Introduction The reconstructive aspects of urological surgery have emerged during the past three decades and become a major component of our surgical speciality. During this time frame many new procedures, such as continent urinary diversion, urinary neobladders, vaginal and penile reconstruction have been added to our surgical armamentarium. The most releyant developments have been observed in the field of urinary diversions. The ileal conduit proposed by Bricker remained the standard urinary diversion for many years. During the last decade, the ileal conduit has become less popular. Indeed, several studies have showed a high conduit-related complication rate in long-term survivors, and therefore, nowadays, the continent ileal neobladder is considered the gold standard in reconstructive surgery after radical cystectomy. Laparoscopic prostate-sparing or nerve-sparing radical cystectomy with ileal neobladder performed with an intracorporeal technique is a new development in the field of minimally invasive urology. An even more recent development is the use of robotics in laparoscopic urological surgery. In this field of reconstructive urology still controversies exist about the importance of an anti-reflux uretero-intestinal anastomosis. We do think that the low pressure of the reservoir associated with sterile urine or with asymptomatic bacterial colonization and the higher incidence of anastomosis stenosis reported in several papers after any anti-reflux technique play an important role against non-refluxing mechanisms. Wood et al. analyse the incidence of positive urinalysis, UTIs and urosepsis in low-pressure ileal neobladders, and whether or not the treatment of asymptomatic bacterial colonization is necessary to prevent urosepsis is debated. The danger to renal function caused by anastomotic stricture is well-documented in orthotopic neobladders and Laven et al. compare open revision of these strictures with endoureterotomy. The important question of whether orthotopic urinary diversions affect quality of cystectomy and cancer-specific survival is investigated by Yossepowitch et al., while the problem of the relative importance of symptom-induced distress and quality of life evaluation following ileal conduit or bladder substitution is investigated by Henningsohn et al. and by Cookson et al., respectively. The reconstruction of genitals in males and females is challenging, and many techniques have been described in recent years. Several techniques for reconstruction of the vagina have been proposed. Parsons et al. report a new interesting technique using a long rectus abdominis myocutaneous flap on an inferior epigastric pedicle.

Reconstructive surgery / B. Patel; A. Minervini. - STAMPA. - (2004), pp. 212-229.

Reconstructive surgery

MINERVINI, ANDREA
2004

Abstract

Introduction The reconstructive aspects of urological surgery have emerged during the past three decades and become a major component of our surgical speciality. During this time frame many new procedures, such as continent urinary diversion, urinary neobladders, vaginal and penile reconstruction have been added to our surgical armamentarium. The most releyant developments have been observed in the field of urinary diversions. The ileal conduit proposed by Bricker remained the standard urinary diversion for many years. During the last decade, the ileal conduit has become less popular. Indeed, several studies have showed a high conduit-related complication rate in long-term survivors, and therefore, nowadays, the continent ileal neobladder is considered the gold standard in reconstructive surgery after radical cystectomy. Laparoscopic prostate-sparing or nerve-sparing radical cystectomy with ileal neobladder performed with an intracorporeal technique is a new development in the field of minimally invasive urology. An even more recent development is the use of robotics in laparoscopic urological surgery. In this field of reconstructive urology still controversies exist about the importance of an anti-reflux uretero-intestinal anastomosis. We do think that the low pressure of the reservoir associated with sterile urine or with asymptomatic bacterial colonization and the higher incidence of anastomosis stenosis reported in several papers after any anti-reflux technique play an important role against non-refluxing mechanisms. Wood et al. analyse the incidence of positive urinalysis, UTIs and urosepsis in low-pressure ileal neobladders, and whether or not the treatment of asymptomatic bacterial colonization is necessary to prevent urosepsis is debated. The danger to renal function caused by anastomotic stricture is well-documented in orthotopic neobladders and Laven et al. compare open revision of these strictures with endoureterotomy. The important question of whether orthotopic urinary diversions affect quality of cystectomy and cancer-specific survival is investigated by Yossepowitch et al., while the problem of the relative importance of symptom-induced distress and quality of life evaluation following ileal conduit or bladder substitution is investigated by Henningsohn et al. and by Cookson et al., respectively. The reconstruction of genitals in males and females is challenging, and many techniques have been described in recent years. Several techniques for reconstruction of the vagina have been proposed. Parsons et al. report a new interesting technique using a long rectus abdominis myocutaneous flap on an inferior epigastric pedicle.
2004
THE YEAR IN UROLOGY
212
229
B. Patel; A. Minervini
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/754525
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