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This proposal aims to reshape surgical approaches to urinary diversion (UD) following radical cystectomy for bladder cancer patients. For over 70 years, post-cystectomy urinary diversion had relied on intestinal conduits, carrying substantial short and long-term postoperative risks including ileus, stricture, anastomotic leaks, metabolic disturbances, decreased renal function and longer in-hospital stays. Our approach explores the ureter’s natural capacity for adaptative dilation, well-documented in congenital megaureter and obstructive uropathies. We have developed a minimally invasive pre-operative ureteral dilation protocol that uses a dual-lumen balloon prototype engineered to gradually dilate the ureter while conserving urinary drainage. By dilating the ureter in the interval between diagnosis and surgery, this technique aims to ensure a tension-free cutaneous ureterostomy without the use of intestinal segments, decreasing perioperative risk, avoiding intestinal complications, and preserving renal function. In addition, our hypothesis addresses the main limitation historically associated with cutaneous ureterostomy: stomal stricture formation. We will use porcine models, widely used in genitourinary research because it closely resembles human anatomy. We aim to demonstrate for the first time, that controlled pre-operative ureteral dilation can result in a stricture-resistant, unstrained permanent diversion. This prototype had the potential to redefine urinary diversion in bladder cancer care, impacting both patients care and urology practice. For patients, it is expected to reduce postoperative complications, it will eliminate the bowel mobilization’s need, avoiding risks such as ileus, anastomotic leak, and the numerous metabolic disturbances associated with the resection of an intestinal segment. For surgeons, this approach aims to decrease the surgical complexity and improve the efficiency of UD by decreasing the operative time for bladder reconstruction. Beyond its application in bladder cancer, this approach could be adapted for numerous urologic reconstructions. In a long term, this project could shift the standard care toward safer, faster, and more durable urinary diversions, transforming outcomes and quality of life of thousands of patients each year.
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