Safety of augmentation cystoplasty in patients with bladder abnormalities undergoing renal transplantation: a systematic review

BACKGROUND Augmentation cystoplasty (AC) has been recently proposed to improve a bladder condition before or after a renal transplantation for an optimal allograft function. Until now, AC in adults with end-stage renal disease (ESRD) is uncommon and rarely practiced. This study aimed to investigate the safety of AC in patients with bladder abnormalities who required renal transplantation. METHODS Studies of patients with ESRD and abnormal bladder who underwent AC were searched in ProQuest, PubMed, EBSCO, and Cochrane Library online databases. Only studies published in English from January 1985 to May 2020 were included. The keywords used were renal transplantation, bladder dysfunction, cystoplasty, and their synonyms. Data were extracted by two independent authors who selected, screened, and assessed the articles’ eligibility and quality. The outcomes were graft survival rate and complications of AC. RESULTS A total of 19 articles were included. AC improved an intravesical pressure, a bladder capacity, and a compliance in patients with ESRD and bladder abnormalities, allowing patients to undergo the renal transplantation. Even though AC in patients with renal transplantation resulted in a significantly higher urinary tract infection rate than patients who underwent renal transplantation only, performing AC after renal transplantation was considered safe. CONCLUSIONS AC was considered safe for patients with bladder abnormalities who underwent renal transplantation.

Laparoscopic cost effective management of cholecystoduodenal fistula

Introduction: Contraindication to laparoscopic surgery is decreasing with time, expertise and innovation. One such uncommon condition is cholecystoduodenal fistula (CDF), now increasingly managed with laparoscopic technique. We are reporting eight such incidentally diagnosed cases during laparoscopic operation, which were successfully and cost-effectively managed with traditional laparoscopic instruments.Materials and Methods: During March 2008 to March 2017, 1500 patient underwent laparoscopic cholecystectomy for benign gall bladder condition or their complications, eight of these having chronic dyspeptic symptoms of gallstone, were found to have cholecystoduodenal fistula, intraoperatively. All cases were managed laparoscopically using common laparoscopic instruments without any special gadgets and extra costs. Medical records of eight cases were reviewed for age, sex, operative technique, intra and post-operative complications and length of stay in hospital.Results: Five patients were male and three were female with a mean age of 63 years. All of them had gall stones at abdominal ultrasound and cholecystoduodenal fistula were found intraoperatively. Fistula tract was dissected, cleaned and sealed with combination of intracorporeal simple transfixation ligation and interrupted stitches to invert the stump within the duodenal wall in transverse fashion. All eight had uneventful postoperative course with hospital stay of 4-7 (mean 5) days.Conclusion: In expert hands cholecystoduodenal fistula can successfully and safely be managed laparoscopically using common instruments and logistics with slight modification of open technique without extra cost.Bangladesh Crit Care J September 2017; 5(2): 110-112

Double anticholinergic therapy for refractory neurogenic and non-neurogenic detrusor overactivity in children: Long-term results of a prospective open-label study

Introduction: In this study, we optimize pharmacotherapy in children who failed anticholinergic monotherapy by simultaneous administration of 2 anticholinergics (oxybutynin and/or tolterodine and/or solifenacin).Methods: This report is an update of our previously published study on double anticholinergic regimen in children with refractory incontinence due to neurogenic (NDO) and non-neurogenic (DO) detrusor overactivity. Patients with an insufficient response (clinically/urodynamically) to an optimized dose of a single anticholinergic (oxybutynin or tolterodine) received a second anticholinergic (tolterodine or solifenacin), in addition to the pre-existing medication. The primary end-point was efficacy (continence) and the secondary end-points were tolerability and safety. The Patient Perception of Bladder Condition (PPBC) scale was used to rate subjective improvement of patients.Results: In total, 56 patients with DO (n = 31) or NDO (n = 25) were enrolled at a mean age of 11.4 ± 3.5 years and were followed for a minimum of 3 months. The duration of double treatment was 36 ± 23 months. Our results found that 23 patients became dry, 18 improved significantly and 15 improved moderately. Urodynamic capacity improved from 158 ± 87 mL to 359 ± 148 mL and maximal pressure of contractions decreased from 76 ± 24 to 22 ± 22 cmH2O (p < 0.0001). The overall success rate was 82%, since 10 patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 28 patients, mild side effects by 20, moderate side effects by 8; 2 patients withdrew from the study due to their side effects. Of the 35 patients who voided spontaneously, 8 developed post-void residuals (>20%).Conclusions: With a larger cohort and prospective follow-up, we reiterated that double anticholinergic regimen in children with DO or NDO refractory to anticholinergic monotherapy is a feasible and efficient approach.

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

Introduction: We evaluate the efficacy and safety of solifenacin to treat incontinence in children with non-neurogenic (DO) or neurogenic detrusor overactivity (NDO) refractory to oxybutininor tolterodine.Methods: We updated and extended our previously published non-randomized uncontrolled study on open-label use of adjusted-dose regimens of solifenacin (1.25-10 mg) in children with refractory incontinence. The follow-up included voiding diaries, post-void residuals, urine cultures, ultrasounds and urodynamic studies. Clinical data were updated as of September 2012. Subjective improvement was assessed with the Patient Perception of Bladder Condition (PPBC) scale. The primary end point was efficacy toward continence and secondary end points were tolerability and safety.Results: Overall, 244 patients (112 girls, 132 boys) were enrolled; 53 with NDO and 191 with DO. Minimal follow-up was 5 months, the mean duration of treatment was 21.0 months and the mean age at initiation was 9.2 years. Urodynamic capacity improved from 145 ± 76 mL to 339 ± 152 mL and the amplitude of uninhibited contractions decreased from 66 ± 26 to 20 ± 20 cmH2O (p < 0.0001). The overall success rate is 91%, and more specifically 94% for non-neurogenic and 79% for neurogenic, which is significantly different (p = 0.013). Twenty-three patients discontinued treatment for unsatisfactory clinical response or bothersome side effects. No side effects were reported by 175 patients, mild by 46, moderate by 9, and 14 withdrew due to their side effects. Ten patients developed post-void residuals of ≥20 mL.Conclusion: Although higher in the non-neurogenic group, high subjective and objective success rates were maintained over a longer follow-up with an adjusted-dose regimen of solifenacin to treat pediatric NDO or DO refractory to oxybutynin or tolterodine. Moreover, we found acceptable tolerability and safety profiles.