Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus

Maffezzini, Massimo; Campodonico, Fabio; Canepa, G; Gerbi, Guido; Parodi, Donatella

doi:10.1016/j.suronc.2007.09.003

Cited by 125 publications

(66 citation statements)

References 52 publications

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“…The remaining 11 articles were selected for further investigation. Of these, 1 study lacked a control group [18], 2 studies made an inappropriate comparison [19,20], and 1 study focused on old people [21]; these studies were all excluded. In the end, 7 articles were identified for inclusion (two RCTs and five cohort studies) [10,11,12,13,22,23,24].…”

Section: Resultsmentioning

confidence: 99%

The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

et al. 2014

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Background: Although the use of mechanical bowel preparation (MBP) is still widely promoted as the dogma before patients undergo ileal urinary diversion, an increasing number of clinical trials have suggested that there is no benefit. Thus, we performed a meta-analysis to evaluate the efficacy of MBP in ileal urinary diversion surgery. Methods: A literature search was performed in electronic databases, including PubMed, Embase, Science Citation Index Expanded as well as the Cochrane Library and the Cochrane Clinical Trials Registry, from 1966 to January 1, 2013. Clinical trials comparing outcomes of MBP versus no MBP for ileal urinary diversion surgery were included in the meta-analysis. Pooled odds ratios with 95% confidence intervals were calculated using the fixed- or random-effects models. Results: In total, two randomized controlled trials and five cohort studies were included in this meta-analysis. The primary outcomes, such as bowel leak and bowel obstruction, showed no statistical difference between the two groups. Additionally, the overall mortality rate and death rate related to operation also manifested that MBP does not offer an advantage over the no MBP. Conclusion: This meta-analysis suggests that MBP does not reduce the incidence of perioperative complications in urinary diversion compared with no MBP. However, large randomized controlled clinical trials are needed to confirm this finding.

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Section: Resultsmentioning

confidence: 99%

The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

et al. 2014

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“…General endotracheal anesthesia is indicated; consideration should be given to a combined general/neuraxial technique for postoperative analgesia [35]. The sensorial block level must be Th10 for TUR BT and Th6 for radical cystectomy or prostatectomy.…”

Section: Choice Of Anesthesiamentioning

confidence: 99%

“…When urine contact with intestinal segment, ammonium, ammonia, hydrogen and chloride are reabsorbed from intestinal segment. Alkalizing agents or drugs such as chlorpromazine or nicotinic acid that blockade the chloride transport can be used successfully for the treatment of this disorder [35].…”

Section: Complicationsmentioning

confidence: 99%

Anesthesia for Urological Surgery

Tekgül¹,

Horsanalı²,

OzanHorsanali³

2017

Current Topics in Anesthesiology

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Because of the variable techniques and patients' positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this mater, it is important to follow current approaches for anesthesiologists. Diferent surgical procedures and complications due to diferent positions or anesthesia were evaluated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery.Keywords: urological anesthesia, anesthesia management, anesthesia complications, urological surgery complications IntroductionAnesthesia for urological surgery includes unique distinctive diferences, as in all other surgical departments. Therefore, anesthesia for urological surgery requires featured training and experience.To reduce the risk of complications in urological surgery, like all other kinds of surgery, regional anesthesia techniques came to prominence with the help of technological developments. For many urological ventures, only neuraxial blockade application could be enough. This also results in decreased complication risks. In surgeries that must be done with general anesthesia, epidural anesthesia can be used for the maintenance of anesthesia or in the postoperative period. In this way, the rate of intraoperative complications can be reduced and patients' comfort can be increased by providing postoperative pain control and also duration of hospital stay can be reduced [1].© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.During the urological surgery, diferent complications can develop depending on surgical techniques used. For example, most of urological ventures require lots of irrigation luids. In this venture, use of unheated irrigation luid can lead to complications such as hypothermia, delayed recovery from anesthesia and tremor [2].In addition to neuraxial blockade, the use of peripheral blockade has gained importance in urological surgery. For example, obturator blockade application for lateral wall localized bladder cancer could reduce intraoperative complications and increased cancer-free survival [3,4]. Anesthesia for kidney and upper urinary tract surgery Oncological surgery of kidney and upper urinary tract Radical and partial nephrectomyRenal cell carcinoma (RCC) is the ninth common cancer in the USA. According to the SEER database analysis, it is estimated that there will be 62,700 new cases and 14,240 people will die because of this disease. The incidence of kidney and renal pelvis cancer was 15.6 per 100,000 in the USA between 2009 and 2013 [5]. All around the world, radical or partial nephrectomy is accepted curative treatment for kidney tumors. Partial nephrectomy can be performed depending...

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“…Nevertheless, we do not consider bowel preparation as an important factor in the preoperative preparation of the patient. Furthermore, we do not advocate prolonged fasting, because it leads to insulin resistance and it is not recommended by international anesthesiology guidelines (25). Moreover, gastric emptying of water and other clear fluids has an extremely fast exponential curve (50% of intake clearance within 20 minutes) (26).…”

Section: Commentsmentioning

confidence: 99%

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

et al. 2011

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Purpose: Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. Patients and Methods: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. Results: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09%) from the intervention and 3 patients (14.3%) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. Conclusions: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

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Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus

Cited by 125 publications

References 52 publications

The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

Anesthesia for Urological Surgery

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

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