Cystectomy and urinary diversion as management of treatment‐refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes

Abstract

Abbreviations & AcronymsObjectives: To investigate perioperative outcomes associated with cystectomy and urinary diversion for treatment-refractory benign urological disease. Methods: A cohort of patients who underwent cystectomy for infection, fistula, bleeding, incontinence, neurogenic bladder or pain between January 2004 and June 2012 was established. Data included baseline demographics, indications for cystectomy and prior treatments, and complications at 30 and 90 days. Primary outcome measures were 30-day and 30 to 90-day complications. Results: The study group comprised eight males and 18 females. The mean age was 57.8 years (95% CI 50.8-64.7). A total of 19 patients (73%) had resolution of their underlying urological pathology at 90 days. A total of 19 patients (73%) experienced a complication in the first 30 days, of which nine (47%) were Clavien grade III or higher. The most common 30-day complications were urinary tract infection (n = 6, 23%) and wound infection (n = 6, 23%). A total of 44% (4/9) of patients with neurogenic bladder experienced a complication within the first 30 days of cystectomy compared with 100% (8/8) of patients with radiation-induced fistula (P = 0.03) and 78% (7/9) of non-neurogenic, non-radiation-induced fistula patients (P = 0.34). Conclusions: Cystectomy with urinary diversion for benign disease might be successful, but is associated with a high rate of perioperative complications. Those with radiationinduced fistula are more likely to experience complications, whereas those with neurogenic bladder carry a lower risk. Patients should be counseled appropriately regarding expected postoperative outcomes.

Assessment of the Quality-of-life and Functional Outcomes in Patients Undergoing Cystectomy and Urinary Diversion for the Management of Radiation-induced Refractory Benign Disease

“…The increasing use of radiation therapy (XRT) for malignancies, including external beam radiation (EBRT) and brachytherapy, presents additional challenges in the management of treatment-refractory benign disease because of damage to the surrounding tissue including fibrosis and changes in vascularity. 6 Previous studies have focused on morbidity and complication rates for cystectomy and urinary diversion for benign disease 7,8 ; however, the impact of cystectomy and urinary diversion for radiation-induced treatmentrefractory benign disease on the functional and HRQOL outcomes has not been previously studied. Our objective was to evaluate the long-term quality of life in patients with nonmalignant treatment-refractory disease before and after cystectomy and urinary diversion and characterize the perioperative complications and functional outcomes in this unique population.…”

“…5,7,[18][19][20][21] Although the impact of disease and treatment has been previously studied for invasive UCB and radical cystectomy, 5,12,22,23 little is known about the effect of radiation-induced treatment-refractory disease on patients' HRQOL. This study identified significant impairments on the physical and mental health of these patients, especially in the role limitations due to physical and emotional problems (RH, RE), vitality (EF), and SF.…”

“…24 Cystectomies with urinary diversion have been associated with significant morbidity and complications. 1,2 Cystectomies for treatment-refractory benign disease after XRT may carry higher morbidity and complication risks .14 3 (75) 6 (40) .3 Length of stay, median (IQR), d 17 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) .52 12.5 (6.5-18) 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) .92…”

Cystectomy for Refractory Hemorrhagic Cystitis: Contemporary Etiology, Presentation and Outcomes

“…In series of cystectomy with urinary diversion for benign indications other than hemorrhagic cystitis, severe (Clavien III to V) complications have been reported in 6.4% to 46% of patients, with mortality rates between 0% and 4%. 11,12 Notably, a series of patients with cystitis secondary to cyclophosphamide by Stillwell and Benson included 5 patients who underwent cystectomy for hemorrhagic cystitis. 5 This report included patients across a wide age range (33 to 72), with perioperative mortality in 1 case.…”

Editorial Comment from Dr Kitamura to Cystectomy and urinary diversion as management of treatment‐refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes

“…1 All patients with radiation-induced fistula experienced complications within 30 days after the cystectomy, and half of them were Clavien grade III or more. At 90 days, 50% of the patients with radiation-induced fistula still had the preoperative problems, whereas 83% of the rest of the cohort experienced resolution.…”