The effectiveness of an enzymatic cocktail, collagenase and trypsin, on the absorptive function of ileal segment was studied to evaluate the changes within groups after performing ileocystoplasty in an animal model. Twenty-one female mixed-bred Persian dogs were randomized into 7 groups. The groups included: 1) negative control group (NCG) in which no ileocystoplasty was performed (n = 3); 2) positive control group (PCG) in which routine ileocystoplasty was performed (n = 3) and groups 3 to 7) those underwent ileocystoplasty with the ileal segment being treated with collagenase and trypsin for 5, 10, 15, 20 or 25 min (groups, 5 minutes enzymatic treatment group (5METG), 10METG, 15METG, 20METG and 25METG; each containing three dogs). To perform the glucose absorption test, 50% dextrose was instilled into the bladder five weeks after surgery. The blood glucose level (BGL) was measured in each group before the study (T1), two weeks after the surgery in PCG and other treatment groups (T2), before anaesthesia (T3), after anaesthesia at 5-minute intervals up to 25 min (T4 to T9, respectively). There was no significant difference in BGL in T1 to T3 and T4 to T9 in 25METG and NCG, however, BGL was found significantly higher in T1 to T3 and T4 to T9 in PCG, 5METG, 10METG, 15METG and 20METG. It can be concluded that collagenase and trypsin can affect absorptive function of the NEOBLADDER and are able to reduce the absorptive function, particularly in early days after the surgery. Moreover, these results also confirm that 50% dextrose instilled into the NEOBLADDER and native urinary bladder will not increase BGL in 25METG and NCG even with increasing the time of exposure of neo- or native urinary bladder to enzymatic cocktail till 25 min.

Persistent mü llerian duct syndrome (PMDS) in the majority of cases is discovered during surgery for inguinal hernia or cryptorchidism. A transverse testicular ectopia (TTE) with cryptorchidism may be very rarely associated to PMDS. Assuming that mü llerian remnants have a very low malignant degeneration potential if compared to the malignancy risk of an undescended and not relocated testis, we describe a simplified surgical technique of orchiopexy that avoids an extensive anatomical dissection, in this way minimizing the risk of losing the deferential blood supply to the testis.

This paper introduces a novel technique, known as appendiceal conduit. It could be used as an alternative for ileal conduit and cutaneous ureterostomy, ultimately applied after radical cystectomy. The six-month follow-up indicated that the patient had appendix-stoma as nipple without any stenosis, nor did he have any hydronephrosis, as confirmed by abdominal sonography.

To evaluate histopathogical changes in the urinary bladder after ileocystoplasty, an experimental model of five healthy mixed breed dogs weighing between 15-25kg, underwent partial cystectomy and immediate ileocystoplasty were used. One dog showed NEOBLADDER perforation and died ten days after operation. The remaining dogs did well, no digestive or voiding problems, no intestinal obstruction and urinary leakage were observed. Gross observations and histological sections were studied on day 45 after cystoplasty. Autopsy revealed distinct margin in the grafted area between bladder and the intestinal cap. No inflammatory exudative discharges, adhesion, leakage or fistulus formations were observed. The histological findings in NEOBLADDER showed original mucosa of the bowel persisted 45 days after cystoplasty in spite of its entirely new environment. Goblet cells hyperplasia were seen in the mucosa of the bowel. The other morphological findings were congestion, edema, inflammatory cell infiltration, metaplastic changes in the urothelium, cryptitis, calcification, heterotropic bone formation in graft area and the presence of fibroblasts, fibrocytes and collagen fibers in submucosa, muscular and serosal layers of the NEOBLADDER. Although the exact etiology of the histological changes is unclear, it seems that direct contact of the intestinal mucosa with urine is essential for the development of the morphologic changes and it has been showed that, in the absence of exposure to urine, morphological changes are not evident in the inner parts of ileal segments.

Enterovesical fistula is an abnormal communication between the bladder and the intestine. The accurate localization of leakage is important for accurate treatment planning. Some imaging techniques can not demonstrate the fistula; therefore, choosing the appropriate imaging technique is necessary. CT enterography (CTE) is a new technique for evaluation of the small bowel and the entire abdomen. CTE examination with multi-detector CT (MDCT) enables us to get excellent quality reformatted images with high spatial resolution. We report a patient with NEOBLADDER and enteroneovesical fistula. We showed the exact location of the fistula and its’ association with the bowels and NEOBLADDER by CTE. The aim of this report is to show that CTE can be a new and effective modality in the detection of enteroneovesical fistulas and to discuss the efficacy of CTE in the detection and evaluation of enterovesical fistula referring to the literature. In conclusion, CTE may be a useful, sensitive, effective, and non-invasive technique for the evaluation of enteroneovesical fistula, leakage from the anastomose sides, and other extraintestinal complications such as urinary tract obstruction or abscess formation.

Objective: To assess the outcome of ileocystoplasty based on clinical, radiological and ultrasonographical findings.Design: experimental study.Animals: Five adult mixed breed dogs, weighing between 15 and 25kg.Procedure: Partial cystecto my with immediate augmentation ileocystoplasty was performed. Clinical signs were observed and recorded up to day 45.Reconstructed bladders were evaluated by radiology and ultrasonography on days 25 and 45.Results: Clinically the animals had a normal appetite and behavidr. No digestive or voiding problems, intestinal obstruction and no urinary leakage, infection and urinary incontinence were observed. A mark edge at the borderline between the original bladder and the ileal segment, the thickening of the suture line at the graft area, lack of normal distention in the ileal segment in comparison with original bladder and presence of floating echogenic small particles in the NEOBLADDER were dominant findings based on radiological and ultrasonographical evaluations. One dog died 10 days after operation. Ultrasonography revealed urinary leakage and presence of liquid in abdomen before die and necropsy showed peritonitis and NEOBLADDER perforation.Conclusion: Although ileum is one of the best parts of gastrointestinal tract for augmentation cystoplasty but perforation of the reconstructed bladder remains the rare condition with relatively high mortality rate.

PURPOSE: To evaluate postoperative renal function and risk factors for the loss of renal function in patients who had undergone radical cystectomy. MATERIALS AND METHODS: A retrospective single institutional study evaluated 70 patients، including 54 men and 16 women who underwent radical cystectomy. The median follow-up period was 34. 5 months (range، 12 to 228 months). In this cohort، four types of urinary diversions were studied، including ileal NEOBLADDER (n = 24)، ileocecal NEOBLADDER (n = 12)، ileal conduit (n = 25)، and cutaneous ureterostomy (n = 9). Postoperative changes in renal function were reviewed، and the estimated serum creatinine-based glomerular filtration rate (eGFR) was calculated. The variables analyzed were age، a prior history of hypertension or diabetes mellitus، pre-operative renal function، type of urinary diversion، the postoperative occurrence of acute pyelonephritis، and the presence of chemotherapy. RESULTS: The mean eGFR was 74. 6 (range، 15. 2 to 155. 1) mL/min/1. 73 m2 before surgery and 63. 6 (range، 8. 7 to 111. 5) mL/min/1. 73 m2 at the last follow-up. The 10-year renal deterioration-free interval was 63. 8%. Multivariate analysis showed that a postoperative episode of acute pyelonephritis [Odds Ratio (OR)، 3. 21; 95% Confidence Interval (CI)، 1. 14 to 9. 02; P =. 03] and the presence of chemotherapy (OR، 3. 27; 95% CI، 1. 33 to 8. 01; P =. 01) were significant adverse factors. CONCLUSION: Twenty-four (34. 2%) patients demonstrated reduced renal function during the follow-up period. Postoperative episodes of acute pyelonephritis and the presence of chemotherapy were found to be significant adverse factors.

Spontaneous bladder perforation is a rare disease which is either idiopathic or occurs following pathologic changes induced by infections, radiotherapy, cancer outlet obstruction, NEOBLADDER construction, cyclophosphamide therapy or bladder stones. It is usually intraperitoneal and often occurs at the dome or posterior wall of the bladder. Patients often present with sudden onset of lower abdominal pain and inability to urinate which mayor may not be accompanied by hematuria and/or progressive lower abdominal distention. Some urine may be drained following urethral catheter insertion but this does not rule out the possibility of bladder perforation. Although U/S and CT scan are invaluable in diagnosis but exact diagnosis should be confirmed by cystography. Sometimes the diagnosis remains unclear at the time of diagnostic laparatomy. It should be noted that any delay in diagnosis and treatment of this condition harbours high mortality rate (about 25%). We introduce a patient who has experienced emergent laparatomy to due to acute abdominal pain due to spontaneous bladder perforation.

BACKGROUND: Drug absorption within intestinal urinary diversions has been reported to cause prolonged and higher grade toxicity.OBJECTIVES: The aim of this study has been to determine the importance and significance of drug absorption via NEOBLADDER after ileocystoplasty.METHODS: Ten healthy adult mixed breed dogs of both sexes (7 males and 3 females), weighing between 15-25 kg were selected. The animals were randomly divided into equal test and control groups. In treatment group, partial cytectomy, resecting 50 percent of the bladder and immediate ileocystoplasty was performed by Lamesch and Dociu technique. In control group an ileal resection and intestinal tract re-anastomosis was achieved without partial cystectomy and ileocystoplasty. In all animals, blood and urine samples were taken before surgery, at hours 1, 3, 6 and 24 after oral administration of Furazolidone (100 mg/dog) and this process was repeated on days 7, 25 and 45 after operation at the same hours. After preparation of the samples, the Furazolidone was measured by HPLC assay. One way analysis of variance and Dunnet test were used for the analysis of the data and P values less than 0.05 were considered statistically significant. RESULTS: In test group, the blood samples showed significant changes of Furazolidone on day 25. The urine samples revealed significant changes on day 45 in both groups and on day 25 in test group.CONCLUSIONS: The results of this study showed absorptive effect of the ileum that decreases with time. Problems arising from drug reabsorption are usually rare and in most drugs a change in dosage (except those which have a narrow treatment ratio) may not be required.