Novel Urinary Tract Reconstruction During Extensive Radial Pelvic Surgery - The Ileal-ureter Cystoplasty
CUA Online Library. Elterman D. 06/24/13; 31280; MP-04.08
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Abstract
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Abstract
Purpose: Locally-invasive pelvic tumors often involve adjacent genitourinary structures necessitating large en-bloc resections of ureter and bladder. Ipsilateral vascular compromise prevents mobilization of the contralateral bladder pedicle and large bladder resection requires augmentation. In this situation, a combined ileal ureter substitution and augmentation cystoplasty – the \"ileal-ureter cystoplasty” (IUC), may be performed. We present our series of this combined procedure at a high volume cancer center.
Materials and Methods: A DataLine search through the institutional database identified patients between January 2005 and December 2012 who had at least one CPT code corresponding to a list of possible bladder or ureteric reconstructive surgeries during non-GU surgery. 142 unique patients were identified as having had 160 records. A thorough chart review identified those patients who had an IUC (n=10).
Results: The primary diagnosis of the patients included sarcoma (n=4), gynecologic malignancy (n=3), and colorectal malignancy (n=3). All cases included en bloc resection of large portions of bladder and ureter along with adjacent structures. All patients had prior pelvic surgery and 7 had prior pelvic radiotherapy. Median operative time was 767 minutes and median length of stay was 10 days. 8 patients had minor complications while 2 had major complications. 9/10 patients voided spontaneously after the procedure.
Conclusions: The IUC is a useful surgical technique to bridge large defects during surgery for pelvic tumors when the ipsilateral bladder vascular supply has been compromised. This reconstructive option provides combined ureteral replacement and bladder augmentation, with reasonable functional outcomes and a reasonably low complication rate.
Purpose: Locally-invasive pelvic tumors often involve adjacent genitourinary structures necessitating large en-bloc resections of ureter and bladder. Ipsilateral vascular compromise prevents mobilization of the contralateral bladder pedicle and large bladder resection requires augmentation. In this situation, a combined ileal ureter substitution and augmentation cystoplasty – the \"ileal-ureter cystoplasty” (IUC), may be performed. We present our series of this combined procedure at a high volume cancer center.
Materials and Methods: A DataLine search through the institutional database identified patients between January 2005 and December 2012 who had at least one CPT code corresponding to a list of possible bladder or ureteric reconstructive surgeries during non-GU surgery. 142 unique patients were identified as having had 160 records. A thorough chart review identified those patients who had an IUC (n=10).
Results: The primary diagnosis of the patients included sarcoma (n=4), gynecologic malignancy (n=3), and colorectal malignancy (n=3). All cases included en bloc resection of large portions of bladder and ureter along with adjacent structures. All patients had prior pelvic surgery and 7 had prior pelvic radiotherapy. Median operative time was 767 minutes and median length of stay was 10 days. 8 patients had minor complications while 2 had major complications. 9/10 patients voided spontaneously after the procedure.
Conclusions: The IUC is a useful surgical technique to bridge large defects during surgery for pelvic tumors when the ipsilateral bladder vascular supply has been compromised. This reconstructive option provides combined ureteral replacement and bladder augmentation, with reasonable functional outcomes and a reasonably low complication rate.
Abstract
Purpose: Locally-invasive pelvic tumors often involve adjacent genitourinary structures necessitating large en-bloc resections of ureter and bladder. Ipsilateral vascular compromise prevents mobilization of the contralateral bladder pedicle and large bladder resection requires augmentation. In this situation, a combined ileal ureter substitution and augmentation cystoplasty – the \"ileal-ureter cystoplasty” (IUC), may be performed. We present our series of this combined procedure at a high volume cancer center.
Materials and Methods: A DataLine search through the institutional database identified patients between January 2005 and December 2012 who had at least one CPT code corresponding to a list of possible bladder or ureteric reconstructive surgeries during non-GU surgery. 142 unique patients were identified as having had 160 records. A thorough chart review identified those patients who had an IUC (n=10).
Results: The primary diagnosis of the patients included sarcoma (n=4), gynecologic malignancy (n=3), and colorectal malignancy (n=3). All cases included en bloc resection of large portions of bladder and ureter along with adjacent structures. All patients had prior pelvic surgery and 7 had prior pelvic radiotherapy. Median operative time was 767 minutes and median length of stay was 10 days. 8 patients had minor complications while 2 had major complications. 9/10 patients voided spontaneously after the procedure.
Conclusions: The IUC is a useful surgical technique to bridge large defects during surgery for pelvic tumors when the ipsilateral bladder vascular supply has been compromised. This reconstructive option provides combined ureteral replacement and bladder augmentation, with reasonable functional outcomes and a reasonably low complication rate.
Purpose: Locally-invasive pelvic tumors often involve adjacent genitourinary structures necessitating large en-bloc resections of ureter and bladder. Ipsilateral vascular compromise prevents mobilization of the contralateral bladder pedicle and large bladder resection requires augmentation. In this situation, a combined ileal ureter substitution and augmentation cystoplasty – the \"ileal-ureter cystoplasty” (IUC), may be performed. We present our series of this combined procedure at a high volume cancer center.
Materials and Methods: A DataLine search through the institutional database identified patients between January 2005 and December 2012 who had at least one CPT code corresponding to a list of possible bladder or ureteric reconstructive surgeries during non-GU surgery. 142 unique patients were identified as having had 160 records. A thorough chart review identified those patients who had an IUC (n=10).
Results: The primary diagnosis of the patients included sarcoma (n=4), gynecologic malignancy (n=3), and colorectal malignancy (n=3). All cases included en bloc resection of large portions of bladder and ureter along with adjacent structures. All patients had prior pelvic surgery and 7 had prior pelvic radiotherapy. Median operative time was 767 minutes and median length of stay was 10 days. 8 patients had minor complications while 2 had major complications. 9/10 patients voided spontaneously after the procedure.
Conclusions: The IUC is a useful surgical technique to bridge large defects during surgery for pelvic tumors when the ipsilateral bladder vascular supply has been compromised. This reconstructive option provides combined ureteral replacement and bladder augmentation, with reasonable functional outcomes and a reasonably low complication rate.
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