Ureteroileal Strictures After Urinary Diversion with an Ileal Segment—Is There a Place for Endourological Treatment at All?

Purpose We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture. Materials and Methods We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies. Results Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001). Conclusions Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.

Stricture of the Afferent Isoperistaltic Tubular Segment: A Late and Rare Cause of Bilateral Dilation of the Upper Urinary Tract After Ileal Bladder Substitution

OBJECTIVE To evaluate the etiology and treatment of bilateral hydronephrosis not responding to bladder substitute drainage after ileal bladder substitution using an afferent isoperistaltic tubular segment. MATERIALS AND METHODS A retrospective analysis was performed of a consecutive series of 739 patients who had undergone bladder substitution from April 1985 to August 2012. RESULTS Of the 739 ileal bladder substitute patients, 10 (1.4%) developed bilateral hydronephrosis unresponsive to complete bladder substitute drainage. The etiology was stenosis of the afferent isoperistaltic tubular segment. The median interval to presentation was 131 months (range 45-192). The incidence of afferent tubular segment stenosis was significantly higher in the 61 ileal bladder substitute patients with recurrent urinary tract infection (9 [15%]) than in the 678 without recurrent urinary tract infection (1 [0.15%]; P <.001). Urine cultures revealed mixed infections (34%), Escherichia coli (18%), Staphylococcus aureus (13%), enterococci (11%), Candida (8%), Klebsiella (8%), and others (8%). Seven patients underwent 10 endourologic interventions, only 1 of which was successful (10%). After failed endourologic treatment, 7 open surgical revisions with resection of the stricture were performed, with all 7 (100%) successful. CONCLUSION Bilateral dilation of the upper urinary tract after ileal orthotopic bladder substitution unresponsive to complete bladder substitute drainage is likely to be caused by stenosis of the afferent isoperistaltic tubular segment. The stenosis occurs almost exclusively in patients with long-lasting, recurrent urinary tract infection and can develop many years after the ileal bladder substitution. Minimally invasive endourologic treatment is usually unsuccessful; however, open surgical revision offers excellent results.

Radical cystectomy and ileal orthotopic bladder substitution after radical retropubic prostatectomy: functional and oncological results

Men with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62-72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution.

Orthotopic Ileal Bladder Substitution in Women: Factors Influencing Urinary Incontinence and Hypercontinence.

BACKGROUND Urinary incontinence or the inability to void spontaneously after ileal orthotopic bladder substitution is a frequent finding in female patients. OBJECTIVE To evaluate how hysterectomy and nerve sparing affect functional outcomes and whether these relate to pre- and postoperative urethral pressure profile (UPP) results. DESIGN, SETTING, AND PARTICIPANTS Prospectively performed pre- and postoperative UPPs of 73 female patients who had undergone cystectomy and bladder substitution were correlated with postoperative voiding and continence status. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome analyses were performed with the Kruskal-Wallis test, Wilcoxon-Mann-Whitney, or two-group post hoc testing with the Bonferroni correction. Chi-square or Fisher exact tests were applied for the categorical data. RESULTS AND LIMITATIONS Of postoperatively continent or hypercontinent patients, 22 of 43 (51.2%) had the uterus preserved; of incontinent patients, only 4 of 30 (13.3%, p<0.01) had the uterus preserved. Of postoperatively continent or hypercontinent patients, 27 of 43 patients (62.8%) had bilateral and 15 of 43 (34.9%) had unilateral attempted nerve sparing. In incontinent patients, 11 of 30 (36.7%) had bilateral and 16 of 30 (53.3%) had unilateral attempted nerve sparing (p=0.02). When compared with postoperatively incontinent patients, postoperatively continent patients had a longer functional urethral length (median: 32mm vs 24mm; p<0.001), a higher postoperative urethral closing pressure at rest (56cm H2O vs 35cm H2O; p<0.001) as well as a higher preoperative urethral closing pressure at rest (74cm H2O vs 47.5cm H2O; p=0.01). The main limitation was the limited number of patients. CONCLUSIONS In female patients undergoing radical cystectomy and bladder substitution, preservation of the uterus and attempted nerve sparing results in better functional outcomes. The preoperative UPPs correlate with postoperative voiding and continence status and may predict which patients are at a higher risk of functional failure after bladder substitution. PATIENT SUMMARY If preservation of the urethra's innervation is not possible during cystectomy, poor functional results with bladder substitutes are likely.

Apparent digestibility and metabolizable energy content of lipid sources in poultry

A trial was conducted to determine the apparent digestibility (ATTD) and AME content of different lipid sources in 21d-old broilers. There were a control diet based on corn and soybean meal without any supplemental fat and 6 additional diets forming a 3x2 factorial with 3 sources of fat (soy oil, SBO; reconstituted monoglyceride oil, RMG; and reconstituted triglyceride oil, RTG) included in the diet (3 or 6%) at expenses (wt:wt) of the basal diet.

Influence of crude protein content, ingredient complexity, feed form, and duration of feeding of the phase I diets on productive performance and nutrient digestibility of Iberian pigs.

The influence of CP content and ingredient complexity, feed form, and duration of feeding of the Phase I diets on growth performance and total tract apparent digestibility -TTAD- of energy and nutrients was studied in Iberian pigs weaned at 28 d of age. There were 12 dietary treatments with 2 type of feeds -high-quality, HQ; and low-quality, LQ-, 2 feed forms -pellets vs. mash-, and 3 durations -7, 14, and 21 d- of supply of the Phase I diets.

Effects of the ruminal comminution rate and microbial contamination of particles on accuracy of in situ estimates of ruminal degradability and intestinal digestibility of feedstuffs.

Effects of considering the comminution rate -kc- and the correction of microbial contamination -using 15N techniques- of particles in the rumen on estimates of ruminally undegraded fractions and their intestinal digestibility were examined generating composite samples -from rumen-incubated residues- representative of the undegraded feed rumen outflow. The study used sunflower meal -SFM- and Italian ryegrass hay -RGH- and three rumen and duodenum cannulated wethers fed with a 40:60 RGH to concentrate diet -75 g DM/kgBW0.75-. Transit studies up to the duodenum with Yb-SFM and Eu-RGH marked samples showed higher kc values -/h- in SFM than in RGH -0.577 vs. 0.0892, p = 0.034-, whereas similar values occurred for the rumen passage rate -kp-. Estimates of ruminally undegraded and intestinal digestibility of all tested fractions decreased when kc was considered and also applying microbial correction. Thus, microbial uncorrected kp-based proportions of intestinal digested undegraded crude protein overestimated those corrected and kc-kp-based by 39% in SFM -0.146 vs. 0.105- and 761% in RGH -0.373 vs. 0.0433-. Results show that both kc and microbial contamination correction should be considered to obtain accurate in situ estimates in grasses, whereas in protein concentrates not considering kc is an important source of error.

Glycerin and lecithin inclusion in diets for brown egg-layinghens: Effects on egg production and nutrient digestibility

The effects of the inclusion of raw glycerin (GLYC) and lecithin in the diet on egg production,egg quality and total tract apparent retention (TTAR) of dietary components was studied inbrown egg-laying hens from 23 to 51 wk of age. The experimental design was completelyrandomized with six diets combined as a 2 × 3 factorial with two levels of GLYC (0 vs.70 g/kg) and three animal fat to lecithin ratios (40:0, 20:20 and 0:40 g/kg). Each treatmentwas replicated eight times and the experimental unit was a cage with ten hens. Productionwas recorded by replicate every 28-d period and cumulatively. For the entire experiment,the inclusion of GLYC in the diet hindered feed conversion ratio per kilogram of eggs (2.071vs. 2.039; P < 0.05) but did not affect any of the other production or egg quality traits studied.The replacement of animal fat by lecithin (40:0, 20:20 and 0:40 g/kg) increased egg weight(60.1, 60.7 and 61.8 g, respectively; P < 0.001) and egg mass production (56.8, 57.5 and58.8 g/d, respectively; P < 0.01) and improved yolk color as measured by the DSM colorfan (9.2, 9.2 and 9.5, respectively; P < 0.001) and feed conversion ratio per kilogram of eggs(2.072, 2.068 and 2.027, respectively; P < 0.05). Feed intake, egg production and body weightgain, however, were not affected. The inclusion of GLYC in the diet did not affect nutrientretention but lecithin inclusion improved TTAR of dry matter (P < 0.05), organic matter(P < 0.05), ether extract (P < 0.001) and gross energy (P < 0.001). In summary, the inclusionof 70 g glycerol/kg diet hindered feed conversion ratio per kilogram of eggs but did notaffect any other production or digestibility trait. The replacement of animal fat by lecithinimproved egg weight, egg yolk color and nutrient digestibility. Consequently, lecithin canbe used as a lipid source in laying hen diets with beneficial effects on egg production

Fermentación in vitro de pepsina/pancreatina con inóculos de conejos

The in vitro gas production of pepsin/pancreatin used in the determination of in vitro digestibility was evaluated using different inocula from rabbits (ileal, caecal and soft faeces from rabbits). In experiment 1 were used 3 different ileal and caecal inocula obtained each one from the combination of the digesta of 3 different 70 d old rabbits.

Composition and digestibility of corn ensilage, cowpea ensilage, soja bean ensilage, and corn-fodder /

Caption title.

A study of the digestibility of rations for the steers with special reference to the influence of the character and the amount of feed consumed /

Cover title.

Feeds of the world, their digestibility and composition,

Bibliography: p. 1-153.

Losses in boiling vegetables and the composition and digestibility of potatoes and eggs.

Mode of access: Internet.

Experiments on the digestibility of prickly pear by cattle /

"May 28, 1908."