Consuegra-Girón J, Morales-Covarrubias J, Cortez-Betancourt R, Guzmán-Hernández F, Velarde-Carrillo A, Sánchez-Gutiérrez F, Vásquez-Flores A

Language: Spanish
References: 10
Page: 88-97
PDF size: 345.35 Kb.

ABSTRACT

There are many indications for lower urinary tract derivation and multiple surgical techniques are employed. Our hospital center is no exception in treating complex lower urinary system cases with this surgery.
Materials and Methods: The study was carried out with patients from the urology, surgical oncology and pediatric surgery specialties who met the required characteristics: type of derivation, derivation indication, complications, pre-and postoperative renal function and follow-up.
Results: Forty-one patients were included in the study: 23 males (56%) and 18 females (44%) with an average age of 57 years. Three patients were under 11 years of age. The types of derivations carried out were: 27 Bricker (66%), 6 Miami (15%), 3 Mitrofanoff (7%), 3 ureterostomies (7%) and 2 Indiana (5%). Surgery indications were: Stage T2 transitional cell cancer (TCC) of the bladder (26 patients, 63%), Stage T1 recurring or multicentric bladder TCC (5 patients), colon and rectal cancer (4 patients), urethral stenosis (2 patients), microcyst (1 patient) and Stage Ta (1 patient). Complications were: no reported complications (12 patients, 29%), obstructive uropathy (6 patients, 15%), enterocutaneous fistula (5 patients, 12%), urinary fistula (4 patients, 10%), chronic renal insufficiency (CRI) (3 patients, 7%), vesicocutaneous fistula (2 patients, 5%), transoperative hemorrhage (2 patients, 5%). One case was reported for each of the following: wall hemorrhage, central catheter migration, parastomal hernia, intestinal obstruction, migrating JJ catheter, neobladder-vaginal fistula, sepsis, incisional hernia, renal exclusion and ileovesical fistula. Five patients died in the immediate postoperative period (principally from metabolic acidosis, multiple organ failure, abdominal sepsis, and one patient from respiratory insufficiency due to glottis edema and chronic obstructive pulmonary disease.
Conclusions: The ileal conduct or Bricker technique was the derivation most frequently used and bladder cancer was the principal indication for that surgery. Renal function was altered from the first year of disease. Ureteral reimplant (in the Urology Service) and intestinal anastomosis and intestinal segment length (in the Oncology Service) techniques should be reviewed due to the cases of obstructive uropathy, enterocutaneous fistula and metabolic problems, respectively, that were encountered.

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