R. Epplen

Dünndarmneoblasenfistel nach radikaler Zystektomie und orthotoper Ileumersatzblase

Intestinal neobladder fistula is one of the rare complications following radical cystectomy which is described in about 1.5-2% of all patients. We report on 2 of 267 consecutive patients who underwent radical cystectomy with an orthotopic neobladder who developed such a fistula. Both patients presented initially with recurrent urinary tract infections, fever and chills. In both cases the final diagnosis was made after oral intake of poppy seeds. Imaging studies of choice to identify the anatomical localisation of the fistula and to exclude accompanying intra-abdominal fluid collections were made by computed tomography and magnetic resonance imaging. The treatment of choice consists of surgical excision of the fistula, double-layer closure of the neobladder and small bowel resection or double-layer closure depending on the size of the fistula. A conservative approach only seems to be justified in patients with significant comorbidities or very small fistulas without systemic symptoms.

Palliative radikale (Zysto-)Prostatektomie bei lokal fortgeschrittenem kastrationsresistenten Prostatakarzinom

BACKGROUND Many patients with castration-resistant prostate cancer suffer from local disease progression, mostly consisting of subvesical obstruction, gross haematuria and rectal invasion with obstructive ileus. We analysed the benefit of palliative radical surgery in this patient cohort. MATERIAL AND METHOD Between 2004 and 2010, 20 patients underwent radical surgery; 12 patients underwent radical cystoprostatectomy, 3 patients required additional rectal resection and 4 patients were treated by radical prostatectomy. One patient with a poor prognosis received an ureterocutaneostomy and a colostomy. In all other patients an ileal conduit was chosen for urinary diversion. RESULTS The reduction of symptoms could be achieved in 16 of 20 (80%) patients. The median symptom-free survival was 15.3 (6-25) months, and median survival was 20.3 (9-28) months. CONCLUSION With radical tumour surgery an effective local symptom control can be achieved. This individual therapeutic concept should be discussed in highly selected patients.

Operative Korrekturmöglichkeiten der Anastomosenstriktur nach radikaler Prostatektomie

BACKGROUND Anastomotic strictures following radical prostatectomy for prostate cancer are reported in about 1-8% of all patients. Endourologic management usually does not result in very high cure rates but is associated with very high rates of recurrences. There is no standard management of these postoperative long-term complications and quite often the patient ends up having a transurethral or suprapubic catheter as a simple long-term solution. RESULTS Twenty-four patients with recurrent anastomotic strictures and a mean of 3.5 (2-9) previous transurethral surgical interventions were operated between 2004 and 2011. All patients underwent perineal bladder neck closure and a continent vesicostomy with either an appendiceal or an ileal stoma implanted in the bladder. The mean OR time was 125 (100-195) min, and the mean time of hospitalisation was 12.5 (9-27) days. There were no significant intra- or perioperative complications. Three patients developed a significant urinary tract infection, two patients had to be treated for the development of a paralytic ileus and one patient needed to undergo revision surgery for a urethral fistula. After a mean follow-up of 37 (10-78) months, two patients developed a stomal stenosis which was corrected surgically. CONCLUSIONS Based on our experience, bladder neck closure and continent vesicostomy represent a valuable therapeutic option in the management of recurrent anastomotic strictures following radical prostatectomy.

Possibilities for surgical correction of an anastomotic stricture after radical prostatectomy

BACKGROUND Anastomotic strictures following radical prostatectomy for prostate cancer are reported in about 1-8% of all patients. Endourologic management usually does not result in very high cure rates but is associated with very high rates of recurrences. There is no standard management of these postoperative long-term complications and quite often the patient ends up having a transurethral or suprapubic catheter as a simple long-term solution. RESULTS Twenty-four patients with recurrent anastomotic strictures and a mean of 3.5 (2-9) previous transurethral surgical interventions were operated between 2004 and 2011. All patients underwent perineal bladder neck closure and a continent vesicostomy with either an appendiceal or an ileal stoma implanted in the bladder. The mean OR time was 125 (100-195) min, and the mean time of hospitalisation was 12.5 (9-27) days. There were no significant intra- or perioperative complications. Three patients developed a significant urinary tract infection, two patients had to be treated for the development of a paralytic ileus and one patient needed to undergo revision surgery for a urethral fistula. After a mean follow-up of 37 (10-78) months, two patients developed a stomal stenosis which was corrected surgically. CONCLUSIONS Based on our experience, bladder neck closure and continent vesicostomy represent a valuable therapeutic option in the management of recurrent anastomotic strictures following radical prostatectomy.

Peritonealkarzinose nach roboterassistierter radikaler Zystektomie

Among patients with metastatic urothelial cancer of the bladder, 16-25% develop peritoneal carcinomatosis. In the majority of cases peritoneal carcinomatosis is associated with multiple metastatic sites. Peritoneal metastases as the single site of metastatic deposits are rare and they have been described following laparoscopic radical nephroureterectomy or cystectomy. We report on a patient who developed peritoneal carcinomatosis as the single site of metastases 8 months after robotic-assisted radical cystectomy, extended pelvic lymphadenectomy and extracorporeal formation of an ileal neobladder for organ-confined, muscle-invasive and poorly differentiated bladder cancer. The indication for robotic-assisted radical cancer surgery for urothelial carcinoma of the upper or the lower urinary tract in patients with locally advanced or poorly differentiated cancer should be made with caution.

Intestinal neobladder fistula after radical cystectomy and orthotopic ileal neobladder

Intestinal neobladder fistula is one of the rare complications following radical cystectomy which is described in about 1.5-2% of all patients. We report on 2 of 267 consecutive patients who underwent radical cystectomy with an orthotopic neobladder who developed such a fistula. Both patients presented initially with recurrent urinary tract infections, fever and chills. In both cases the final diagnosis was made after oral intake of poppy seeds. Imaging studies of choice to identify the anatomical localisation of the fistula and to exclude accompanying intra-abdominal fluid collections were made by computed tomography and magnetic resonance imaging. The treatment of choice consists of surgical excision of the fistula, double-layer closure of the neobladder and small bowel resection or double-layer closure depending on the size of the fistula. A conservative approach only seems to be justified in patients with significant comorbidities or very small fistulas without systemic symptoms.

[Peritoneal carcinomatosis after robotic-assisted radical cystectomy].

Among patients with metastatic urothelial cancer of the bladder, 16-25% develop peritoneal carcinomatosis. In the majority of cases peritoneal carcinomatosis is associated with multiple metastatic sites. Peritoneal metastases as the single site of metastatic deposits are rare and they have been described following laparoscopic radical nephroureterectomy or cystectomy. We report on a patient who developed peritoneal carcinomatosis as the single site of metastases 8 months after robotic-assisted radical cystectomy, extended pelvic lymphadenectomy and extracorporeal formation of an ileal neobladder for organ-confined, muscle-invasive and poorly differentiated bladder cancer. The indication for robotic-assisted radical cancer surgery for urothelial carcinoma of the upper or the lower urinary tract in patients with locally advanced or poorly differentiated cancer should be made with caution.

Dünndarmneoblasenfistel nach radikaler Zystektomie und orthotoper Ileumersatzblase@@@Intestinal neobladder fistula after radical cystectomy and orthotopic ileal neobladder

Intestinal neobladder fistula is one of the rare complications following radical cystectomy which is described in about 1.5-2% of all patients. We report on 2 of 267 consecutive patients who underwent radical cystectomy with an orthotopic neobladder who developed such a fistula. Both patients presented initially with recurrent urinary tract infections, fever and chills. In both cases the final diagnosis was made after oral intake of poppy seeds. Imaging studies of choice to identify the anatomical localisation of the fistula and to exclude accompanying intra-abdominal fluid collections were made by computed tomography and magnetic resonance imaging. The treatment of choice consists of surgical excision of the fistula, double-layer closure of the neobladder and small bowel resection or double-layer closure depending on the size of the fistula. A conservative approach only seems to be justified in patients with significant comorbidities or very small fistulas without systemic symptoms.

Palliative radikale (Zysto-)Prostatektomie bei lokal fortgeschrittenem kastrationsresistenten Prostatakarzinom@@@Palliative radical (cysto)prostatectomy in locally advanced castration-resistant prostate cancer

BACKGROUND Many patients with castration-resistant prostate cancer suffer from local disease progression, mostly consisting of subvesical obstruction, gross haematuria and rectal invasion with obstructive ileus. We analysed the benefit of palliative radical surgery in this patient cohort. MATERIAL AND METHOD Between 2004 and 2010, 20 patients underwent radical surgery; 12 patients underwent radical cystoprostatectomy, 3 patients required additional rectal resection and 4 patients were treated by radical prostatectomy. One patient with a poor prognosis received an ureterocutaneostomy and a colostomy. In all other patients an ileal conduit was chosen for urinary diversion. RESULTS The reduction of symptoms could be achieved in 16 of 20 (80%) patients. The median symptom-free survival was 15.3 (6-25) months, and median survival was 20.3 (9-28) months. CONCLUSION With radical tumour surgery an effective local symptom control can be achieved. This individual therapeutic concept should be discussed in highly selected patients.

Operative Korrekturmöglichkeiten der Anastomosenstriktur nach radikaler Prostatektomie@@@Possibilities for surgical correction of an anastomotic stricture after radical prostatectomy

BACKGROUND Anastomotic strictures following radical prostatectomy for prostate cancer are reported in about 1-8% of all patients. Endourologic management usually does not result in very high cure rates but is associated with very high rates of recurrences. There is no standard management of these postoperative long-term complications and quite often the patient ends up having a transurethral or suprapubic catheter as a simple long-term solution. RESULTS Twenty-four patients with recurrent anastomotic strictures and a mean of 3.5 (2-9) previous transurethral surgical interventions were operated between 2004 and 2011. All patients underwent perineal bladder neck closure and a continent vesicostomy with either an appendiceal or an ileal stoma implanted in the bladder. The mean OR time was 125 (100-195) min, and the mean time of hospitalisation was 12.5 (9-27) days. There were no significant intra- or perioperative complications. Three patients developed a significant urinary tract infection, two patients had to be treated for the development of a paralytic ileus and one patient needed to undergo revision surgery for a urethral fistula. After a mean follow-up of 37 (10-78) months, two patients developed a stomal stenosis which was corrected surgically. CONCLUSIONS Based on our experience, bladder neck closure and continent vesicostomy represent a valuable therapeutic option in the management of recurrent anastomotic strictures following radical prostatectomy.