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1.
Medicine (Baltimore) ; 99(27): e20902, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629682

RESUMEN

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols were introduced in clinical practice to reduce complication rates and hospital stay. We performed a randomized controlled single center study to evaluate perioperative benefits of an adapted ERAS protocol in patients with bladder cancer who underwent radical cystectomy (RC) and ileal urinary diversions (IUD). MATERIALS AND METHODS: Forty five from 90 consecutive randomized patients were enrolled in an adapted ERAS protocol. Length of stay, diet issues, return of bowel function, readmission rates and complications were examined. RESULTS: Among patients following ERAS protocol, we found a significant reduction in time to first flatus (1 vs 5 days, P < .001), time to first stool (2 vs 5 days, P < .001), time to normal diet (5 vs 6 days, P < .001) and length of stay (16 vs 18 days, P < .001). Also, postoperative ileus at less than 4 days was lower than in non-ERAS patients (15.6% vs 24.4%), but with a marginal trend toward significance (P = .05). Readmission rate was lower in the ERAS group, but the difference did not reach statistical significance. We also found a lower readmission and complication rate in patients with ERAS protocol (6.6% vs 11.1%, P = .23 and 46.6% vs 57.5%, P = .29, respectively). CONCLUSIONS: Implementation of ERAS protocol for patients undergoing RC in our center was associated with a significant reduction in the time to the first flatus, time to the first stool, time to a normal diet, length of hospital stay.


Asunto(s)
Protocolos Clínicos , Cistectomía/rehabilitación , Recuperación Mejorada Después de la Cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/rehabilitación , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento
2.
Int Braz J Urol ; 45(6): 1094-1104, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31808396

RESUMEN

INTRODUCTION: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). OBJECTIVE: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. EVIDENCE ACQUISITION: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). EVIDENCE SYNTHESIS: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. CONCLUSION: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably infl uence how the patient accepts the new condition.


Asunto(s)
Cistectomía/rehabilitación , Calidad de Vida , Derivación Urinaria/rehabilitación , Cistectomía/métodos , Cistectomía/psicología , Femenino , Humanos , Masculino , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Factores de Tiempo , Resultado del Tratamiento , Derivación Urinaria/métodos , Derivación Urinaria/psicología
3.
Int. braz. j. urol ; 45(6): 1094-1104, Nov.-Dec. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1056337

RESUMEN

ABSTRACT Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB). Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions. Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI). Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed. Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably influence how the patient accepts the new condition.


Asunto(s)
Humanos , Masculino , Femenino , Calidad de Vida/psicología , Derivación Urinaria/rehabilitación , Cistectomía/rehabilitación , Factores de Tiempo , Derivación Urinaria/métodos , Derivación Urinaria/psicología , Cistectomía/métodos , Cistectomía/psicología , Encuestas y Cuestionarios/normas , Resultado del Tratamiento
4.
Tissue Eng Part B Rev ; 25(3): 237-248, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30794111

RESUMEN

IMPACT STATEMENT: Tissue Engineering (TE) approaches are needed to advance the field of reconstructive urology. We indicate that regeneration of ureteral tissue and the formation of a urinary diversion using TE approaches are possible, although it is currently very time-consuming and complex to achieve well-developed neotissue. Faster regeneration approaches using novel scaffolds are desirable. The findings of this review may help to develop smart hybrid scaffolds and enhance the design of future studies, which may ultimately lead to improved care for patients with ureteral defects as well as to curb complications associated with urinary diversion.


Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Regeneración , Ingeniería de Tejidos/métodos , Andamios del Tejido/química , Uréter/citología , Derivación Urinaria/rehabilitación , Animales , Humanos
5.
Int J Gynecol Cancer ; 28(2): 267-273, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-26807639

RESUMEN

OBJECTIVES: This retrospective, multicentric study investigates quality-of-life issues and emotional distress in gynecological cancer survivors submitted to pelvic exenteration (PE). METHODS: The Global Health Status scale of European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30; the EORTC QLQ-CX24 (CX24), and EORTC QLQ-OV28 questionnaires were administered at least 12 months from surgery only in women with no evidence of further recurrence after PE. Statistical analysis was performed by the analysis of variance (for repeated measures. RESULTS: Ninety-six subjects affected by gynecological malignancies receiving PE were enrolled in the study. Anterior PE was performed in 47 patients (49%), posterior PE was performed in 29 cases (30.2%), and total PE performed in 20 women (20.8%). In 38 cases (39.6%), a definitive colostomy was performed. Urinary diversion with continent pouch was created in 11 patients. (11.5%), whereas in the remaining cases, a noncontinent pouch was reconstructed. Patients showed a significant discomfort in attitude to disease (71.5 ± 4.7), body image (48.9 ± 6.4), financial difficulties (56.2 ± 5.8), gastrointestinal symptoms (constipation, 47.8 ± 5.1; diarrhea, 62.4 ± 6.6; appetite loss, 43.6 ± 6.7), insomnia (64.5 ± 6.6), Global Health Status (64.6 ± 3.8), physical functioning (65.8 ± 4.6), role functioning (58.8 ± 5.8), and emotional functioning (67.4 ± 4.2). A higher number of ostomies (hazard rate [HR], 7.613; P = 0.012), the creation of a noncontinent bladder (HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516; P = 0.008) emerged as independent predictors of poorer Global Health Status scores. Older age (HR, 11.235; P = 0.003), vaginal/vulvar cancer (HR, 7.369; P = 0.013), total/posterior PE (HR, 7.393; P = 0.013), higher number of ostomies (HR, 7.613; P = 0.012), the creation of a noncontinent bladder (HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516; P = 0.008) emerged as independent predictors of lower body image levels. CONCLUSIONS: Long-term psycho-oncological support is strongly recommended. The reduction of ostomies seems the most effective way to improve patients' quality of life.


Asunto(s)
Neoplasias de los Genitales Femeninos/cirugía , Exenteración Pélvica/rehabilitación , Calidad de Vida , Adulto , Anciano , Imagen Corporal/psicología , Femenino , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/psicología , Neoplasias de los Genitales Femeninos/rehabilitación , Estado de Salud , Humanos , Persona de Mediana Edad , Exenteración Pélvica/psicología , Exenteración Pélvica/estadística & datos numéricos , Estudios Retrospectivos , Encuestas y Cuestionarios , Derivación Urinaria/psicología , Derivación Urinaria/rehabilitación , Derivación Urinaria/estadística & datos numéricos
6.
Rev Esp Anestesiol Reanim ; 64(6): 313-322, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28214097

RESUMEN

OBJECTIVE: To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital. MATERIAL AND METHODS: A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared. RESULTS: No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001). CONCLUSION: Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.


Asunto(s)
Protocolos Clínicos , Cistectomía/rehabilitación , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Derivación Urinaria/rehabilitación , Anciano , Femenino , Estudio Históricamente Controlado , Mortalidad Hospitalaria , Humanos , Intubación Gastrointestinal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/rehabilitación , Cuidados Preoperatorios/métodos , Evaluación de Programas y Proyectos de Salud , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía
7.
Beijing Da Xue Xue Bao Yi Xue Ban ; 48(5): 822-824, 2016 10 18.
Artículo en Chino | MEDLINE | ID: mdl-27752163

RESUMEN

OBJECTIVE: To determine whether chewing gum during the postoperative period facilitates the recovery of bowel function in patients after radical cystectomy with ileum urinary diversion. METHODS: In the study, 60 patients who underwent radical cystectomy followed by ileum urinary diversions during Nov. 2014 and Nov. 2015 in Department of Urology of Peking University First Hospital were randomized into three groups: gum chewing group, placebo group treated with the abdomen physical therapy machine and control group treated with ordinary method. Time to flatus, time to bowel movement, incidence of postoperative distension of the abdomen and abdominal pain, and gut related complications (such as ileus, intestinal fistula, and volrulus) of all the patients were recorded and analysed. RESULTS: In gum chewing group, the median time to flatus was 57 hours (49-72 hours), and the median time to bowel movement was 95 hours (88-109 hours), which were significantly shortened compared with the other two groups of patients (82 hours, 109 hours in placebo group and 81 hours, 108 hours in control group, respectively). No significant difference of the median time to flatus and to bowel movement was observed between placebo group and control group. There were no significant differences in the incidence of postoperative distension of the abdomen and abdominal pain, and gut related complications among the three groups. CONCLUSION: Chewing gum had stimulatory effect on bowel function recovery after cystectomy followed by ileum urinary diversion. Chewing gum was safe and simple, and could be routinely used for postoperative treatment after cystectomy and ileum urinary diversion.


Asunto(s)
Goma de Mascar , Cistectomía/rehabilitación , Cuidados Posoperatorios/métodos , Recuperación de la Función , Derivación Urinaria/rehabilitación , Abdomen , Dolor Abdominal/etiología , Goma de Mascar/efectos adversos , Cistectomía/efectos adversos , Defecación/fisiología , Femenino , Humanos , Ileus , Intestinos , Complicaciones Posoperatorias/epidemiología , Derivación Urinaria/efectos adversos
8.
Eur Urol ; 70(6): 995-1003, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27297680

RESUMEN

CONTEXT: Enhanced recovery after surgery (ERAS) protocols aim to improve surgical outcomes by reducing variation in perioperative best practices. However, among published studies, results show a striking variation in the effect of ERAS pathways on perioperative outcomes after cystectomy. OBJECTIVE: To perform a systematic review of the literature and a meta-analysis comparing the effectiveness of ERAS versus standard care on perioperative outcomes after cystectomy. EVIDENCE ACQUISITION: We performed a literature search of PubMed, EMBASE, Web of Science, Google Scholar, the Cochrane Library, and the health-related grey literature in February 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis and the Cochrane Handbook. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine. Thirteen studies (1493 total patients) met the inclusion criteria (ERAS: 801, standard care: 692). A pooled meta-analysis of all comparative studies was performed using inverse-weighted, fixed-effects models, and random-effects models. Publication bias was graphically assessed using contour-enhanced funnel plots and was formally tested using the Harbord modification of the Egger test. EVIDENCE SYNTHESIS: Pooled data showed a lower overall complication rate (risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p = 0.017, I2=35.6%), a shorter length of stay (standardized mean difference:-0.87, 95% CI: -1.31 to -0.42, p=0.001, I2=92.8%), and a faster return of bowel function (standardized mean difference: -1.02, 95% CI: -1.69 to -0.34, p=0.003, I2=92.2%) in the ERAS group. No difference was noted for the overall readmission rates (RR: 0.74, 95% CI: 0.39-1.41, p=0.36, I2=51.4%), although a stratified analysis showed a lower 30-d readmission rate in the ERAS group (RR: 0.39, 95% CI: 0.19-0.83, p=0.015, I2=0%). CONCLUSIONS: ERAS protocols reduce the length of stay, time-to-bowel function, and rate of complications after cystectomy. PATIENT SUMMARY: Enhanced recovery after surgery pathways for cystectomy reduce complications and the amount of time patients spend in the hospital.


Asunto(s)
Cistectomía/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/epidemiología , Nivel de Atención , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Vías Clínicas , Cistectomía/rehabilitación , Humanos , Tiempo de Internación , Derivación Urinaria/rehabilitación
9.
Urologe A ; 55(10): 1335-1338, 2016 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-27287241

RESUMEN

Radical cystectomy and urinary diversion are a challenge for patients. Requirements for the successful participation of the patient are sufficient urinary diversion management and recuperation/recovery as the result of urological rehabilitation. A social medical assessment reviews the individual oncological prognosis and the rehabilitation results to determine the return to work.


Asunto(s)
Cistectomía/rehabilitación , Salud Pública/métodos , Medicina Social/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/rehabilitación , Alemania , Humanos , Evaluación de Resultado en la Atención de Salud/métodos
10.
Scand J Urol ; 50(1): 39-46, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26313582

RESUMEN

OBJECTIVE: The aim of this study was to assess the effect of introducing an enhanced recovery programme (ERP) to an established robot-assisted radical cystectomy (RARC) service. MATERIALS AND METHODS: Data were prospectively collected on 221 consecutive patients undergoing totally intracorporeal RARC between December 2003 and May 2014. The ERP was specifically designed to support an evolving RARC service, where increasing proportions of patients requiring radical cystectomy underwent RARC. Patient demographics and outcomes before and after implementation of the ERP were compared. The primary endpoint was length of stay (LOS). Secondary outcomes included age, American Society of Anesthesiologists (ASA) score, preoperative staging, operative time, complications and readmissions. Differences in outcomes between patients before and after implementation of ERP were tested with the Jonckheere-Terpstra trend test and quantile regression with backward selection. RESULTS: Following implementation of the ERP, the demographics of the patients (n = 135) changed, with median age increasing from 66 to 70 years (p < 0.01), higher ASA grade (p < 0.001), higher preoperative stage cancer (pT ≥ 2, p < 0.05) and increased likelihood of undergoing an ileal conduit diversion (p < 0.001). Median LOS before ERP was 9 days [interquartile range (IQR) 8-13 days] and after ERP was 8 days (IQR 6-10 days) (p < 0.001). ASA grade and neoadjuvant chemotherapy also affected LOS (p < 0.05 and p < 0.01, respectively). There was no significant difference in 30 day complication rates, readmission rates or 90 day mortality, with 59% experiencing complications before ERP implementation and 57% after implementation. The majority of complications were low grade. CONCLUSIONS: Patient demographics changed as the RARC service evolved from selected patients to a general service. Despite worsening demographics, LOS decreased following ERP implementation. This evidence-based ERP safely standardized perioperative care, resulting in decreased LOS and decreased variability in LOS.


Asunto(s)
Carcinoma de Células Transicionales/cirugía , Cistectomía/rehabilitación , Tiempo de Internación/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Procedimientos Quirúrgicos Robotizados/rehabilitación , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/rehabilitación , Anciano , Carcinoma de Células Transicionales/patología , Estudios de Cohortes , Ambulación Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patología
11.
Scand J Urol ; 49(4): 302-7, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25660105

RESUMEN

OBJECTIVE: This article describes the authors' experiences with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol for open radical cystectomy (ORC). Adherence to the ERAS cystectomy protocol was assessed; secondary outcome measures were impact on perioperative complication rate (Clavien-Dindo classification), time to first defecation, postoperative length of stay and hospital readmission rate. MATERIALS AND METHODS: This retrospective feasibility study compared outcomes with patients in a historical control group. The study group (ERAS) consisted of 31 consecutive patients undergoing ORC and urinary diversion during 1 year from 1 January to 31 December 2011. The control group (pre-ERAS) comprised 39 consecutive patients operated on during 2010. Follow-up was 30 days. RESULTS: There were no significant demographic differences between the two groups, and no differences in complications graded Clavien III or above, or in total length of stay. The ERAS group had statistically significantly shorter mean time to first passage of stool and statistically significantly lower readmission frequency than the pre-ERAS group. The number of patients was small and the study was not randomized; moreover, the use of historical controls inevitably introduced different types of bias. CONCLUSIONS: Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.


Asunto(s)
Carcinoma de Células Transicionales/cirugía , Protocolos Clínicos , Cistectomía/rehabilitación , Readmisión del Paciente/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/epidemiología , Cuidados Preoperatorios/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Estudio Históricamente Controlado , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
12.
BJU Int ; 114(3): 375-83, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24467630

RESUMEN

OBJECTIVE: To describe and assess the evolution of an enhanced recovery programme (ERP) for open radical cystectomy. PATIENTS AND METHODS: We introduced a mentored ERP for radical cystectomy in January 2011. The programme underwent service evaluation and multiple changes in August 2012 that we define as marginal gains. We present a retrospective review of 133 consecutive patients undergoing open radical cystectomy, grouped according to the three stages of the ERP from October 2008 to April 2013: (1) non-ERP group (October 2008 to December 2010): n = 69; (2) ERP-1 group (January 2011 to July 2012): n = 37; and (3) ERP-2 group (August 2012 to April 2013): n = 27. Primary outcomes were length of hospital stay (LOS), readmission, morbidity at 90 days using the Clavien classification system and mortality. Secondary outcomes were time to flatus, ileus rates, re-operation rates and oncological outcomes. RESULTS: There were no differences in patient demographics among any of the groups for: age, gender, BMI, American Society of Anesthesiologists score and the use of neoadjuvant chemotherapy. There were no differences in readmission, morbidity and mortality rates. The overall 90-day mortality was six patients (4.5%). There were significant differences in ileus rates between the non-ERP, the ERP-1 and the ERP-2 groups: 44.9% (31 patients), 29.7% (11 patients) and 14.8% (four patients), respectively (P = 0.017). There was a significant difference in the presence of pathological lymphadenopathy in the ERP-2 group: non-ERP group, 10.1%; ERP-1 group, 16.2%; and ERP-2 group, 44.4%; P = 0.002. There was also a difference in the mean (sd) lymph node yield in ERP-2: non-ERP group, 8.4 (5.4) nodes; ERP-1, 8.2 (6.4) nodes; and ERP-2, 16.7 (5.4) nodes (P < 0.001). The median (range) LOS was 14 (7-91) days, 10 (6-55) days and 7 (3-99) days in the non-ERP, ERP-1 and ERP-2 groups, respectively (P < 0.001). CONCLUSIONS: Auditing an already successful ERP and implementing a number of marginal gains has led to a significant decrease in the median LOS for radical cystectomy. The LOS for open radical cystectomy at University Hospital Southampton has halved. In the second phase of our ERP, our median LOS is 7 days.


Asunto(s)
Cistectomía , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/rehabilitación , Derivación Urinaria/rehabilitación , Anciano , Anciano de 80 o más Años , Auditoría Clínica , Cistectomía/métodos , Femenino , Flatulencia , Fluidoterapia , Estudios de Seguimiento , Humanos , Ileus , Masculino , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Recuperación de la Función , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/cirugía , Micción
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 33(8): 1250-2, 2013 Aug.
Artículo en Chino | MEDLINE | ID: mdl-23996779

RESUMEN

OBJECTIVE: To compare the postoperative recovery among patients undergoing orthotopic bladder substitution with sigmoid or ileal grafts. METHODS: The clinical data and postoperative recovery (postoperative complications, continence recovery time and postoperative hospital stay) of 84 patients receiving orthotopic bladder substitution with sigmoid or ileal grafts after radical cystectomy for bladder cancer were analyzed. RESULTS: Of the 84 cases, 70 had continent urinary reservoirs constructed, among whom 58 (aged 48-89 years) received an ileal neobladder (IN) and 12 (aged 28-80 years) received a sigmoid neobladder (SN). The postoperative complications rate, continence recovery time and postoperative hospital stay in IN group was 29.3% (17/58), 91.4%, and 23.5 days, as compared to 58.3%(7/12) (P=0.04), 66.7% (P=0.03), and 25 days (P=0.04) in patients in SN group, respectively. CONCLUSION: A neobladder constructed from ileal grafts achieves better postoperative recovery results compared to a neobladder constructed from sigmoid grafts.


Asunto(s)
Íleon/trasplante , Procedimientos de Cirugía Plástica/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Adulto , Anciano , Anciano de 80 o más Años , Colon Sigmoide/trasplante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/rehabilitación , Neoplasias de la Vejiga Urinaria/rehabilitación , Derivación Urinaria/rehabilitación
14.
Urol Nurs ; 31(3): 183-9, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21805758

RESUMEN

Interstitial cystitis (IC) is a chronic inflammatory condition characterized by urinary frequency, urgency, and pain in the bladder or pelvis that for some can be debilitating. At present, IC is without cure, yet various management modalities are available. This article provides a general overview of the history, symptoms, diagnosis, and treatment of IC. A specific case study that focuses on a surgical management option is highlighted.


Asunto(s)
Cistitis Intersticial/cirugía , Derivación Urinaria/enfermería , Cistitis Intersticial/diagnóstico , Cistitis Intersticial/terapia , Femenino , Humanos , Persona de Mediana Edad , Atención Perioperativa/enfermería , Derivación Urinaria/rehabilitación
15.
Acta Chir Iugosl ; 58(1): 103-5, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21630555

RESUMEN

UNLABELLED: The aim of this study is to evaluate the results and complications after radical cystectomy due to carcinoma of the bladder and to point out the significance of post-operative physical treatment and rehabilitation of these patients. MATERIAL AND METHOD: In the period of 3 years (2007-2010), at the Urological Clinic in Belgrade, we performed 195 total cystectomies for invasive bladder carcinoma with the use of different types of urinary diversion. The operation was performed in 162 men (83%) and 33 women (17%). RESULTS: Survival, complications and postoperative recovery was dependent on the type of urinary diversion which was used, stage of disease and general condition of patients before surgery. The worst result was achieved in patients who underwent ureterocutaneostomy and the complications were represented in 30% of patients. In the group of patients where the ileal conduit was applied, complications were recorded in 10% of patients, while mortality was 5%. In the group of patients where the continent urinary diversion was performed, complications were recorded in 5% of patients in mind of stecoral fistulas, urinary fistulas and ileus. CONCLUSION: The timely application of the physical therapy and rehabilitation in these patients is of great importance, because it reduces complications and allows faster recovery and release from the hospital.


Asunto(s)
Cistectomía/rehabilitación , Modalidades de Fisioterapia , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/rehabilitación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Aktuelle Urol ; 41(4): 245-51, 2010 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-20517822

RESUMEN

OBJECTIVE: Published evidence does not support a clear advantage in quality of life for continent versus incontinent urinary diversion or vice versa. PATIENTS AND METHODS: We retrospectively assessed 61 patients after radical cystectomy with the EORTC-QLQ-C30 and -BLM30 instruments. Analysis was performed in dependence of age, sex, technique of urinary diversion and time-course of therapy. RESULTS: 36 patients had an incontinent and 20 patients a continent urinary diversion. Younger patients (p = 0.001) and those with a continent urinary diversion (p = 0.03) were found to have a statistically significant higher incidence of financial problems. Also patients with continent urinary diversion had significantly (p = 0.032) more problems in social integration. Furthermore, there were significant differences in social integration (p = 0.03) and emotional ability (p = 0.008) in the age-dependent analysis. Patients with a continent diversion had significantly more meteoristic problems (p = 0.007). CONCLUSION: This study also could not demonstrate any clear differences in dependence on the technique of urinary diversion. A good postoperative quality of life seems possible independent of age.


Asunto(s)
Cistectomía/psicología , Complicaciones Posoperatorias/psicología , Calidad de Vida/psicología , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/psicología , Reservorios Urinarios Continentes , Adaptación Psicológica , Anciano , Imagen Corporal , Estudios de Cohortes , Cistectomía/rehabilitación , Emociones , Femenino , Humanos , Escisión del Ganglio Linfático/psicología , Escisión del Ganglio Linfático/rehabilitación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Evaluación de Procesos y Resultados en Atención de Salud , Satisfacción del Paciente , Complicaciones Posoperatorias/rehabilitación , Estudios Retrospectivos , Conducta Sexual , Ajuste Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/psicología , Derivación Urinaria/rehabilitación
17.
J Am Coll Surg ; 210(1): 93-9, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20123338

RESUMEN

BACKGROUND: This article outlines our current perioperative management of patients undergoing cystectomy and urinary diversion using advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge. STUDY DESIGN: Three hundred sixty-two consecutive patients underwent radical cystectomy and urinary diversion with curative intent (2001 through 2008). Each underwent a perioperative care plan ("fast track" program). Throughout our experience, evidence-based modifications to this program were instituted. We analyzed the impact of these modifications and report the outcomes with the most recent 100 patients in whom no additional modification has been used. RESULTS: Mean age of patients is 66.3 years, with 44% of the patients older than age 70 years and 12% older than age 80 years. We found no detrimental effects to immediate removal of the orogastric tube at the end of the procedure, but found a beneficial effect of empiric metoclopramide use, with lower rates of nausea and vomiting. Perioperative antibiotic coverage has been reduced to 24 hours as per American Urological Association guidelines. Gum-chewing has also been shown to be of benefit with regard to a more rapid recovery of bowel function. Use of nonnarcotic analgesics (eg, ketrolac) has also been central in the pathway. Finally, early institution of an oral diet has been an original and central component to our fast track program. CONCLUSIONS: Successful application of a fast track program has been applied to our patients undergoing radical cystectomy and urinary diversion, with the potential to use evidence-based modifications to reduce morbidity and improve recovery.


Asunto(s)
Cistectomía/rehabilitación , Atención Perioperativa/organización & administración , Derivación Urinaria/rehabilitación , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Masculino , Neoplasias de la Vejiga Urinaria/cirugía
18.
J Wound Ostomy Continence Nurs ; 35(3): 316-20, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18496089

RESUMEN

PURPOSE: Patient recovery from life-altering surgery is a complex event requiring interactions among multiple factors that influence recovery. Two such factors are occupational stability and spouse/partner relationship stability. METHODS: We surveyed persons who have undergone ostomy surgery. Subjects were recruited from the general population, without regard to geographic region or clinical setting. Participation in the study was voluntary; subjects had given prior permission to be contacted about survey-based research. Additional subjects were recruited from Web-based ostomy sites and local ostomy support group meetings. INSTRUMENT: The survey instrument contains 113 items designed to investigate pre- and postsurgery aspects of the lives of those who have undergone ostomy surgery. RESULTS: Ostomates experiencing a postsurgery change in both occupation and work habits were significantly more likely to report a nonpositive life satisfaction score than those experiencing no postoperative change in occupation or work habit. Additionally, a stable spouse/life partner relationship emerged as predictive of positive life satisfaction scores. For those that were married prior to surgery and remained married after surgery, and in which there was no change in occupation or work habit, 95.7% reported a positive life satisfaction score. CONCLUSIONS: Multiple stabilizing forces exist that influence the recovery of a patient following life-altering surgery such as creation of a stoma. Stability in occupation and spouse/partner relationship positively influenced life satisfaction scores following ostomy surgery.


Asunto(s)
Adaptación Psicológica , Actitud Frente a la Salud , Colostomía/psicología , Convalecencia/psicología , Ileostomía/psicología , Derivación Urinaria/psicología , Actividades Cotidianas/psicología , Colostomía/rehabilitación , Femenino , Humanos , Ileostomía/rehabilitación , Estilo de Vida , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Ocupaciones , Satisfacción Personal , Cuidados Posoperatorios/psicología , Calidad de Vida/psicología , Recuperación de la Función , Apoyo Social , Esposos/psicología , Encuestas y Cuestionarios , Estados Unidos , Derivación Urinaria/rehabilitación
19.
Rev Med Suisse ; 4(182): 2614-7, 2008 Dec 03.
Artículo en Francés | MEDLINE | ID: mdl-19160991

RESUMEN

The patient who undergoes radical cystectomy requires a urinary diversion which will significantly impact on his everyday life. He will have to choose with his surgeon between three different types of diversions that enable urine to flow out of his body adequately. Hence, preoperative information is of paramount importance. The team providing it needs an iconographic support, unfortunately not readily available. In order to clearly explain to the patient the various types of diversions that he may benefit from, their everyday care and to have him/her share the experiences of previous patients, we have elaborated a multi-disciplinary information sequence associated with the creation of video support.


Asunto(s)
Cistectomía , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria , Conducta de Elección , Cistectomía/psicología , Humanos , Planificación de Atención al Paciente , Educación del Paciente como Asunto , Calidad de Vida , Derivación Urinaria/psicología , Derivación Urinaria/rehabilitación , Reservorios Urinarios Continentes
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