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  • 1
    Article
    Article
    Language: German
    In: Uro-News, 11/2018, Vol.22(11), pp.66-66
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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  • 2
    In: BJU International, January 2012, Vol.109(2), pp.288-297
    Description: To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1464-410X.2011.10242.x Byline: Peter U. Ardelt (1), Christopher R.J. Woodhouse (*), Hubertus Riedmiller ([dagger]), Elmar W. Gerharz ([double dagger]) Keywords: continent urinary diversion; efferent segment; continence mechanism; appendix; ileal nipple Abstract: Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? While the ileal conduit and orthotopic neobladder are the most commonly used diversions today, continent cutaneous reservoirs remain an invaluable treatment option for a well-defined subset of indications. After several decades of surgical experience a continuous optimisation process, especially for the continence mechanism, is still ongoing. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. At present, no consensus has been reached regarding an optimal technique. Common problems include stomal stenosis with impaired catheterisation, urinary incontinence, and nipple gliding. This review critically examines published reports on the various efferent segments used in continent catheterisable urinary reservoirs. It compares data regarding the complications as well as clinical performance. Hence, it provides a valuable comparison and insight into some of the biophysical properties, shortcomings and complications of the different outlets. Also, this view clearly demonstrates that literature evidence for each technique remains poor. OBJECTIVE * To critically assess the biophysical properties and current status of outlet formation in heterotopic intestinal urinary diversion. As despite three decades of clinical experience with continent cutaneous urinary diversion through bowel segments, no consensus has been reached for the optimal efferent segment although its function largely determines patient satisfaction. METHODS * A comprehensive Medline literature search using the Medical Subject Headings database (search terms: continent urinary diversion followed by either efferent segment, nipple, Mitrofanoff, Yang-Monti, Benchekroun, tapered ileum, intussuscepted ileum, Kock pouch, T-valve, or Ghonheim) was conducted to identify all full-length original articles addressing the various principles and techniques of outlet formation as well as their outcomes and complications. * Examined series were published in English between 1966 and 2010. * All studies were systematically evaluated using a checklist (study design, number of patients, etc.) and rated according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (LoE). RESULTS * While there was a continuous flow of publications over the last three decades, the vast majority of studies were retrospective case series with numerous confounding factors and poorly defined, non-standardized outcomes (LoE, 3). Only a few investigations compare different efferent segments (LoE, 2a). * No randomized studies exist. * The major biophysical principles are based on the use of flap, nipple, and hydraulic valves. * Vermiform appendix, intussuscepted ileal nipple, and the Yang-Monti tube are the most popular techniques and have well-established data on outcomes, complications, and failure rates. * Artificial sphincter systems and tissue engineering have provided disappointing results thus far. Most reconstructive strategies are subject to a process of on-going improvement. CONCLUSIONS * The continuous quest for optimization has not led to a single universally applicable efferent segment in continent cutaneous urinary diversion. * While all techniques have their unique set of advantages and disadvantages, they will always remain a compromise. Success depends on selecting the optimal strategy for individual patients. * A major change in principles in the near future is unlikely. Author Affiliation: (1)Department of Urology, Albert-Ludwigs-University Medical School, Freiburg, Germany, (*)The Centre for Urology, Royal Free and University College London Medical School, London, UK ([dagger])Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Wurzburg ([double dagger])Frankfurt Urology Associates, Frankfurt, Germany Article History: Accepted for publication 20 January 2011 Article note: Peter Ardelt, Department of Urology, Albert-Ludwigs-University Medical School, Hugstetter Strasse 55, D-79106 Freiburg, Germany. e-mail: peter.ardelt@uniklinik-freiburg.de
    Keywords: Continent Urinary Diversion ; Efferent Segment ; Continence Mechanism ; Appendix ; Ileal Nipple
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 3
    Language: English
    In: The Journal of Urology, 2010, Vol.184(5), pp.2038-2042
    Description: We provide the long-term results of renal transplantation into continent urinary intestinal reservoirs as a planned 2-stage procedure. Between November 1990 and January 2009, 18 patients underwent cadaveric or living related renal transplantation into continent urinary reservoirs (continent cutaneous diversion 16, orthotopic substitution 2). All patients were prospectively followed. Of these patients 15 are currently free of dialysis. At a mean followup of 89.2 months (range 2 to 188) 13 patients had a serum creatinine ranging from 0.6 to 3.1 mg/dl (mean 1.49) after the first transplantation. Two patients underwent a second transplantation 12 and 122 months after loss of the transplant for renal vein thrombosis and chronic allograft dysfunction, respectively. Two additional patients had to resume hemodialysis 62 and 109 months after renal transplantation. The second transplantation was delayed mainly due to compliance problems. One patient died of fulminant septicemia after laparotomy elsewhere for bowel obstruction with normal renal function before that episode. The continence mechanism needed correction in 3 patients, and 2 further revisions were required for ureteral kinking and lymphocele. The patients with orthotopic substitution (2) voided to completion and showed complete continence. All patients with cutaneous diversion were continent day and night with easy catheterization. This study is among the largest single series to date of renal transplantation into continent urinary diversions. Long-term followup confirms that this approach is a safe and socially well accepted treatment option in carefully selected patients.
    Keywords: Kidney Transplantation ; Urinary Diversion ; Urinary Reservoirs ; Continent ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 4
    In: BJU International, March 2010, Vol.105(5), pp.698-705
    Description: To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1464-410X.2009.08908.x Byline: Peter C. Rubenwolf, Antje Beissert (*), Elmar W. Gerharz, Hubertus Riedmiller Keywords: neurogenic bladder dysfunction; continent urinary diversion; enterocystoplasty; long-term complications Abstract: Study Type - Therapy (case series)Level of Evidence 4 OBJECTIVE To assess the long-term results of continent urinary diversion (CUD) and enterocystoplasty (ECP) in children with irreversible lower urinary tract dysfunction (LUTD). PATIENTS AND METHODS The study included 44 children with irreversible LUTD who had a CUD or ECP between 1992 and 2007. Patients were followed for the functional outcome of surgery with a focus on complications related to the reservoir, bowel, uretero-intestinal anastomosis and upper urinary tract. Data were collected prospectively and outcomes were evaluated using a standardized protocol. RESULTS The median (range) follow-up was 7.3 (3.5-17) years. Complete continence was achieved in 94% overall, i.e. in 95% of patients with continent cutaneous diversion, 83% with ECP and all children with continent anal diversion. Upper urinary tract and renal function remained stable in 89% and 95%, respectively. Surgical intervention was required for adhesive small bowel ileus in 6%, stoma-related complications in 39%, ureteric stenosis in 8%, and stone formation in 19%. Of these complications, 54% required only minor interventions; 41% of patients needed prophylactic alkaline substitution. Bowel habits remained unchanged or improved in 68%. CONCLUSION Our results show that CUD and ECP in children are effective procedures with acceptable long-term complication rates. However, conclusions from our data might be limited, as this was a small study including highly selected patients treated at one tertiary academic centre. Being an audit of practice in our institution and given the variety of concepts, these results might differ from those centres using other approaches in the surgical treatment of LUTD. Importantly, this type of surgery should be restricted to carefully selected patients in whom all attempts of restoring the LUT failed. Author Affiliation: (*)Paediatrics, Bavarian Julius-Maximilians-University Medical School, Wurzburg, Germany Article History: Accepted for publication 15 May 2009 Article note: Peter C. Rubenwolf, Department of Paediatric Urology, Regensburg University Hospital, Steinmetzstrasse 1, 93049 Regensburg, Germany., e-mail: Peter.Rubenwolf@barmherzige-regensburg.de
    Keywords: Neurogenic Bladder Dysfunction ; Continent Urinary Diversion ; Enterocystoplasty ; Long‐Term Complications
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 5
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e477-e477
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 6
    Article
    Article
    Language: German
    In: Uro-News, 9/2016, Vol.20(9), pp.82-82
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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  • 7
    Article
    Article
    Language: German
    In: Uro-News, 7/2016, Vol.20(7-8), pp.62-62
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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  • 8
    Language: German
    In: Uro-News, 12/2016, Vol.20(12), pp.70-70
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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  • 9
    Article
    Article
    Language: German
    In: Uro-News, 5/2018, Vol.22(5), pp.58-58
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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  • 10
    Article
    Article
    Language: German
    In: Uro-News, 2/2018, Vol.22(2), pp.70-70
    ISSN: 1432-9026
    E-ISSN: 2196-5676
    Source: Springer (via CrossRef)
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