Year : 2013 | Volume
: 29 | Issue : 4 | Page : 292--293
Urological reconstruction in the modern era
Andrew C Thorpe
Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
Andrew C Thorpe
Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN
|How to cite this article:|
Thorpe AC. Urological reconstruction in the modern era.Indian J Urol 2013;29:292-293
|How to cite this URL:|
Thorpe AC. Urological reconstruction in the modern era. Indian J Urol [serial online] 2013 [cited 2021 Sep 25 ];29:292-293
Available from: https://www.indianjurol.com/text.asp?2013/29/4/292/120109
I would like to sincerely thank the Editor of the Indian Journal of Urology for inviting me to guest edit a symposium on Reconstructive Urology. In putting together this supplement, we aimed to be as all-encompassing as possible. Reconstructive urology covers a very broad spectrum, and we wished to be as wide ranging as the subject would allow. I am indebted to my colleges in the United Kingdom, who are well recognized as experts within the UK, for their support in submitting their articles in a timely fashion to the Journal.
We have started the symposium at the upper tract, with a review on the management of recurrent pelvi-ureteric (PUJ) obstruction. While laparoscopic pyeloplasty is well recognized as one of the gold standards of treatment for primary PUJ obstruction, there is very little written in the contemporary literature on the management of recurrent PUJ obstruction. The review article in this symposium has attempted to pull together and synthesize the current thinking and evidence for the investigation and treatment of this condition - it is often difficult to make a definitive diagnosis and decide on an appropriate management pathway but I think you will find this review helpful in your clinical practice.
Following on from PUJ obstruction, we have produced a collection of review articles dealing with bladder reconstruction. Over the past three decades, the number of patients undergoing bladder reconstruction has multiplied exponentially. Surgeons are becoming far more experienced in bladder reconstructive techniques and patients are becoming increasingly aware (possibly with the advent of the Internet) of the number of options that are available to them following cystectomy, whether this be for oncological or functional reasons. The first article assesses the options of bladder reconstruction per se following cystectomy and includes a review on orthotopic and heterotopic pouches. It also includes a section on quality of life following reconstruction, with studies now suggesting that patients who undergo simple ileal conduit diversion still have a quality of life equivalent to patients undergoing bladder reconstruction. Interposing bowel into the urinary tract may have profound metabolic consequences for the patient, and the second article in this section goes into this in some detail, illustrating the different metabolic changes, depending on the section of the bowel used and how to investigate, monitor and treat these problems. The third review in this section looks into the Mitroffanoff principle in a little more detail, exploring the types of tissue used for a continent diversion and the principle complications that can occur with this type of operation.
We have included two functional urology reviews. The first is an article on clam enterocystoplasty in the treatment of the overactive bladder. Even with the wide range of antimuscarinics now available (and more recently the new B3 agonists), and the options of intravesical botulinum toxin injections and sacral nerve modulation techniques, there is still a need for this operation. When the simpler options have run out and the patient (either neuropathic or idiopathic) is still symptomatic and requires treatment, this is still an excellent option to fall back on, as the review article illustrates in detail. The second review in this section covers reconstruction and the long-term follow-up of neuropathic patients. This group of patients in particular can prove to be very complex and require follow-up for life. Maintenance of upper tract function is obviously paramount, with patients often developing quite severe and protracted complications if they are not monitored in the correct and timely manner. The advent of specialized spinal injury units has lead to a better understanding of neurogenic urinary tract dysfunction. This review article has focused on pathologies such as spinal trauma and spina bifida where long-term outcomes data are now readily available on preservation of renal function, improvement of quality of life and prevention of life-threatening and serious complications in this complex group of patients.
The number of patients undergoing radical prostatectomy as treatment for organ-confined prostate cancer has increased over the last 10 years, whether as an open, laparoscopic or robotically assisted procedure. The seventh article in this symposium reviews the role of bladder neck sparing and its relationship to return of urinary continence following this operation. An increasing number of men with early prostate cancer are coming forward from screening programs or are demanding prostate-specific antigen estimations from their primary care physicians. This in turn is generating more radical prostatectomy procedures, which in turn will affect the continence of a large number of male patients. This systematic review has found that there is no difference in positive margin rates when comparing bladder neck sparing with bladder neck reconstruction in patients undergoing all types of radical prostatectomy hence showing that it is an oncologically sound procedure. It also shows that there is an earlier return to continence and a lower bladder neck stricture rate with radical prostatectomies that incorporates a bladder neck sparing approach.
I do hope that you will agree that we have managed to produce a wide ranging, interesting and clinically useful symposium for you to read and enjoy.