Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_959_Библиотеки_им_академика_М_И_Перельмана
.pdf
464 Challenging Concepts in Urological Surgery
(a) (b)
(b)(a)
https://t.me/med1917
Figure 48.3 CT of the pelvis showing (a) pelvic collection; (b) CT- guided drainage of pelvic collection
with the pigtail.
On a follow- up nephrostogram, contrast continued to leak into the pelvis from a
point near the right ureteroileal anastomosis. This resulted in a persistent presacral
pelvic collection. This was drained for the third time under CT guidance.
One week later, the patient underwent bilateral retrograde ureteric stent insertion
by interventional radiology (Figure 48.5) utilizing an antegrade approach through
the nephrostomies. This procedure helped to further divert urine away from the defective ileal conduit. The internal– external urinary stents negated the ongoing need
for nephrostomy drains and are much better tolerated by the patient with drainage in
to the stoma bag.
Figure 48.4 Nephrostograms showing (a) a leak close to the right ureteroileal anastomosis; (b) a
stricture proximal to the left ureteroileal anastomosis. A CT scan on follow- up showed an ongoing
pelvic collection measuring 3 × 6 × 11 cm which was drained a second time under CT guidance by
interventional radiologists.
Figure 48.5 Static image during fluoroscopy showing bilateral retrograde ureteric stents.
https://t.me/med1917
465Case 48 Acute interventional radiology procedures in urology
A year later, the patient continued to have intermittent septic episodes and the
small bowel stoma output was high. Following which, he had a laparotomy, reversal
of ileostomy, and ileocolic anastomosis. In addition, the chronic pelvic collection was
drained intraoperatively.
A solitary metastasis in the right lobe of the liver has increased in size on MRI followup, measuring 4 cm, and the patient underwent a liver resection (metastatectomy) as
the lesion was not amenable to radiofrequency ablation due to its proximity to the
diaphragm and the risk of potential thermal injury.
On the latest follow- up CT scan, the pelvic collection was found to be small and
no further drainage was undertaken. The patient undergoes urinary stent exchange in
radiology every 6 weeks.
Learning point Ureteric stents
Antegrade, retrograde, or internal (double J) stents are routinely placed by interventional
radiologists.
Retrograde (transileal conduit) ureteric stent insertion
A retrograde stent is a catheter placed in patients who have undergone surgical treatment, such as
cystectomy with ileal conduit formation in which it exits from the conduit and extends retrogradely to
the renal pelvis.
It is estimated that 15% of patients develop complications in the form of a stricture at the
ureteroenteric junction causing obstruction.
hydronephrosis by percutaneous methods can reach up to 100%. In addition, placement of retrograde
transileal conduit stents can be successful in 90– 95% of cases.
6– 8
Treatment success of ureteric strictures and subsequent
9
466 Challenging Concepts in Urological Surgery
https://t.me/med1917
A retrograde (transileal conduit) ureteric stent can be placed by an antegrade method if the patient has
a nephrostomy in situ or by a retrograde approach, if not, through the stoma.
Retrograde placement of a retrograde (transileal conduit) ureteric stent technique
The ileal conduit is opacified by contrast that is allowed to reflux through the ureteroenteric junction
leading to visualization of the ureter with success rates ranging from 14% to 86%. This can be performed
by inserting a Foley catheter alongside an angle- tipped catheter in to the ileal loop. A guidewire is
introduced through the catheter to access the ureteroenteric anastomosis and advanced up the ureter.
The catheter is advanced into the renal pelvis and exchanged for a stiff guidewire. A catheter can then
be advanced over the wire and its pigtail is formed within the renal pelvis. The distal end of the catheter
can be cut to an appropriate length and left within the stoma bag for drainage.
Antegrade placement of a retrograde ureteric stent technique
The patient can be placed initially in a lateral oblique position or can be rotated from a prone position
after obtaining initial access to the pelvicalyceal system. The renal collecting system is accessed under
ultrasound guidance and contrast is injected, providing visualization of the urinary tract to the ileal
conduit. A guidewire is advanced through the collecting system and manipulated using a catheter
down the ureter and out the stoma. An angled- tip hydrophilic wire can be used. Once the wire is
out through the stoma, providing through and through access, tension should be maintained on
both ends of the wire and an antegrade or retrograde catheter can be advanced to allow guidewire
exchange for a stiffer working wire to allow stent insertion through the stoma to form the pigtail
within the renal pelvis. The wire can be removed once the catheter is adequately positioned. If there
is a need to leave a covering nephrostomy then the wire can be pulled back to the renal pelvis and a
nephrostomy tube can then be placed.
A final word from the expert
This patient required multiple interventional radiology procedures and the diversion of urine
away from the postoperative pelvis allowed an attempt at a corrective laparotomy (although
sadly this was only partially successful) and has allowed wound healing and a return to a
relatively normal life for the patient at home.
Urinary diversion through the stents into the ileal conduit (urostomy) bag is much better
managed by the patient at home than bilateral nephrostomy drains which impact heavily on the
activities of daily living such as dressing and bathing. The risk of inadvertent nephrostomy tube
displacement despite locking pigtail mechanisms, sutures and dressings can be up to 14.5%.
Although better tolerated, ureteric stents draining in to a stoma bag can become encrusted
by lithogenic urine and require regular exchanges every 2– 3 months. Accidental displacement
when changing the stoma bag is rarely complete and salvage via a retrogradely introduced
guidewire under fluoroscopic guidance is usually successful. One of the few advantages of
nephrostomies over stents draining in to a single stoma bag is the difficulty with the latter
of recognizing reduced output from one or other kidney in the context of drain blockage or
displacement.
Urinary leaks post cystectomy/ pelvic exenteration and ileal conduit urinary diversion are
uncommon (approximately 2%) but usually arise from the ureteroileal anastomosis and an early
clinical presentation is a predictor for the need for adjuvant upstream urinary diversion with
nephrostomies.11 Ischaemic breakdown of the proximal ileal conduit itself is very uncommon
but patient frailty and chemoradiotherapy are likely to have played a role.
Ultimately, if the surgeon is prepared to operate, the interventional radiologist should be
prepared to provide all necessary support as required.
10
467Case 48 Acute interventional radiology procedures in urology
https://t.me/med1917
References
1. PelvEx Collaborative. Factors affecting outcomes following pelvic exenteration for locally
recurrent rectal cancer. Br J Surg. 2018;105(6):650– 657.
2. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in
hydronephrosis. J Am Med Assoc. 1955;157(11):891– 894.
3. Ramchandani P, Cardella JF, Grassi CJ, et al. Quality improvement guidelines for percutan-
eous nephrostomy. J Vasc Interv Radiol. 2003;14(9 Pt 2):S277– S281.
4. Zagoria RJ, Dyer RB. Do’s and don’t’s of percutaneous nephrostomy. Acad Radiol
1999;6(6):370– 377.
5. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications.
Semin Intervent Radiol. 2011;28(4):424– 437.
6. Pappas P, Stravodimos KG, Kapetanakis T, et al. Ureterointestinal strictures following
Bricker ileal conduit: management via a percutaneous approach. Int Urol Nephrol.
2008;40(3):621– 627.
7. Alago W Jr, Sofocleous CT, Covey AM, et al. Placement of transileal conduit retrograde
nephroureteral stents in patients with ureteral obstruction after cystectomy: technique and
outcome. AJR Am J Roentgenol. 2008;191(5):1536– 1539.
8. Tal R, Bachar GN, Baniel J, Belenky A. External- internal nephro- uretero- ileal stents in pa-
tients with an ileal conduit: long- term results. Urology. 2004;63(3):438– 441.
9. Makramalla A, Zuckerman DA. Nephroureteral stents: principles and techniques. Semin
Intervent Radiol. 2011;28(4):367– 379.
10. Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a
prospective multi- operator study at a UK training centre. Clin Radiol. 2004;59(3):255– 261.
11. Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol
2004;22(3):157– 167.
https://t.me/med1917
https://t.me/med1917
INDEX
For the benefit of digital users, indexed terms that span two pages (e.g., 52– 53) may, on occasion,
appear on only one of those pages.
Tables, figures, and boxes are indicated by t, f, and b following the page number
A
AAST see American Association for the
Surgery of Trauma (AAST)
abdominal sacrocolpopexy, vaginal
sacrospinous fixation vs. 276
abiraterone
adverse effects 101t
bone metastases management in prostate
cancer 99
metastatic prostate cancer 96
ABP (acute bacterial prostatitis) 11
acquired cryptorchidism 425
acupuncture, bladder pain syndrome 250
acute bacterial prostatitis (ABP) 11
acute interventional radiology 461– 67
acute kidney injury (AKI) 300– 1, 302
acute (T- cell)- mediated rejection 413
acute urinary diversion 120
acute urinary retention (AUR) 211– 20
bladder stones 47– 49
definition 221
initial treatment 223
risk factors 213, 213t
see also benign prostatic enlargement
adjuvant chemotherapy, metastatic penile
cancer 178
adrenalectomy 148
Adriamycin see MVAC (methotrexate/ vinblastine/
Adriamycin (doxorubicin)/ cisplatin)
ADT see androgen deprivation therapy (ADT)
advanced pelvic malignancy, radiotherapy 313
AFP see alpha- fetoprotein (AFP)
age
non- muscle- invasive bladder cancer 108
testicular cancer 185
AKI (acute kidney injury) 300– 1, 302
alpha- adrenergic agonists 355t
alpha- fetoprotein (AFP)
metastatic testicular cancer 199
testicular cancer 189t
testis cancer 185
alprostadil 335
ALS/ MPCA trial 100
American Association for the Surgery of
Trauma (AAST)
bladder and ureteric trauma 390, 390t
renal trauma scale 381
American Urological Association 366t
amitriptyline 249
AML see angiomyolipoma (AML)
amoxycillin resistance 3
Amplatz, small- volume neobladders 56
AMR (antimicrobial resistance) 3, 4
anaemia 97
anaesthetics
examination of impalpable testes 428
orchidopexy 427
anastomoses, ketamine- induced bilateral
urinary tract injury 305
Anderson– Hynes pyeloplasty 65– 66
androgen deprivation therapy (ADT) 89
adverse effects 97
bone health management 98
continuous vs. intermittent 97
metastatic prostate cancer 95
timing of 96
anejaculation 352
angiomyolipoma (AML) 149
computed tomography 150f
epithelioid type see epithelioid
angiomyolipoma
radiology 150
anorgasmia (AO) 352
causes and treatment 356, 356t
antegrade placement, retrograde (transileal
conduit) ureteric stent insertion 466
antenatal hydronephrosis 449
anterior colporrhaphy 274
anterior enterocele 272
anterior vaginal wall prolapse 272
anthracyclines 111
anti- androgens 95, 96
antibiotics, vesicoureteral reflux 453
antibodies
renal transplantation management 411
renal transplantation rejection 413
470 Index
https://t.me/med1917
anticholinergic drugs
dementia 231
discontinuation of 231
neurogenic bladder 263, 438
retrograde ejaculation management 355t
urge urinary incontinence 230– 31
anti- incontinence surgery, urethral
diverticulum surgery and 294
antimetabolites, renal transplantation 411
antimicrobial resistance (AMR) 3, 4
antimuscarinic therapy 438
anti- sacrococcygeal ligament 272f
AO see anorgasmia (AO)
apalutamide 96
APGAR (Appearance, Pulse, Grimace, Activity,
and Respiration) scores 449
ARASENS trial 96
L- arginine, bladder pain syndrome 249– 50
artificial urinary sphincter 52– 56, 53f
ascending testis 425
aspiration, priapism 376
ASSURE trial 148
asymptomatic inflammatory prostatitis 19
atezolizumab 131, 132
audiological studies 190
augmentation cystoplasty 233, 263
augmented bladders 55– 56
AUR see acute urinary retention (AUR)
autoimmune arthritis 311
autologous fascial sling (AFS)
mid- urethral tape vs. 240
stress urinary incontinence
management 239– 40
autotransplantation 158, 159f, 159
surgery 158
avelumab 132
axitinib 140
azoospermic patient 321– 29
genetic abnormalities 324
hormone levels 324t
semen fluid analysis 322, 323, 323t
B
bacterial prostatitis 12, 16
balanitis xerotica obliterans (BXO) 444
appearance of 445f
circumcision and 443
histology 444f, 444
balloon dilatation, small- volume
neobladders 56
BCG
adverse effects 110
contraindications 110
durvalumab and, non- muscle- invasive
bladder cancer 112
failure 110
high- grade non- muscle- invasive bladder
cancer 128– 29
non- muscle- invasive bladder cancer
management 109
outcomes of 130
palliative cystectomy 123
behavioural techniques, bladder pain
syndrome 250
bell clapper deformity 363
benign prostate hyperplasia (BPH)
bladder stones 48
definition 215
benign prostate obstruction (BPO) 216
benign prostatic enlargement 211– 20
see also acute urinary retention (AUR)
BEP (bleomycin, etoposide, cisplatin)
metastatic NSGCT 190
non- seminomatous germ cell tumour 200
beta human chorionic gonadotropin (β- HCG)
metastatic testicular cancer 199
testicular cancer 185, 189t
bilateral nephrostogram 303f
bilateral orchidectomy 95
bilateral retrograde ureteric stents 465f
bilateral ureteric reimplantation 301
bilateral ureteric stents 301, 302f
biomarkers, bladder pain syndrome 250
biopsy, percutaneous in oncocytoma 72, 75– 76
bisphosphonates 98
bivalving, bladder 391
bladder
augmented bladders 55– 56, 438
bivalving of 391
cancer see bladder cancer
capacity 420, 437
closure of 392
congenital neuropathic bladder
dysfunction 433
drainage in urinary retention 255
drainage post repair 392
filling rate measurement 422
function assessment 420
grossly trabeculated bladder 422f
hydrodistension 250
large volume neobladder see large- volume
neobladder
neurogenic bladder see neurogenic bladder
non- neurogenic neurogenic see non-
neurogenic neurogenic bladder
overactive see overactive bladder (OAB)
471Index
https://t.me/med1917
pain see bladder pain syndrome (BPS)
small- volume neobladder see small- volume
neobladder
thickened walls 420f
trauma see bladder and ureteric trauma
bladder and ureteric trauma 389– 95
bladder drainage post- repair 392
examination 389
imaging 390f
initial assessment 389
see also ureteric trauma
bladder cancer
diagnosis 118
genetic classification 119
histological staging 120
muscle- invasive see muscle- invasive
bladder cancer (MIBC)
non- muscle invasive see non- muscle-
invasive bladder cancer (NMIBC)
pathology subtypes 119
pT1 tumours 119
staging 118
transitional cell carcinoma 130
transurethral resection see transurethral
resection of the bladder tumour (TURBT)
see also high- grade non- muscle- invasive
bladder cancer
bladder diary 212
bladder neck (BN) procedures 439
bladder outflow obstruction (BOO) 215– 16
Bladder Outflow Obstruction Index
(BOOI) 214, 215
bladder pain syndrome (BPS) 247– 52
clinical assessment 248
diagnosis 248
differential diagnosis 247b, 247
investigations 248
management 249
pathophysiology 251
bladder stones 47– 60
acute urinary retention 47– 49
benign prostate hyperplasia 48
clinical features 48
mesh on 49f, 49– 50
risk factors 48
size effects 54, 55f
treatment options 48
urethral strictures 50– 51, 51f
see also small- volume neobladder
Blaivas classification, stress urinary
incontinence 241t
bleomycin
contraindications 201
metastatic prostate cancer 178– 79
see also BEP (bleomycin, etoposide, cisplatin)
blood gas analysis, priapism 376
blood groups, renal transplantation 410
blood tests
ketamine- induced bilateral urinary tract
injury 299
muscle- invasive bladder cancer 117
urinary retention 222
BMG (buccal mucosal graft) 286, 287t
BN (bladder neck) procedures 439
bone metastases 99
BOO (bladder outflow obstruction) 215– 16
BOOI (Bladder Outflow Obstruction
Index) 214, 215
botulinum toxin A
bladder pain syndrome 250
intradetrusor 263
neurogenic bladder 438
BPO (benign prostate obstruction) 216
BPS see bladder pain syndrome (BPS)
brain death examination 408
BRAVO randomized controlled trial 119
buccal mucosal graft (BMG) 286, 287t
Bulkamid® 239
bulking materials, vesicoureteral reflux
correction 453
BXO balanitis xerotica obliterans (BXO)
C
cabazitaxel 101t
CAD (coronary artery disease) 332
calcineurin inhibitors 411
calcium supplements 98
carboplatin 130, 131
cardiac function tests, pre- chemotherapy 190
cardiovascular system, androgen deprivation
therapy 97
CARD trial 100
castration
medical castration 95
metastatic prostate cancer 95
surgical castration 95
catheterization
clean intermittent catheterization 423
clean intermittent self- catheterization 261
haematuria 389
haematuria after 223
indwelling catheters 263
intermittent self- catheterization 226
removal 312
self catheterization 263
transurethral catheter 389
472 Index
https://t.me/med1917
cauda equina syndrome (CES) 255
cervical prolapse 272
CFTR gene mutations 324
CHAARTED trial 96
checkpoint inhibitors 113
chemotherapy
high- grade non- muscle- invasive bladder
cancer 132
metastatic bladder transitional cell
carcinoma 131
metastatic penile cancer 178
neoadjuvant chemotherapy see neoadjuvant
chemotherapy (NAC)
non- muscle- invasive bladder
cancer 111, 112
non- seminomatous germ cell
tumour 200, 202
pre- testing 190
residual masses in testicular
cancer 199– 207
second- line 132
serum tumour markers 201
children
neurogenic bladder 433– 41
vesicoureteral reflux 449– 57
chronic kidney disease (CKD)
aetiology 405
definition 405
chronic prostatitis/ chronic pelvic pain
syndrome (CP/ CPPS)
aetiology 16
clinical evaluation 16
subtype classification 18t
therapy 18
chronic urinary retention (CUR) 221– 28
definition 221
definitive management 226
initial treatment 223
therapy 225
ciprofloxacin 12
circumcision
balanitis xerotica obliterans and 443
indications for 444
monitoring after 445
penile cancer 166
urinary tract infection prevention 453
CISC (clean intermittent
self- catheterization) 261
cisplatin
metastatic bladder transitional cell
carcinoma 131
metastatic prostate cancer 178– 79
muscle- invasive bladder cancer 117
TIP (paclitaxel, ifosfamide, cisplatin) 179
see also BEP (bleomycin, etoposide,
cisplatin); MVAC (methotrexate/
vinblastine/ Adriamycin (doxorubicin)/
cisplatin)
CKD see chronic kidney disease (CKD)
clam ileocystoplasty 265f
ileal chimney with 301
clean intermittent catheterization 423
clean intermittent self- catheterization
(CISC) 261
Coaptite® 239
coccygeus muscle 272f
coccyx 272f
Cochrane review, pelvic floor muscle
training 238
colosuspension
mid- urethral tape vs. 240
stress urinary incontinence
management 240
colour Doppler ultrasound, testicular
torsion 365
colpocleisis 276
colporrhaphy, anterior 274
ComBAT study 213
combination chemotherapy, non- muscle-
invasive bladder cancer 112
complement- dependent cytotoxicity test 410
complex urethral diverticulum 295
computed tomography (CT)
acute interventional radiology 461, 462f
angiomyolipoma 148, 150f
bladder and ureteric trauma 390f
bladder stones 47f, 47
bladder stones on mesh 49f, 49
growing teratoma syndrome 187f, 194– 95
guidance in laparotomy 463, 464f
high- grade non- muscle- invasive bladder
cancer 127f, 127, 129f, 130f, 130, 132f
hydronephrosis 38f
ketamine- induced bilateral urinary tract
injury 300
large- volume neobladder 57f
localized renal cancer with vena cava
tumour thrombosis 137f, 137
metastatic germ cell cancer 191f, 191
metastatic testicular cancer 201f, 201
muscle- invasive bladder cancer 117
oncocytoma 71f, 74
prostatitis 12f, 12, 13f
renal masses 75
renal stones 25, 26f
renal trauma 381, 382f
473Index
https://t.me/med1917
ureteric stones 36f, 36, 37
ureteropelvic junction obstruction 65f, 65
ureteropelvic junction obstruction
(UPJO) 63, 64f
computed tomography urogram
(CTU) 155f, 155
congenital neuropathic bladder
dysfunction 433
congenital penile curvature 345
connective tissue
pelvis 273
vesicovaginal fistula 311
conservative surgery, penile cancer 168, 169
continuous isoperistaltic ileal segment 302– 4,
303f, 304f
contralateral fixation, testicular torsion 367
contralateral testis biopsy 187
contrast enhanced ultrasonography 365
coronary artery disease (CAD) 332
counselling, urethral diverticulum 292
CP see chronic prostatitis/ chronic pelvic pain
syndrome (CP/ CPPS)
CPPS see chronic prostatitis/ chronic pelvic
pain syndrome (CP/ CPPS)
cranberry supplements 5– 6
creatinine
ketamine- induced bilateral urinary tract
injury 305
renal failure 224t
Crohn’s disease 43
cryptorchidism 425
acquired 425
effects of 426
testicular cancer 186
CT see computed tomography (CT)
CTU (computed tomography
urogram) 155f, 155
cutaneous loop ureterostomy 454
cyclosporine 249
cystectomy
palliative 123
radical 122f
cystitis, interstitial see interstitial cystitis
cystocele 272
ureterovaginal prolapse 271f
cystography
bladder and ureteric trauma 392f, 392
flexible see flexible cystoscopy
cystometry, voiding 81
cystoplasty, augmentation 233, 263
cystoprostatectomy, radical 117
cystoscopy
bladder pain syndrome 248– 49
bladder stones on mesh 50
rigid 117
vesicovaginal fistula 312f, 312
cystourethrocele 272
cystourethrography, voiding 261
D
dapoxetine 357
darolutamide 96
daytime urination frequency 229
deceased donors, renal
transplantation 407, 408f
DeLancey’s supports 273
delayed ejaculation 352
causes and treatment 356, 356t
delayed orgasmia (DO) 352
dementia, anticholinergic drugs 231
denosumab 98
detrusor leak point pressure (DLPP) 261
detrusor overactivity (DO)
definition 216
urodynamics 232f
detrusor sphincter dyssynergia 254
detrusor underactivity (DUA) 216
diabetes 355
diclofenac 36
dimercaptosuccinic acid (DMSA) scan
neurogenic bladder 436f, 436, 437f
vesicoureteral reflux 453, 454, 455f
dimethylsulfoxide 306
direct visual internal urethrotomy
(DVIU) 282, 287
disorder of sex differentiation (DSD) 427
diuresis, post- obstruction 224
DLPP (detrusor leak point pressure) 261
DMSA scan see dimercaptosuccinic acid
(DMSA) scan
DNA damage 100
DO (delayed orgasmia) 352
docetaxel
adverse effects 101t
bone metastases in prostate cancer 99
metastatic prostate cancer 95, 96
donor nephrectomy, renal
transplantation 409– 10
Doppler ultrasound, priapism 377
doxorubicin 111
see also MVAC (methotrexate/ vinblastine/
Adriamycin (doxorubicin)/ cisplatin)
drug history, ejaculatory orgasmic
disorders 353
drug- induced urinary retention 254
DSD (disorder of sex differentiation) 427
Соседние файлы в папке Библиотека им академика М.И. Перельмана