Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?

Vakalopoulos, Ioannis; Dimitriadis, Georgios; Anastasiadis, Anastasios; Gkotsos, G.; Radopoulos, D.

doi:10.1007/s11255-011-9904-2

Cited by 25 publications

(21 citation statements)

References 20 publications

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“…In general, quality of life was comparable between both groups as assessed by the above-mentioned various questionnaires. This lack of difference could be explained by the lower complication rate of UC and by the lower expectations of the UC group [24]. Even in the presence of several biases, these data suggest that quality of life after UC is not that miserable as widely presumed.…”

Section: Discussionmentioning

confidence: 98%

“…Regardless of the type of urinary diversion, the majority of patients reported having a good overall quality of life, with no significant differences among the three urinary diversion subgroups. In a small-sized randomised controlled trial, Vakalopoulos et al [24] compared the quality of life in patients who underwent a UC versus those with an orthotopic bladder substitute. Along with a face-to-face interview, patients completed several quality of life questionnaires, e.g.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

et al. 2015

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Objective: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥75 years. Patients and Methods: We performed a retrospective, multicentre study of a consecutive series of patients aged ≥75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. Conclusion: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

et al. 2015

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“…However, UCS is often performed in cases where intraoperative survival may be affected because of complications associated with locally advanced bladder tumor and intestinal and general health problems. OUD is not suitable in cases where the bladder tumor involves the bladder neck or for patients with renal dysfunction (creatinine clearance <50 mg/dL) and heart failure (ejection fraction <45%), and UCS or IC is often preferred for these patients (18). The incidence of bladder tumor is increasing across the world, leading to more radical cystectomy and UD procedures.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Patients Who Underwent Ureterocutaneostomy

Kızılay¹,

Şimşir²,

Cüreklibatir³

et al. 2018

uob

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Objective: Ureterocutaneostomy (UCS) is a urinary diversion (UD) method which is used rarely in a carefully selected patient group. In this study, we aimed to present the data and long-term outcomes of patients who underwent UCS treatment in our clinic. Materials and Methods: A total of 36 patients who underwent UCS between January 2000 and December 2017 were included in the study. All patients had unilateral or bilateral ureteral-skin anastomosis. The demographic data, diagnoses, comorbidities, side of UCS (unilateral-bilateral), anesthesia method, operation time, and complications of the patients were recorded from the hospital registry system. The complications and survival status of the patients until the study date were evaluated. The study data were presented as mean (minimum-maximum) and number (percent). Results: Mean follow-up time was 128.5 (8-192) months. The mean American Society of Anesthesiologists score was 3.25. The patients had significant comorbidities, mainly hypertension, chronic obstructive pulmonary disease, and coronary artery disease. UCS was performed most frequently after radical cystectomy due to muscle-invasive bladder tumour (75%) and was usually bilateral (75%). The most common indications for UCS were significant comorbidities (55%). Only 3 (8.33%) patients developed ureteral-skin anastomosis, 6 (16.66%) patients developed pyelonephritis, and 9 patients died during the follow-up period. Conclusion: Although UCS is not a first-line UD method, it should still be kept in mind in the 21 st century for patients unable to tolerate segment excision from the gastrointestinal tract and postoperative complications due to comorbidities.

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“…Moreover, the ureterocutaneostomy diversion is not a procedure applicable to the majority of patients and mostly ileal conduit or neo-badder is performed. But for some elderly patients whose operation should be rapidly terminated due to the deteriorated health state, and those with decreased life expectancy due to associated comorbidities or inability to use intestinal segments owing to related problems, it is a less invasive approach and rational option (18). Furthermore, a randomized, prospective study with larger sample and different kinds of urinary diversions would better assess the feasibility of ELRC for the selected elderly bladder patients.…”

Section: Discussionmentioning

confidence: 99%

Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

Feng

Song

et al. 2016

Int. braz j urol.

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Objective:This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients.Patients and Methods:A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed.Results:A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05).Conclusions:ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.

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Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?

Cited by 25 publications

References 20 publications

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

Long-Term Outcomes of Patients Who Underwent Ureterocutaneostomy

Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

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