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    Evaluation of conservative approach in the management of ureteroenteric strictures following radical cystectomy with Bricker ileal conduit: a single-center experience
    (TAYLOR & FRANCIS LTD, 2016) Baten, Evert; Akand, Murat; Floyd, Michael S., Jr.; Van Cleynenbreugel, Ben; Albersen, Maarten; Everaerts, Wouter; Van Poppel, Hendrik
    Objective: The aim of this study was to evaluate the risk factors and treatment options for ureteroenteric strictures (UES) following radical cystectomy (RC) and ileal conduit (IC) formation, and specifically to comment on the conservative management of UES in asymptomatic patients. Materials and methods: The datasheets were reviewed of 304 consecutive patients who were treated with an RC and IC between January 2001 and May 2011 in a Belgian tertiary center and who followed a strict follow-up protocol. Long-term treatment outcomes were retrospectively analyzed. Results: Twenty-two patients (7.2%) were diagnosed with UES (affecting 27 ureters in total), when a new-onset hydroureteronephrosis or increase of the pre-existing hydroureteronephrosis was detected by ultrasound or computed tomography. A retrograde loopogram was then performed to confirm the UES. The mean follow-up time was 33 months. A decline in renal function, the presence of flank pain and urinary tract infections were indications for interventional treatment. Six patients underwent double-J stent placement, two patients received percutaneous nephrostomies as a definitive treatment and two patients underwent ureterointestinal reimplantation. Asymptomatic patients with a UES and a favorable renal function were conservatively managed. They remained asymptomatic during follow-up and required no active treatment. Conclusions: No clinical variable was independently associated with an increased risk of UES. These long-term data suggest that a selected patient population of asymptomatic patients with good renal function at the time of UES diagnosis can be safely managed conservatively.
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    The N-shaped orthotopic ileal neobladder: functional outcomes and complication rates in 119 patients
    (SPRINGER INTERNATIONAL PUBLISHING AG, 2016) De Sutter, Thomas; Akand, Murat; Albersen, Maarten; Everaerts, Wouter; Van Cleynenbreugel, Ben; De Ridder, Dirk; Goethuys, Hans
    Background: We report our long-term experience with 119 cases of N-shaped orthotopic ileal neobladder. Methods: Between March 1996 and July 2013, a total of 119 patients (102 men, 17 women) underwent cystectomy with creation of an N-shaped orthotopic ileal neobladder. The Clavien-Dindo classification score was used for grading early (<3 months postoperative), late, and pouch-related and non-pouch-related complications. Daytime and nighttime continence were evaluated for male and female patients separately, with patients subdivided in three groups: completely continent, use of <= 1 pad, and use of >1 pad. Results: Median follow-up was 75 months (range 3-204). Early complications (15 major, 54 minor) occurred in 39.5 % of 119 patients whereas 53.1 % presented with late complications (56 major, 39 minor; 111 patients evaluated). Urinary infection and outlet obstruction were both the most frequent early and late pouch-related complications; early non-pouch-related complications were mainly infectious and gastrointestinal, and the most common late non-pouch-related problem was wound herniation. At 12 months, 96 and 60 % of the men and 84.6 and 66.7 % of the women respectively achieved daytime and nighttime continence. Conclusion: Complication rates of the N-shaped orthotopic ileal neobladder were relatively high, probably because of meticulous recording and follow-up. Daytime continence rates were better than nighttime rates. N-shaped orthotopic ileal neobladder can be a good option for urinary diversion in selected patients who undergo radical cystectomy.
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    Retrograde intrarenal surgery for renal stones - Part 1
    (AVES, 2017) Van Cleynenbreugel, Ben; Kilic, Ozcan; Akand, Murat
    The main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective. With this modality, nowadays, the vast majority of renal stones can be treated successfully without need of open surgery or percutaneous nephrolithotomy. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, in cases with prior unsuccessful shock wave lithotripsy (SWL), infundibular stenosis, renoureteral malformation, musculoskeletal deformity, bleeding diathesis as well as obese patients. The efficiency of this procedure has been also proved in pediatric patients. In the first part of this detailed review for RIRS, history, indications and contraindications, preoperative preparation, antibiotic prophylaxis, anesthesia, surgical technique related to flexible ureteroscopes and auxiliary equipment being used, postoperative care and complications of this operation are discussed with up-to-date literature.
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    Retrograde intrarenal surgery for renal stones - Part 2
    (AVES, 2017) Kilic, Ozcan; Akand, Murat; Van Cleynenbreugel, Ben
    Retrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature.