Urinary diversion in high-risk elderly patients: Modified cutaneous ureterostomy or ileal conduit?

Deliveliotis, Ch.; Papatsoris, Athanasios; Chrisofos, Michael; Dellis, Andreas; Liakouras, Christos; Skolarikos, Andreas

doi:10.1016/j.urology.2005.03.031

Cited by 89 publications

(124 citation statements)

References 19 publications

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“…deliveliots et al compared complication rates after modified cutaneous ureterostomy and the ileal conduit in high-risk patients. CU was associated with lower early and late complication rates, as shorter length of hospitalization 10 .…”

Section: Resultsmentioning

confidence: 86%

“…It avoids surgical and metabolic complications such as small bowel obstruction, paralytic ileum, delirium and delayed restart of deambulation 10 . We report on our experience with cutaneous ureterostomy with definitive ureteral stenting as urinary diversion option after radical cystectomy in unfit patients and after palliative handling.…”

Section: Muscle Invasive Bladder Cancer (Mibc) Accounts Formentioning

confidence: 99%

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Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

et al. 2013

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PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.

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Section: Resultsmentioning

confidence: 86%

Section: Muscle Invasive Bladder Cancer (Mibc) Accounts Formentioning

confidence: 99%

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

et al. 2013

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“…Yapılan çalışmalarda komplikasyonların standart şekilde bildirilmemesi, hospitalizasyon sürelerinin farklılığı, postoperatif dönemin tanımsal farklılıkları (30 gün, 90 gün) gibi nedenlerle oranlar oldukça değişkendir. Örnek olarak postoperatif ileus oranı değişik serilerde %2 ile %32 arasında seyrederken benzer şekilde postoperatif ateş, pyelonefrit gibi infeksiyöz komplikasyon oranları %5 ile %40 arasında oldukça değişken seyretmektedir (11,15,16,17,18,19). Yaşlı hastalarda daha genç hastalardan farklı olarak majör cerrahi sonrası delirium veya oryantasyon bozukluğu gibi nörolojik komplikasyonların daha fazla izlendiği bilinmesine rağmen genel olarak radikal sistektomi komplikasyonlarının değerlendirildiği serilerde bu konu spesifik olarak çalışılmamıştır.…”

Section: Yaşlı Hastalarda Hangi Komplikasyonlar İzlenir?unclassified

“…Bu grupta ortotopik mesane komplikasyon oranları genç hastalara göre yaşlı hastalarda daha yüksek seyretmekle beraber, özellikle kontinans oranları anlamlı olarak düşük bildirilmiştir (13,19). Günümüzde artık üreterokutaneostomi sık uygulanılmamakla beraber ciddi komorbiditesi olan hastalar veya ileri evre hastalarda halen uygun bir tedavi seçeneği olarak bildirilmiştir (17,22). Ek olarak 80 yaş üzeri hastalarda yapılan bir çalışmada üreterokutaneostominin ileal konduite göre daha düşük fistül oranlarına sahip olduğu belirtilmiştir (23).…”

Section: Yaşlılarda Ortotopik Mesaneunclassified

Radical Cystectomy in Elderly Patients: Predicting Complications and Mortality, Technical Aspects and Postoperative Care

Kuyumcuoğlu¹,

Özdedeli²

2015

uob

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GirişTüm dünyada sık görülen kanserlerden birisi olan mesane kanseri en sık ölüme yol açan beşinci kanser tipidir (1). İnsidansı yaş ile birlikte artmakta ve en sık 70 yaşın üzerinde görülmektedir. Günümüzde kemoterapi ve radyoterapi seçeneklerinin ve standartlarının yükselmesi bu hasta grubunda bimodal, trimodal mesane koruyucu cerrahi opsiyonlarının sistektomiye yakın sonuçlar elde edilmesini sağlasa da, radikal sistektomi ameliyatı geçmişte olduğu gibi günümüzde de kas invazif tümörlerde altın standart olarak kabul edilmekte ve ürolojinin en temel, en vazgeçilmez ameliyatlarından birisi olma özelliğini sürdürmektedir. Radikal sistektomi ve üriner diversiyon geçmişteki gibi yüksek morbidite ve mortalite ile seyretmemesine karşın halen ürolojinin belki en ciddi ve en invazif ameliyatlarından birisi olduğu açıktır. Genel olarak dünyada yaşam beklentisinin giderek artması, özellikle yeni millenyumda tüm tıp hizmetlerinde olduğu gibi ürolojide de yaşam kalitesi parametrelerini gündeme getirmiştir. Sistektomi ve üriner diversiyonda hastanın beden imajı, sosyal işlevlerini yerine getirme yetisi, cinsel işlev gibi faktörleri ciddi derecede etkileyen ameliyatlar olmaları nedeniyle giderek önem kazanmışlardır. Geçmişte ciddi morbidite ve mortalite kaygıları ile yaşlı hastalarda radikal sistektomi ve üriner diversiyon ameliyatından mümkün oldukça kaçınılmaya çalışılmıştır. Ancak, Summary ÖzetBladder cancer is one of the leading cancers all over the world and is the fifth among the cancer related mortality. Radical cystectomy and urinary diversion surgery; even if it has lost its traditional morbidity and mortality rates, still stands as one of the serious and major operations in urologic armamentarium. Quality of life issues are gaining much more importance in the new millennium with the significantly increased life expectancy. As demonstrated in many studies, the age of the patient is a factor increasing morbidity and mortality rates in radical cystectomy and urinary diversion. In the last decades beside geriatric patients' increased expectancies, new developments in surgical techniques and materials, postoperative care and anesthetic agents and techniques, the morbidity and mortality rates of radical cystectomy has reached to acceptable levels in this population as well as the quality life issues. As demonstrated in contemporary large clinical series, centers with high volume of patients, patient selection which will be made by considering postoperative care and comorbidity are remarkable since they are factors increasing the success. Key Words: Bladder cancer, radical cystectomy, urinary diversion, complications, mortality, elderly Tüm dünyada sık görülen kanserlerden birisi olan mesane kanseri en sık ölüme yol açan beşinci kanser tipidir. Radikal sistektomi ve üriner diversiyon cerrahisi geçmişte görülen yoğunlukta morbidite veya mortalite ile seyretmemesine karşın halen ürolojinin belki en ciddi ve en invaziv ameliyatlarından birisidir. Genel olarak dünyada yaşam beklentisinin giderek artması ile özellikle yeni mi...

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“…Although cutaneous ureterostomy is less preferred compared with other permanent urinary diversions, it is more appropriate for urinary diversion in elderly patients, patients with poor performance status, and when an intestinal segment cannot be used to form the internal reservoir. 1 When tubeless cutaneous ureterostomy is successfully performed, this procedure is as efficient as the other types of incontinent diversions. 2 However, the ureter should be long enough to position the stoma site in the lower quadrant of the abdominal wall.…”

Section: Introductionmentioning

confidence: 99%

Clinical benefits of tubeless umbilical cutaneous ureterostomy

Numakura

Tsuchiya

Takahashi

et al. 2015

CUAJ

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Introduction: We assess a novel technique of tubeless bilateral cutaneous ureterostomy, with a single umbilical stoma, for bladder cancer patients with short ureters after cystectomy. The benefit of cutaneous ureterostomy is equal to other incontinent urinary diversions, when the tubeless procedure is successfully achieved. This simple technique makes it easy to monitor the upper urinary tract (UUT) and is beneficial to patients with a high risk of UUT recurrence. Methods: This old and new surgical technique was used to perform total cystectomy and urinary diversion on three patients with bladder cancer at a high risk of UUT recurrence. Results: Two men and one woman (mean age: 73 years) underwent this surgery and the mean follow-up period was 8.3 years. The surgical approaches were laparotomy (n = 2) and laparoscopy (n = 1). One case developed para-stomal erosion, whereas another developed ureteral stenosis requiring catheter reinsertion. Although postoperative hydronephrosis was observed in all cases, the mean preoperative and postoperative serum creatinine levels were 0.70 and 0.76, respectively. UUT recurrence was not observed during the follow-up period. Conclusion: This tubeless umbilical cutaneous ureterostomy procedure greatly improves the outcome of urinary diversion for cancer patients with short ureters at a high risk of UUT recurrence. The benefits are equivalent to other urinary diversions when the tubeless procedure is successfully achieved.

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Urinary diversion in high-risk elderly patients: Modified cutaneous ureterostomy or ileal conduit?

Cited by 89 publications

References 19 publications

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

Radical Cystectomy in Elderly Patients: Predicting Complications and Mortality, Technical Aspects and Postoperative Care

Clinical benefits of tubeless umbilical cutaneous ureterostomy

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