INTRODUCTION AND OBJECTIVES: Mortality of Radical cystectomy (RC) differs in the literature from as low as 2.3% for a 90day mortality in a single institution, to as high as 7.9% for a prospective multi-institutional series or 5% for a retrospective review of administrative population-based database. 90-day mortality rate of RC in a nation-wide population-based study has not been explored.The aim of this study is to investigate 90-day mortality rate of RC for bladder cancer in a nation-wide population-based study, and to evaluate the effect of number of RC per hospital on the surgical outcomes.METHODS: We used mandatory hospital discharge forms (CMBD) of all patients submitted to RC due to bladder cancer in Spain during 2011-2015. Morbidity and mortality were assessed using discharge codes of the primary admission or any other registered admission up to 3 months after the procedure. Demographics of patients including age, sex, and Charlson comorbidity score as well as hospital size and number of RCs/year have also been recorded.We calculated in-hospital, 30-, 60-and 90-day mortality. Average annual RC volume was used as a continuous variable (logtransformed) and also grouped into deciles in order to identify any potential non-linear relationships. Logistic regression model with mixed effect was performed adjusting for year of surgery, comorbidity, surgical approach, type of admission, age, sex, and hospital size.RESULTS: A total of 12154 RC were operated on in 196 hospitals. 87.2% of the patients were males, mean age was 68.1 years (SD 9.8). 88.9% of the cases received open surgery, 10% laparoscopic surgery and 1.2% robot-assisted surgery. Most hospitals (110) performed <[ 10 RC/year whereas only 5 did more than 38/year. 30-, 60-and 90-day mortality rates of the series were 2.9%, 5.1% and 6.5%, respectively. Lowest mortality rates (3.3% at 90 days) are achieved in hospitals doing more than 38 cases per year. The 90-day adjusted mortality rate is associated with annual average RC volume with a 20.6% decrease per 10 extra RCs /year (95% CI 12.3%-28.1% p<0.001). High Charlson comorbidity index, advanced age, and open surgical approach were the clinical variables associated with higher mortality.CONCLUSIONS: In the setting of a nation-wide populationbased study we report a mortality rate comparable to previous multiinstitutional studies. Our study identifies an inverse association between 90-day mortality and hospital volume. The lack of centralization for RC is of concern in that low-volume centers have a mortality higher than high-volume centers. This would have a more pronounced benefit for patients at high-risk.
Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture.Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008][2009][2010][2011][2012][2013][2014][2015][2016][2017][2018][2019][2020][2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments.Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs.
months).Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs.2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis.Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.
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