Orthotopic urinary diversion in the elderly

Hugen, Cory M.; Daneshmand, Siamak

doi:10.1007/s00345-015-1696-z

Cited by 12 publications

(12 citation statements)

References 32 publications

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“…Despite old age not being a contraindication to neobladder diversion, it is associated with increased comorbidities and frailty, potentially lowering suitability for continent UD. 19,24 In agreement with previous literature, 9,11,23 men were more likely to undergo continent reservoir UD. The present study demonstrated no increase in the proportion of females receiving continent reservoir UD.…”

Section: Discussionsupporting

confidence: 91%

“…17 This may be explained by increasing evidence that RC should be the standard of care in older people, a shift of procedures into the public system or improved diagnostic techniques leading to the diagnosis of more invasive disease, therefore requiring more invasive treatment. 15,18,19 This increase in RC rate is similar to that found in Germany, increasing by 31% between 2006 and 2014. 9 This study found no change in the proportion of continent reservoir UD or other method over the past 20 years.…”

Section: Discussionsupporting

confidence: 80%

“…This study found the annual number of cystectomies in Australia have approximately doubled over the last 20 years despite the number of new cases of bladder cancer only increasing by approximately 30% over this time . This may be explained by increasing evidence that RC should be the standard of care in older people, a shift of procedures into the public system or improved diagnostic techniques leading to the diagnosis of more invasive disease, therefore requiring more invasive treatment . This increase in RC rate is similar to that found in Germany, increasing by 31% between 2006 and 2014 …”

Section: Discussionmentioning

confidence: 68%

“…Interestingly, this study also demonstrated a significant increase in the proportion of patients aged greater than 75 years who underwent UD. Despite old age not being a contraindication to neobladder diversion, it is associated with increased comorbidities and frailty, potentially lowering suitability for continent UD …”

Section: Discussionmentioning

confidence: 99%

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National trends in urinary diversion over the past 20 years: an Australian study

Best

Patel

2019

ANZ Journal of Surgery

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Background To investigate the trends in urinary diversion (UD) in Australia over the past 20 years, to correlate with patient demographics and to compare with international data. Methods A retrospective analysis of Medicare Australia data was performed using the relevant Medicare Benefit Schedule procedure codes over the past 20 years. Included diversion procedures were ureterocutaneous, ureterocolonic, intestinal conduit and continent reservoir. All patients aged older than 15 years were included in the analyses. Results Over the past two decades, 6124 cystectomies and 7166 UDs were subsidized by Medicare Australia. The median age group for UD was 65–74 years old and 71.8% were male. Intestinal conduit accounted for the majority of UDs (84.9%), followed by continent reservoirs (11.8%). Ureterocolonic and ureterocutaneous accounted for small proportions (2.9% and 0.4%, respectively). The absolute numbers of UD procedures increased over the past 20 years but the proportion of different methods remained constant. The rates of continent reservoir UD were significantly higher in men and people aged less than 55 years old (P < 0.001 for both). Over the course of the study, the proportion of people aged greater than 75 years undergoing UD increased significantly (P < 0.001). Conclusion In contrast to major international academic institutions, the proportion of continent reservoir UDs performed in Australia has not changed over the past two decades. Intestinal conduit remains the most common UD procedure.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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National trends in urinary diversion over the past 20 years: an Australian study

Best

Patel

2019

ANZ Journal of Surgery

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“…Hugen and Daneshmand make the case that age itself should not be the main determinant of whether a patient receives continent diversion [3]. To some degree, continent diversion is the default option in their hands, and the ileal loop is offered only for specific contraindications.…”

mentioning

confidence: 99%

Evolving concepts in muscle-invasive bladder cancer

Black

Kassouf

2016

World J Urol

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with MIBC are receiving treatment with curative intent [2]. The need for geriatric assessment of the MIBC patient and the involvement of a geriatrician in the multidisciplinary management of these patients go well beyond simple fine-tuning of therapy and instead are critical to increasing access to aggressive therapy, which should not be ruled out based on age alone. Various preoperative prehabilitation programs integrating exercise and nutrition will likely play a significant role in the future, in particular with the elderly and frail who may be rendered fitter for radical interventions.Patient age also influences the choice of urinary diversion at the time of radical cystectomy, with widely varying attitudes on the appropriateness of continent diversion in older patients. Hugen and Daneshmand make the case that age itself should not be the main determinant of whether a patient receives continent diversion [3]. To some degree, continent diversion is the default option in their hands, and the ileal loop is offered only for specific contraindications. Siddiqui and Izawa, on the other, believe that the potential quality-of-life advantages of the continent diversion do

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Orthotopic bladder substitution: Surgical aspects and optimization of outcomes

2021

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Objectives Orthotopic bladder substitution (OBS) is a management option for urinary diversion in men and women undergoing cystectomy. The aim of the procedure is to provide a functional continent urinary reservoir of adequate capacity, compliance and low pressure. We have provided a narrative review of the existing literature and highlighted areas where improvement and standardization can be recommended. Methods Literature search included database search for publications from January 1970 to November 2020, using keywords including OBS, bladder reconstruction, neobladder, radical cystectomy, robotic cystectomy, intracorporeal neobladder, surgical technique, patient selection and outcomes. Results Due to various factors including indications, operative technique and risk of complications, OBS is an enormous undertaking and commitment for patients, surgeons and health professionals involved in the care pathway. The main considerations for patient selection, the technical elements of the procedure and the rationale behind these are discussed. Previously considered to be a choice for a select few, the inclusion criteria have expanded over the last decade. Similarly, surgical techniques including the choice and configuration of bowel segments, construction of anastomosis and nerve or organ sparing procedures have evolved over the years. Minimally invasive laparoscopic and robotic assisted surgery has added further perspectives to the existing literature on OBS. Understanding the principles of operative techniques and assessing the best evidence to influence patient management is crucial as it has a major impact on clinical outcomes. Peri‐ and post‐operative care, focused on the prevention of complications and morbidity, affects long‐term functional and oncological outcomes, which ultimately dictates the quality of life. Conclusions This concise overview of OBS literature highlights the importance of pre‐operative, peri‐operative, and post‐operative aspects with regards to the optimization of patient care. To achieve the best results, meticulous attention should be paid in all these areas, surgical and multi‐disciplinary. Patient education and counseling, with shared decision making are central to the success of the procedure.

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Orthotopic urinary diversion in the elderly

Abstract: It is appropriate to offer an orthotopic neobladder to well-selected elderly patients following radical cystectomy.

Cited by 12 publications

References 32 publications

National trends in urinary diversion over the past 20 years: an Australian study

National trends in urinary diversion over the past 20 years: an Australian study

Evolving concepts in muscle-invasive bladder cancer

Orthotopic bladder substitution: Surgical aspects and optimization of outcomes

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