Cystectomy With Urinary Diversion for Benign Disease: Indications and Outcomes

Osborn, David; Dmochowski, Roger R.; Kaufman, Melissa R.; Milam, Douglas F.; Mock, Stephen; Reynolds, W. Stuart

doi:10.1016/j.urology.2014.02.030

Cited by 40 publications

(24 citation statements)

References 10 publications

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“…Based on iterative examinations of the records and previously published studies on diversion in the NIS data, we determined that this code was the most specific for urinary diversion that would exclude non‐diversion procedures, such as bladder augmentation. This is also consistent with previous studies that report non‐conduit diversions comprised only 12.9% of the urinary diversions performed . Next, we excluded records with a primary diagnosis of any malignancy (ICD‐9: 140‐239) and those for patients under the age of 18.…”

Section: Methodssupporting

confidence: 78%

“…In 2000, Neulander et al reported no complications in a series of 19 patients undergoing simple cystectomy and urinary diversion secondary to radiation damage. Recently, however, several single‐institution case series have shown that the complication rate for a cystectomy for benign indications is actually quite high, contrary to what was previously reported . In 2011, Rowley et al published a series of 23 patients who underwent urinary diversion with concomitant supratrigonal cystectomy for benign indications.…”

Section: Discussionmentioning

confidence: 98%

“…Urinary diversion for benign indications is relatively rare, and can be performed with or without a concomitant cystectomy. Diversion is typically offered as a last resort for refractory lower urinary tract dysfunction (LUTD) secondary to neurogenic bladder (eg, spinal cord injury, spina bifida, and multiple sclerosis are common indications), radiation cystitis, interstitial cystitis, or recurrent fistula formation . There are varying opinions as to whether a cystectomy should be performed concurrently at the time of urinary diversion.…”

Section: Introductionmentioning

confidence: 99%

“…Overall, there is a paucity of data describing the risks associated with benign cystectomy. Recent reports from single institution case series suggest the complication rates range from 39% to 73% . However, whether these rates differ between patients undergoing a concomitant cystectomy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population‐based analysis

Brown

Osborn

Mock

et al. 2016

Neurourology and Urodynamics

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AIMS Beyond single-institution case series, limited data are available to describe risks of performing a concurrent cystectomy at the time of urinary diversion for benign end-stage lower urinary tract dysfunction. Using a population-representative sample, this study aimed to analyze factors associated with perioperative complications in patients undergoing urinary diversion with or without cystectomy. METHODS A representative sample of patients undergoing urinary diversion for benign indications was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Perioperative complications of urinary diversion with and without concomitant cystectomy were identified and coded using the International Classification of Diseases, version 9. Multivariate logistic regression models identified hospital and patient-level characteristics associated with complications of concomitant cystectomy with urinary diversion. RESULTS There were 15,717 records for urinary diversion identified, of which 31.8% demonstrated perioperative complications: urinary diversion with concurrent cystectomy (35.0%) and urinary diversion without concomitant cystectomy (30.6%). Comparing the two groups, a concomitant cystectomy at the time of urinary diversion was significantly associated with a complication (OR = 1.23, 95%CI: 1.03–1.48). Comorbid conditions of obesity, pulmonary circulation disease, drug abuse, weight loss, and electrolyte disorders were positively associated with a complication, while private insurance and southern geographic region were negatively associated. CONCLUSIONS A concomitant cystectomy with urinary diversion for refractory lower urinary tract dysfunction elevates risk in this population-representative sample, particularly in those with certain comorbid conditions. This analysis provides critical information for preoperative patient counseling.

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Section: Methodssupporting

confidence: 78%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population‐based analysis

Brown

Osborn

Mock

et al. 2016

Neurourology and Urodynamics

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“…In the case of the latter, the technique is often supratrigonal [2]. Several studies have demonstrated that blood loss is significantly less when performing supratrigonal cystectomies in comparison to radical cystectomies (RC); however, the postop complications, specifically, ileus rates, remain similar [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Urinary Diversion in the Elderly

Ayoub

Westney

2015

Curr Bladder Dysfunct Rep

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The elderly or older population segment has a heterogenous definition in the literature with the majority including patients aged between 60 and 80 years. Several studies have proven that a cystectomy can be performed safely in the elderly population. We sought out to review the literature identifying the specific complications and the considerations requiring attention when performing a urinary diversion on an elderly patient. A review of literature performed using PubMed revealed paucity of citations specifically looking at different urinary diversion techniques and the specific complications related in an elderly population. However, we extrapolated additional data from articles that studied cystectomy surgical cohorts with identifiable age stratification. Particular complications and areas deserving of additional attention included gastrointestinal, renal, ureteroenteric anastomotic technique, metabolic disorders, quality of life, and voiding dysfunction. Detailed history and proper counseling of the patient and family are central to the selection of the appropriate urinary diversion technique and help maintain realistic patient expectations with a higher satisfaction rate. It is of paramount importance when considering continent urinary diversions to address the feasibility of adhering to a higher level of maintenance and the patient's ability to withstand diversionrelated complications.

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Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time?

Dyke

Ortiz

Baumgarten

et al. 2020

Neurourology and Urodynamics

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Aims: Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion. Methods: From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I). Results: PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I. Conclusions: For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.

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Cystectomy With Urinary Diversion for Benign Disease: Indications and Outcomes

Cited by 40 publications

References 10 publications

Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population‐based analysis

Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population‐based analysis

Urinary Diversion in the Elderly

Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time?

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