Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy

Longo, Nicola; Imbimbo, Ciro; Ficarra, Vincenzo; Mangiapia, Francesco; Lorenzo, Giuseppe Di; Creta, Massimiliano; Imperatore, Vittorio; Mirone, Vincenzo

doi:10.1111/bju.13462

Cited by 78 publications

(94 citation statements)

References 26 publications

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“…Interestingly, our study failed to demonstrate significant differences in terms of perioperative complications between patients with IC or CU. Conversely, Longo et al [23] recently showed in a series of patients aged >75 with relevant comorbidities that singlestoma CU had reduced perioperative complications with no significant impairment of health-related quality of life. In another recent study analyzing the impact of perioperative complications in patients aged >75 years, major complications were reported in 27% of patients who underwent IC and in 36% of those who received CU.…”

Section: Discussionmentioning

confidence: 94%

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Zattoni¹,

Palumbo

Giannarini³

et al. 2017

Urol Int

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Objective: To evaluate perioperative outcomes and early survival in a series of octogenarians who underwent radical cystectomy (RC) and urinary diversion for bladder cancer. Patients and Methods: We retrospectively evaluated the clinical records of 44 patients aged ≥80 years who underwent open RC and urinary diversion at 2 high-volume centers between July 2013 and December 2015. Estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) were evaluated. Ninety-day postoperative complications were stratified according to the type of urinary diversion. Univariable analysis was performed to identify predictors of overall and major complications. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: Median age was 83 years (interquartile range [IQR] 81-85). Age-adjusted Charlson score was ≥4 in 37 (84%) patients, and American Society of Anesthesiologists score was ≥3 in 34 (77%) patients. Ileal conduit (IC) was performed in 21/44 (48%) cases, cutaneous ureterostomy (CU) in 20/44 (45%), and no urinary diversion was required for 3 (7%) dialytic patients. Median EBL was 700 mL (IQR 500-1,000) and 23 (52%) patients required blood transfusion. Median LOS was 13 days (IQR 10-18). Overall complications were recorded in 29 (66%) patients, with major complications observed in 12 (27%), with death occurring in 1. No differences in complications were observed between IC and CU. The 2-year OS estimate was 62.5%. Conclusions: Open RC in octogenarians has an acceptable rate of major complications and mortality. IC should be considered a good urinary diversion in these patients.

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Section: Discussionmentioning

confidence: 94%

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Zattoni¹,

Palumbo

Giannarini³

et al. 2017

Urol Int

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“…In a large single‐center series, the overall long‐term complication rate was reported to be 40.8%, with three neobladder‐related deaths . Furthermore, a recent single‐center study investigating the mortality and morbidity rates of RC, particularly among elderly patients aged >75 years, showed that intraoperative and early postoperative complications occurred in 16 and 43%, respectively, and complications of Clavien grade IVa/V were observed in 10% . As Cookson et al .…”

Section: Rc For Bcg‐unresponsive Diseasementioning

confidence: 92%

Bacillus Calmette–Guérin‐unresponsive non‐muscle‐invasive bladder cancer: Its definition and future therapeutic strategies

et al. 2019

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Bacillus Calmette–Guérin induction with or without maintenance is the gold standard therapy for intermediate‐/high‐risk non‐muscle‐invasive bladder cancer; however, one‐third of patients treated with adequate bacillus Calmette–Guérin therapy do not achieve sufficient responses, and this is referred to as “bacillus Calmette–Guérin failure.” The term, bacillus Calmette–Guérin failure, is ambiguous and includes a very heterogeneous population of patients. By strictly focusing on patients who are unlikely to benefit from additional bacillus Calmette–Guérin therapy and who need to be treated with radical cystectomy, the new concept of “bacillus Calmette–Guérin unresponsive” was recently proposed, and might accelerate the development of novel therapeutic options for bacillus Calmette–Guérin‐unresponsive disease. A promising therapeutic strategy for bacillus Calmette–Guérin‐unresponsive disease is the blockade of the programmed cell death‐1/programmed cell death‐ligand 1 pathway, which is considered to be activated by bacillus Calmette–Guérin therapy. Several large clinical trials have been carried out to assess the potential of programmed cell death‐1/programmed cell death‐ligand 1 blockade in bacillus Calmette–Guérin‐naïve high‐risk non‐muscle‐invasive bladder cancer and bacillus Calmette–Guérin‐unresponsive disease. Furthermore, clinical trials that are targeting bacillus Calmette–Guérin‐unresponsive disease with other strategies, such as vaccines, gene therapy, and targeted and cytotoxic therapies, are ongoing. The findings of these trials are awaited in order to establish appropriate bladder‐sparing approaches for patients with bacillus Calmette–Guérin‐unresponsive disease.

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“…BCa is the most common malignancy of the urinary tract, the seventh most common cancer in men and the 17th in women (1,(15)(16)(17). Transurethral resection of bladder tumors is the gold standard for removal of BCa, to allow diagnosis and, in many cases, definitive treatment (1,(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Transurethral resection of bladder tumors is the gold standard for removal of BCa, to allow diagnosis and, in many cases, definitive treatment (1,(15)(16)(17). However, tumor may recur or progress to muscle invasive disease and further adjuvant intravesical therapies are often needed (1).…”

Section: Discussionmentioning

confidence: 99%

Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up

Imperatore

Creta²,

Meo³

et al. 2018

Arch Ital Urol Androl

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Objective: We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies. Patients and methods: We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed. Results: The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable. Conclusions: Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis.

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Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy

Abstract: The present results show that CU with a single stoma can represent a valid alternative to IC in elderly patients with relevant comorbidities, reducing peri-operative complications without a significant impairment of QoL.

Cited by 78 publications

References 26 publications

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Bacillus Calmette–Guérin‐unresponsive non‐muscle‐invasive bladder cancer: Its definition and future therapeutic strategies

Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up

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