Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions.
Eur Urol
; 53(4): 834-42; discussion 842-4, 2008 Apr.
Article
em En
| MEDLINE
| ID: mdl-17904276
ABSTRACT
PURPOSE:
We present a single institute experience of the four most widely used diversions after cystectomy in 281 patients, with an evaluation of the association between clinical factors, complication rates, functional results, and metabolic complications. MATERIALS ANDMETHODS:
Between 1990 and 2005, 281 consecutive cystectomies were performed at our institute. Four different diversions were offered an ileal conduit according to Bricker (IC; 118 patients), an Indiana pouch (IP; 51 patients), and orthotopic diversions after cystectomy/neobladder (N; 62 patients), or sexuality-preserving cystectomy and neobladder (SPCN; 50 patients).RESULTS:
Forty-four percent developed early complications IC 48%, IP 43%, N 42%, and SPCN 38%. High ASA score was the only variable significantly associated with early major complications (ASA 1 vs. 3 HR, 0.32; 95%CI, 0.14-0.72). Late complication rate was 51% with fewer complications in the IC group, IC 39%, IP 63%, N 59%, and SPCN 60% (HR, 0.32; 95%CI, 0.14-0.72), which was explained by fewer uncomplicated urinary tract infections (one third of all late complications) in the IC group. There were no differences in experienced late major complications. We found no significant association between tumour stage, ASA, age, preoperative radiotherapy, gender, and diversion-related complication rates. Complete daytime and nighttime continence, respectively, was achieved in 96% and 73% after IP, 90% and 67% after neobladder, and 96% and 67% after SPCN. Metabolic changes were found in 24% of the patients 21% after IC, 26% after IP, and 28% after orthotopic diversion (neobladder and SPCN combined); low vitamin B12 was measured in 23%, 15%, and 15% respectively.CONCLUSIONS:
Cystectomy with any subsequent diversion remains a procedure with considerable morbidity. High ASA score was associated with more early complications. Orthotopic diversions provide good functional results, but at the cost of more late complications compared with ileal conduits. We found no evidence that age, ASA score, positive lymph nodes, extravesical tumour growth, or previous radiotherapy were contraindications per se for any diversion.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Derivação Urinária
/
Neoplasias da Bexiga Urinária
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur Urol
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Holanda