tomography (CT) revealed a right renal tumor. Laparoscopic right nephrectomy was performed accordingly in June 2017. Pathologically, the tumor was diagnosed as MTSCC. Six months after the surgery, the patient remains free of recurrence and metastasis. Here we review the characteristics of 5 MTSCC cases in patients on hemodialysis reported in Japan.

In the present report, we describe a patient with microcystic variant of urothelial carcinoma in urinary bladder. In March 2016, a 71-year-old man presented with bladder tumors found incidentally by ultrasonography. Cystoscopy and contrast-enhanced computed tomography (CT) revealed multiple invasive tumor of posterior wall, with a maximum diameter of 33 mm. Transurethral resection (TUR) of bladder tumors was performed. Pathological diagnosis was urothelial carcinoma, high grade, T2 or more. Invasive urothelial carcinoma was diagnosed and laparoscopic radical cystectomy with orthotopic neobladder was performed accordingly in April 2016. Pathological findings indicated a diagnosis of microcystic variant of urothelial carcinoma. At present, six months after surgery, the patient remains free of recurrence and metastasis. Here we review the characteristics of 4 microcystic variant of urothelial carcinoma cases reported in Japan.