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Inicio Actas Urológicas Españolas (English Edition) Laparoscopic cystectomy and intracorporeal continent urinary diversion (Mainz II...
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Vol. 38. Issue 3.
Pages 200-204 (April 2014)
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Vol. 38. Issue 3.
Pages 200-204 (April 2014)
Skill and talent
Laparoscopic cystectomy and intracorporeal continent urinary diversion (Mainz II) in treatment for interstitial cystitis
Cistectomía laparoscópica y derivación urinaria continente intracorpórea (Mainz II) en el tratamiento de la cistitis intersticial
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O.A. Castilloa,b,
Corresponding author
octavio.castillo@indisa.cl

Corresponding author.
, N. Miranda-Utreraa
a Departamento de Urología, Clínica INDISA, Santiago, Chile
b Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
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Abstract
Introduction

Interstitial cystitis (IC) is a difficult-to-manage chronic and insidious condition. We present a series of patients with IC who failed to respond to conservative treatment. The patients underwent total cystectomy with completely intracorporeally performed continent urinary diversion (Mainz II rectosigmoid pouch) as a radical alternative to the treatment of this condition.

Materials and methods

Eight patients who fulfilled the clinical criteria for IC according to the National Institute of Health and in whom all previous conservative treatments had failed between January 2001 and April 2009 were operated on. A descriptive analysis was made with the following variables: age, surgical risk according to the American Society of Anesthesiology (ASA), total surgical time (ST), ST of the cystectomy, ST of the urinary diversion, early and late complications, time of hospital stay, bleeding and need of transfusion, specimen extraction pathway and uterine sparing.

Results

Mean age was 54.25 (±17.8) years, total mean ST 286.4 (±44.8)min, mean ST of the cystectomy 86.2 (±25.6)min, mean ST of the diversion 123.7 (±28.6)min, mean bleeding 321.4 (±242.9)cc, mean time of hospital stay 8.3 (±1.3) days. Fifty percent were ASA I, 37.5% ASA II and 12.5% ASA III. A hysterectomy was made in 50% of the cases. In 5 cases (62.5%) the bladder was extracted through the rectum and in 3 cases (37.5%) through the vagina. The only early complication was urinary sepsis in one patient. There was no conversion in the series.

Conclusions

Total cystectomy with urethrectomy and intracorporeal continent urinary diversion is an effective and definitive alternative for the treatment of treatment resistant IC. Their technical difficulty and its learning curve limit their application to centers with an extensive experience in laparoscopy.

Keywords:
Interstitial cystitis
Cystitis
Laparoscopy
Urinary diversion
Resumen
Introducción

La cistitis intersticial (CI) es una enfermedad de difícil manejo y de curso crónico e insidioso. Presentamos una serie de pacientes diagnosticadas de CI sin respuesta al tratamiento conservador, sometidas a cistectomía total con ureterectomía y derivación urinaria continente (Mainz II) laparoscópica totalmente intracorpórea, como alternativa radical al tratamiento de esta enfermedad.

Material y métodos

Entre enero de 2001 y abril de 2009 se operaron 8 pacientes que cumplían criterios clínicos y de exclusión para CI según el National Institute of Health y en las cuales había fracasado el tratamiento conservador. Se realizó un análisis descriptivo de la serie con las siguientes variables: edad, riesgo quirúrgico según la Sociedad Americana de Anestesiología (ASA), tiempo quirúrgico (TQ) total, TQ de la cistectomía, TQ de la derivación, complicaciones tempranas y tardías, tiempo de ingreso, sangrado y necesidad de transfusión, vía de extracción de la pieza y conservación del útero.

Resultados

La edad media fue 54,25 (±17,8) años, el TQ medio total 286,4min (±44,8), el TQ medio de la cistectomía 86,2min (±25,6), el TQ medio de la derivación 123,7min (± 28,6), el sangrado medio 321,4cc (±242,9) y el tiempo medio de ingreso 8,3días (±1,3). El 50% era un ASA I, el 37,5% ASA II y el 12,5% ASA III. En el 50% de los casos se realizó una histerectomía. En 5 casos (62,5%) se extrajo la pieza por el recto y en 3 casos (37,5%) por la vagina. La única complicación precoz fue una sepsis. No hubo conversión en la serie.

Conclusiones

La cistectomía total con ureterectomía y derivación urinaria continente por vía laparoscópica e intracorpórea es una alternativa eficaz y definitiva para el tratamiento de la CI rebelde al tratamiento conservador. Su dificultad técnica y su curva de aprendizaje limitan su reproducibilidad a centros con importante experiencia laparoscópica.

Palabras clave:
Cistitis intersticial
Cistitis
Laparoscopia
Derivación urinaria

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