Int Urol Nephrol DOI 10.1007/s11255-015-0958-4
UROLOGY - ORIGINAL PAPER
Should simultaneous ureteral reimplantation be performed during sigmoid bladder augmentation to reduce vesicoureteral reflux in neurogenic bladder cases? Peng Zhang1 · Yong Yang2 · Zhi‑jin Wu1 · Ning Zhang2 · Chao‑hua Zhang1 · Xiao‑dong Zhang1
Received: 14 December 2014 / Accepted: 21 March 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Purpose To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR. Methods We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up. Results The mean follow-up time was 57 months (range 12–117). All patients displayed significantly increased safe cystometric capacity (P 0.05 >0.05 0.05
5.5 ± 1.25
Group A: SBA + ureteral reimplantation Group B: SBA only
opened on its antimesenteric border to form a patch. The antimesenteric border was incised longitudinally, and a detubulized “U” shape sigmoid patch was created. An incision was made laterally between the main branches of the inferior vesical vessels anterior to the trigone and ureteral orifice to a point approximately 2 cm from the internal urethral meatus. A tunneled reimplantation technique was performed in the native bladder for the antireflux procedure. The antireflux operation was performed by intravesical mobilization of the terminal ureter, with subsequent reimplantation through a new hiatus and a submucosal tunnel. The detubulized sigmoid patch was sutured onto the opened bladder with continuous Vicryl sutures in 1 layer. A double-J ureter catheter was inserted into each reimplanted ureter as a stent, and the augmented bladder was emptied with a urethral catheter and another catheter, used as a bladder fistula. Another drain was placed as suprapubic tube to create a bladder fistula. Postoperative management included bladder irrigation with normal saline, beginning on the third day after surgery, using the indwelling catheters to prevent obstruction by secretions. The ureteral stents were removed within 4 weeks, and then cystography was performed to identify whether any bladder leakage existed. The patients were advised to continue with regular bladder irrigation using CISC even after being discharged from the hospital. Patients who had a VUR pressure lower than 20 cmH2O and higher grades of IV–V before SBA were simultaneously treated with antireflux ureteral reimplantation.
International Continence Society guidelines [9]. Safe cystometric capacity (the volume at which the intra-vesical pressure increases by more than 40 cmH2O from the beginning of the bladder-filling phase during VUD, indicating a loss of bladder compliance) [10], bladder compliance, VUR pressure, overactive contractions, Intravenous pyelography (IVP), and other urodynamic parameters were measured. VUD was routinely performed 6 and 18 months after SBA and annually thereafter. Routine postoperative follow-up at our institution also included renal ultrasound and renal function tests. Clinical outcomes regarding the frequency of CISC, the catheterized volume, continence, the need for subsequent urological interventions, medication use, catheterization habits, bowel function, and patient evaluations of their quality of life (QOL) and concerns about the future were assessed using a questionnaire administered by mail or a telephone interview. At least 6 months after the operation, QOL and 5-point Likert scales (which were created by us and are uro specific) were used to assess (1) patients’ satisfaction with their quality of life and (2) their concerns about the future, respectively. For the QOL question on “satisfaction with quality of life,” the patients rated their satisfaction as follows: 0—very good; 1—good; 2—mostly satisfied; 3—just so–so; 4—mostly dissatisfied; 5—unpleasant; and 6—very painful. For the 5-point questionnaire on “worries about the future,” the patients rated their worry as follows: 0—none at all; 1—a little bit worried; 2—minor worry; 3—moderate worry; and 4—very worried. Statistical analysis
Evaluation Multi-channel VUD (Laborie Company, Bonito, Canada) was routinely performed in all patients as part of the preoperative evaluation and for postoperative urodynamic testing at follow-up. We performed VUD in accordance with
The results are reported as the means ± SDs. The statistical analysis was performed with SPSS software, version 13.0 (SPSS, Chicago, USA). The independent t test and paired t test were used to compare the data. P 0.05) were found in any of the data except persistent VUR rate after operation (P
UROLOGY - ORIGINAL PAPER
Should simultaneous ureteral reimplantation be performed during sigmoid bladder augmentation to reduce vesicoureteral reflux in neurogenic bladder cases? Peng Zhang1 · Yong Yang2 · Zhi‑jin Wu1 · Ning Zhang2 · Chao‑hua Zhang1 · Xiao‑dong Zhang1
Received: 14 December 2014 / Accepted: 21 March 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Purpose To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR. Methods We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up. Results The mean follow-up time was 57 months (range 12–117). All patients displayed significantly increased safe cystometric capacity (P 0.05 >0.05 0.05
5.5 ± 1.25
Group A: SBA + ureteral reimplantation Group B: SBA only
opened on its antimesenteric border to form a patch. The antimesenteric border was incised longitudinally, and a detubulized “U” shape sigmoid patch was created. An incision was made laterally between the main branches of the inferior vesical vessels anterior to the trigone and ureteral orifice to a point approximately 2 cm from the internal urethral meatus. A tunneled reimplantation technique was performed in the native bladder for the antireflux procedure. The antireflux operation was performed by intravesical mobilization of the terminal ureter, with subsequent reimplantation through a new hiatus and a submucosal tunnel. The detubulized sigmoid patch was sutured onto the opened bladder with continuous Vicryl sutures in 1 layer. A double-J ureter catheter was inserted into each reimplanted ureter as a stent, and the augmented bladder was emptied with a urethral catheter and another catheter, used as a bladder fistula. Another drain was placed as suprapubic tube to create a bladder fistula. Postoperative management included bladder irrigation with normal saline, beginning on the third day after surgery, using the indwelling catheters to prevent obstruction by secretions. The ureteral stents were removed within 4 weeks, and then cystography was performed to identify whether any bladder leakage existed. The patients were advised to continue with regular bladder irrigation using CISC even after being discharged from the hospital. Patients who had a VUR pressure lower than 20 cmH2O and higher grades of IV–V before SBA were simultaneously treated with antireflux ureteral reimplantation.
International Continence Society guidelines [9]. Safe cystometric capacity (the volume at which the intra-vesical pressure increases by more than 40 cmH2O from the beginning of the bladder-filling phase during VUD, indicating a loss of bladder compliance) [10], bladder compliance, VUR pressure, overactive contractions, Intravenous pyelography (IVP), and other urodynamic parameters were measured. VUD was routinely performed 6 and 18 months after SBA and annually thereafter. Routine postoperative follow-up at our institution also included renal ultrasound and renal function tests. Clinical outcomes regarding the frequency of CISC, the catheterized volume, continence, the need for subsequent urological interventions, medication use, catheterization habits, bowel function, and patient evaluations of their quality of life (QOL) and concerns about the future were assessed using a questionnaire administered by mail or a telephone interview. At least 6 months after the operation, QOL and 5-point Likert scales (which were created by us and are uro specific) were used to assess (1) patients’ satisfaction with their quality of life and (2) their concerns about the future, respectively. For the QOL question on “satisfaction with quality of life,” the patients rated their satisfaction as follows: 0—very good; 1—good; 2—mostly satisfied; 3—just so–so; 4—mostly dissatisfied; 5—unpleasant; and 6—very painful. For the 5-point questionnaire on “worries about the future,” the patients rated their worry as follows: 0—none at all; 1—a little bit worried; 2—minor worry; 3—moderate worry; and 4—very worried. Statistical analysis
Evaluation Multi-channel VUD (Laborie Company, Bonito, Canada) was routinely performed in all patients as part of the preoperative evaluation and for postoperative urodynamic testing at follow-up. We performed VUD in accordance with
The results are reported as the means ± SDs. The statistical analysis was performed with SPSS software, version 13.0 (SPSS, Chicago, USA). The independent t test and paired t test were used to compare the data. P 0.05) were found in any of the data except persistent VUR rate after operation (P
