[Radical cystectomy and urinary diversion-what is important ?] / Radikale Zystektomie und Harnableitung worauf kommt es an?
Urologe A
; 57(6): 673-678, 2018 Jun.
Article
em De
| MEDLINE
| ID: mdl-29696301
ABSTRACT
BACKGROUND:
In Germany, radical cystectomy with urinary diversion is the primary therapeutic option for localized muscle invasive urothelial bladder cancer. Modifications in the pre-, peri-, and postoperative phase have significantly improved outcomes.OBJECTIVES:
Different factors and parameters are directly associated with patients' outcome. An overview on how to best approach this procedure is provided in this article. MATERIALS ANDMETHODS:
The data regarding preparation and the procedure for the radical cystectomy followed by urinary diversion are separately analyzed.RESULTS:
During the preoperative phase, Fast Track and ERAS (Enhanced Recovery after Surgery) concepts should be an integral part of therapeutic management. Different aspects of such models are presented and discussed. Comorbidities such as diabetes mellitus, hypertension, malnutrition or anemia should also be treated early. In the perioperative phase, optimized fluid management and close interaction with the anesthesiologist are needed. Use of vasopressors during surgery and controlled hypotension (about 80â¯mmâ¯Hg) help reduce perioperative blood loss. Blood product use should be minimized. The use of epidural anesthesia to improve the stress reaction of the body improves pain management and functional recovery. Radical cystectomy is associated with the best oncological outcome, preserving functional structures to maintain a good quality of life. Nerve-sparing procedures in men and women should be used where appropriate. The use of robotic assisted radical cystectomy (RARC) is also discussed.CONCLUSION:
The ileum conduit is still the most common urinary diversion worldwide. However, numerous other urinary diversions to provide patients with the highest quality of life are available. Centers with a high case load seem to be associated with an improved outcome.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Derivação Urinária
/
Neoplasias da Bexiga Urinária
/
Carcinoma de Células de Transição
/
Cistectomia
Tipo de estudo:
Prognostic_studies
Limite:
Female
/
Humans
/
Male
País/Região como assunto:
Europa
Idioma:
De
Ano de publicação:
2018
Tipo de documento:
Article