Urinary tract reconstruction: Applied urodynamics

Sixty-four patients underwent urinary reconstruction guided by urodynamic investigation. Twenty-eight patients had myelodysplasia (MM) and 26 had spinal cord injuries (SCI). Operative outcomes were assessed by repetitive urodynamic testing. Bladder reservoir function and detrusor contractile activity were correctly assessed in all 64 patients. Operative creation of a more adequate reservoir was required in 58 patients. Assessment of urethral continence function was inaccurate in six instances wherein we judged urethral sphincter function adequate when, in fact, it was not. Ureteral function was judged radiographically or by furosimide renography, or Whitaker perfusion testing. In the two instances where ureteral function was in doubt, it made no difference in outcome. There was a striking resolution of ureteral radiographic abnormalities after reconstruction which we attribute to the low-pressure reservoir.     

Surgical treatment of stomal prolapse: A systematic review and meta-analysis of the literature

Aim

This study aimed to assess success, recurrence, and overall complication rates among different surgical procedures for stomal prolapse.

Methods

This study was a PRISMA-compliant systematic review. PubMed, Scopus, and Google Scholar were searched until March 2022. Studies that assessed surgical treatments of stomal prolapse in adults were included. The primary outcome was recurrence of stomal prolapse and the secondary outcome was 30-day complications. A random-effect meta-analysis was used to estimate the weighted mean rates of recurrence.

Results

Six studies published (111 patients; 103 males) were included. 52 (46.8%) patients had end colostomies, 35 (31.5%) had loop colostomies. Seven procedures were assessed and included local stoma reconstruction (40%), stapled local repair (27%), modified Altemeier technique (10%), mesh strip repair (9%), stoma relocation (6%) redo laparotomy repair (5%), and colectomy and end ileostomy (3%). The weighted mean recurrence rate after local stoma reconstruction was 37.2% (95% CI: −1.8 to 76.3), higher than that after the stapled local repair technique (14.9%; 95% CI: 1.7–28.2). The crude recurrence rate of the modified Altemeier technique was 20%, and of stoma relocation was 66.6%. No recurrence was detected after the mesh strip technique (n = 10). The median follow-up ranged between 7 months and 2.5 years.

Conclusion

Several surgical techniques are available to treat stomal prolapse. Local stoma reconstruction may be associated with high rates of recurrence while the stapled local repair and modified Altemeier procedure has relatively low recurrence. Further larger studies are needed to compare the efficacy of these techniques.     

膀胱癌尿流改道腹壁造口患者护理依赖现状及相关因素研究

目的 调查膀胱癌尿流改道腹壁造口患者护理依赖情况,并分析其影响因素.方法 于2020年5月至2021年5月便利抽取膀胱癌尿流改道腹壁造口患者168例,采用一般资料调查表、护理依赖量表、自尊量表、创伤应激障碍量表平民版、个人掌控感量表进行调查,应用多元线性回归分析膀胱癌尿流改道腹壁造口患者护理依赖影响因素.结果 膀胱癌尿流改道腹壁造口患者护理依赖总分为(57.07±8.31)分.多元线性回归结果显示,年龄、文化程度、并存疾病、自尊水平、创伤后应激障碍以及个人掌控感是膀胱癌癌尿流改道腹壁造口患者护理依赖的影响因素(P＜0.05,P＜0.01),可解释总变异的66.1％.结论 膀胱癌尿流改道腹壁造口患者护理依赖发生率较高.临床护理人员应结合患者年龄、文化程度、并存疾病、自尊水平、创伤后应激障碍程度以及个人掌控感,制定有效干预措施,降低患者护理依赖程度,提高其生活质量.     

Pouch Volume,Stoma Diameter and Weight Loss in Swedish Adjustable Gastric Banding (SAGB)

Background: Weight loss appears to be inversely related to pouch volume following gastric restriction procedures for morbid obesity. The aim of this study was to investigate the changes in pouch volume with time and the relationship between pouch volume and stoma diameter and subsequent weight loss following the Swedish Adjustable Gastric Banding (SAGB). Methods: During 1990 50 patients were operated upon. Their mean BMI at surgery was 46 and at 2 years 28. We followed these patients with endoscopy at 6 weeks and 3, 18 and 24 months after surgery. During endoscopy pouch volume was estimated according to a standardized classification system and measured stoma diameter using balloon catheters. Results: The results indicate that the pouch dilates during the first few months after surgery but that the size thereafter is fairly stable. There is also a relationship between pouch volume and subsequent weight loss. Pouch volume seems to be the primary determinator for weight loss. Conclusion: The smaller the pouch the greater the weight loss. Reduction of the stoma diameter is a good instrument for regulating the degree and speed of weight loss in patients with small pouches, but much less powerful in patients with large pouches.     

Indwelling trans-anastomotic rectal tubes in colorectal surgery: a survey of usage in UK and Ireland

BACKGROUND: The use of rectal tubes in colorectal surgery appears to be a matter of individual choice, with little documented evidence to support their use. This study assesses the current practice of rectal tubes amongst consultant members of the Association of Coloproctology of Great Britain & Ireland (ACPGBI). METHODS: A piloted questionnaire was sent to practising ACPGBI consultant members listed in the 2003-04 directory. Statistical analysis was performed using SPSS software and Fishers exact test. RESULTS: Three hundred and thirty-nine replies were received from 579 posted questionnaires (response rate = 58.5%). Rectal tubes were used by 116 (35%) of responding surgeons. Rectal tubes were more commonly used by surgeons with less than 10 years practice as a consultant (P < 0.005). The main indications for tube placement were following ileo-anal or colonic pouch surgery (73%), after any anterior resection (36%) (rectal tubes were reserved for only low anterior resections by 16% of surgeons) and in the rectal stump after total or subtotal colectomy for acute colitis (11%). Twenty-three percent of these practising surgeons would use a rectal tube as an alternative to a diverting stoma, predominantly in selected patients following ileo-anal pouch surgery. A Foley catheter was the commonest type of tube used (70%) and this was usually placed above the anastomosis (80%). Rectal tubes were left in situ for a median of 5 days (range = 1-13 days). Three surgeons (2.6%) reported serious complications including tube perforation of the bowel or anastomosis. Several different mechanisms were suggested for the purpose and functioning of the rectal tube, the commonest being to decompress the rectum and/or pouch. CONCLUSION: Rectal tube placement is simple and safe and is used by a third of colorectal surgeons in UK and Ireland. Given their simplicity, the efficacy of rectal tubes in reducing local anastomotic complications requires further evaluation within the confines of a randomised controlled trial.