Abdelbasset A. Badawy

Buccal Mucosa Graft for Ureteral Stricture Substitution: Initial Experience

OBJECTIVES To evaluate the use of buccal mucosa tubal graft for reconstruction of extensive ureteral stricture. MATERIAL AND METHODS Between April 2006 and July 2008, 5 patients (mean age, 51.2 years) underwent reconstructive ureteral surgery for ureteral obstruction using buccal mucosa graft. The indication of surgery was extensive ureteral stricture of a 4.4-cm average length (range, 3.5-5.0). The site of stricture was in the proximal and the middle ureter in 3 and 2 patients, respectively. The causes of stricture were postinflammatory (3 cases) and iatrogenic after ureteroscopic procedures for impacted stones (2 cases). RESULTS All 5 patients underwent successful ureteral defect replacement using buccal mucosal tube. The intraoperative course was uneventful without any major complications. Mean operative time was 106 minutes (range, 85-130). With a mean follow-up of 24 months (range, 14-39), the operated kidneys showed no obstruction. CONCLUSIONS Oral buccal mucosal tubal graft for reconstruction of extensive ureteral stricture is a good available option. Although the results of this initial experience are encouraging, a bigger series and longer follow-up is recommended to evaluate our procedure.

Orthotopic diversion after cystectomy in women: A single-centre experience with a 10-year follow-up

Abstract Objective: To evaluate and update the clinical and surgical outcome of orthotopic diversion in an eligible cohort of women with bladder carcinoma. Patients and methods: From 1999 to 2010, 78 women (mean age 42.4 years) had a radical cystectomy (RC) with orthotopic diversion using ileal neobladder reconstruction to treat invasive bladder carcinoma. The mean (SD) follow-up was 62 (25) months. Results: The histopathological pattern was squamous cell carcinoma in 52 (67%) patients, transitional cell carcinoma in 17 (22%), mixed in four (5%) and undifferentiated carcinoma in five (6%). Three patients were completely incontinent day and night. Stress urinary incontinence after this surgery was reported in 11 (14%) patients, with daytime continence reported in 64 (82%); 59 (76%) patients were completely continent day and night. Chronic retention developed in nine (12%) patients. There was pouch prolapse through the vaginal stump in five (6%) patients, and a pouch-vaginal fistula in seven (9%). Sexual dysfunction was reported in 45 (69%) patients of 65 sexually active women. Stones formed in the pouch in five (6%) patients, while there were renal stones in four renal units. Oncological recurrence was reported in 15 (19%) patients, which was local in 11 (14%) and distant in four (5%).

Orthotopic genital sparing radical cystectomy in pre-menopausal women with muscle-invasive bladder carcinoma: A prospective study

Introduction: Invasive cancer bladder is a life-threatening disease that is best treated with radical cystectomy and a suitable urinary diversion. The aim of this study was to evaluate the oncological outcome, voiding and sexual functions after genital sparing radical cystectomy with orthotopic bladder reconstruction in pre-menopausal women with bladder cancer. Materials and Methods: 18 pre-menopausal women who underwent radical cystectomy and orthotopic urinary diversion with preservation of genital organs were included for this study. The patients were followed-up clinically and radiologically to assess their oncological outcome in addition to their voiding and sexual function. Results: Mean age of the patients was 37.8 years, and the median follow-up after surgery was 70 months. One patient was lost to follow-up at 12 months post-operatively. The surgery was completed as planned in all patients, with a mean operative time of 290 min and an average blood loss of 750 mL. 14 patients were able to void satisfactorily, being continent day and night, while four patients needed clean intermittent catheterization. Sexual life remained unchanged in 15 cases, while three patients reported dysparunea. Till the last follow-up, there was no local recurrence while distant metastases were detected in three cases, two of whom died. Conclusions: Genital sparing cystectomy is a valid option for managing carefully selected women with muscle-invasive bladder cancer with good functional and sexual outcomes.

Transobturator vaginal tape (inside-out) for stress urinary incontinence after radical cystectomy and orthotopic reconstruction in women.

Abstract Objectives: To evaluate the safety and clinical efficacy of the transobturator vaginal tape ‘inside-out’ (TVT-O) procedure for managing new-onset stress urinary incontinence (SUI) after radical cystectomy (RC) and orthotopic W-neobladder construction in women. Patients and methods: Between January 2004 and June 2010, 57 women were treated with RC and orthotopic ileal neobladder reconstruction. Six of these patients (median age 44 years, range 39–62; grade 2 muscle-invasive squamous cell carcinoma in four and transitional cell carcinoma in two) developed de novo SUI that was moderate in four and severe in two. The median (range) duration of SUI was 11 (9–18) months. All six patients underwent TVT-O for control of their SUI. Results: Four patients were completely dry day and night (three of them can initiate voiding and one cannot, and uses intermittent catheterization). One patient improved, as assessed by using fewer pads (from 5–7 pads to 1 pad/day and night). She can initiate voiding but has minimal leakage only on moderate exertion. One patient who had severe SUI showed no improvement. Patients were followed for a mean (range) of 18 (17–32) months, with no deterioration in the continence status. Conclusion: These encouraging results confirm the safety and clinical efficacy of TVT-O for managing new-onset SUI after RC and ileal neobladder construction, although a larger survey and a longer follow-up are needed.

A novel algorithm for the non-invasive detection of bladder outlet obstruction in men with lower urinary tract symptoms

Abstract Objective: To determine the ability of bladder wall thickness (BWT) in combination with non-invasive variables to distinguish patients with bladder outlet obstruction (BOO). Patients and methods: Patients completed the International Prostate Symptom Score (IPSS) questionnaire and prostate size was measured by transrectal ultrasonography (US). Pressure-flow studies were performed to determine the urodynamic diagnosis. BWT was measured at 250-mL bladder filling using transabdominal US. Recursive partition analysis (RPA) recursively partitions data for relating independent variable(s) to a dependent variable creating a tree of partitions. It finds a set of cuts of the dependent variable(s) that best predict the independent variable, by searching all possible cuts until the desired fit is reached. RPA was used to test the ability of the combined data of BWT, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), IPSS, and prostate size to predict BOO. Results: In all, 72 patients were included in the final analysis. The median BWT, voided volumes, PVR, mean Qmax, and IPSS were significantly higher in patients who had an Abrams/Griffiths (A/G) number of >40 (55 patients) compared to those with an A/G number of ≤40 (17 patients). RPA revealed that the combination of BWT and Qmax gave a correct classification in 61 of the 72 patients (85%), with 92% sensitivity and 65% specificity, 87% positive predictive value, and 76% negative predictive value (NPV) for BOO (area under the curve 0.85). The positive diagnostic likelihood ratio of this reclassification fit was 2.6. Conclusions: It was possible to combine BWT with Qmax to create a new algorithm that could be used as a screening tool for BOO in men with lower urinary tract symptoms.