A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

Abstract

Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE) for female dialysis patients suffering from urothelial carcinoma (UC). Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis

“…Our review showed that significant postoperative complications affect about a third of the patients undergoing this surgical procedure. The most commonly stated complications include prolonged paralytic ileus, 28,29 infectious-related adverse events, 15 acute kidney failure, 28 ureter-intestinal anastomosis leak, 28 port hernia, 22 and retroperitoneal hemorrhage. 30 In this study, we found that the most commonly encountered complications are surgical site infections (11%), renal failure (9%), and other infectious complications (20.6%).…”

“…Regarding postoperative complications, some articles adopted a descriptive classification for listing complications while others used the Clavien-Dindo Classification (CDC). 27 In the former studies, the most commonly described complications were prolonged paralytic ileus, 28,29 infectious-related adverse events, 15 and postoperative mortality. 13,28 Other mentioned complications were acute kidney failure, 28 ureter-intestinal anastomosis leak, 28 port hernia, 22 and retroperitoneal hemorrhage 30 A total of 47 patients from the included studies had a CDC for complications.…”