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Cystectomy and urinary diversion as management of treatment‐refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes
Author(s) -
Cohn Joshua A,
Large Michael C,
Richards Kyle A,
Steinberg Gary D,
Bales Gregory T
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12284
Subject(s) - medicine , cystectomy , urinary diversion , perioperative , surgery , complication , urinary system , fistula , bladder cancer , cohort , urology , cancer
Objectives To investigate perioperative outcomes associated with cystectomy and urinary diversion for treatment‐refractory benign urological disease. Methods A cohort of patients who underwent cystectomy for infection, fistula, bleeding, incontinence, neurogenic bladder or pain between J anuary 2004 and J une 2012 was established. Data included baseline demographics, indications for cystectomy and prior treatments, and complications at 30 and 90 days. Primary outcome measures were 30‐day and 30 to 90‐day complications. Results The study group comprised eight males and 18 females. The mean age was 57.8 years (95% CI 50.8–64.7). A total of 19 patients (73%) had resolution of their underlying urological pathology at 90 days. A total of 19 patients (73%) experienced a complication in the first 30 days, of which nine (47%) were C lavien grade III or higher. The most common 30‐day complications were urinary tract infection ( n = 6, 23%) and wound infection ( n = 6, 23%). A total of 44% (4/9) of patients with neurogenic bladder experienced a complication within the first 30 days of cystectomy compared with 100% (8/8) of patients with radiation‐induced fistula ( P = 0.03) and 78% (7/9) of non‐neurogenic, non‐radiation‐induced fistula patients ( P = 0.34). Conclusions Cystectomy with urinary diversion for benign disease might be successful, but is associated with a high rate of perioperative complications. Those with radiation‐induced fistula are more likely to experience complications, whereas those with neurogenic bladder carry a lower risk. Patients should be counseled appropriately regarding expected postoperative outcomes.