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Laparoscopic and robot-assisted continent urinary diversions




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Video: Double Yang-Monti ileal conduit

Video: Mitrofanoff appendicovesicostomy

Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique

Denis Rey*, Elie Helou*, Marco Oderda*, Jacopo Robbiani*, Laurent Lopez* and Pierre-Thierry Piechaud*

*Department of Urology, Clinique Saint Augustin, Bordeaux, France, Saint Joseph University, Beirut, Lebanon and Department of Urology, University of Turin, Turin, Italy

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OBJECTIVE

• To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches.

PATIENTS AND METHODS

• Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty.

• Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4).

• The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire.

RESULTS

• All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months.

• Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure.

• Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient.

• Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery.

CONCLUSION

• While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

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