Purely Laparoscopically Completed Continent Urinary Diversion Charite Hospital Experience

The first purely laparoscopically completed continent urinary diversion (rectosigmoid pouch) was reported by Turk et al. in 2001 (11). The authors demonstrated that purely laparoscopic reconstructed rectosigmoid pouch was feasible and safe with the same functional outcomes as after open Mainz II procedure. Recently, among their 20 laparo-scopic radical cystectomy series, this group documented the oncologic and functional data of 12 patients undergoing laparoscopic rectosigmoid pouch creation for continent urinary diversion with follow-up for longer than two years (range, 13-42 months, median 33) (15). Median operative time was 485 minutes (range, 365-830); median blood loss was 200 mL (range 190-800); median hospital stay was 15 days (range, 11-30); two patients required reoperation due to persistent leakage of the pouch and rectovaginal fistula, respectively. Unilateral hydronephrosis with loss of the renal function was found in one.

All had negative surgical margins, and an average of 10 lymph nodes (range, 5-16) were removed, resulting in positive lymph nodes in three patients (25%). No patients developed local recurrence. Three (25%) developed systematic disease (two in bone and one in liver and lung) at a median follow-up of 33 months (median time to progression), 22 months; and two (17%, pT3aG3 and pT3aG3N1) of the three patients died of the metastatic disease 15 and 24 months after surgery. All patients were continent during the day. Eleven patients were continent at night, but one was using two or five pads per night.

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