Choice of urine derivation method after radical cystectomy in the high anesthesiological risk group

Abstract

Background. Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. Muscle invasion can occur in 48 % of patients. Epidemiologically, the peak incidence of bladder cancer is observed in men at the seventh decade of life. At the time of diagnosis, many of these patients have serious comorbidity. The trauma of radical cystectomy in combination with comorbidity creates an insurmountable barrier to radical treatment in a large part of patients. Refusal to use intestinal segments for urine diversion dramatically reduces the invasiveness of the intervention. However, the implementation of bilateral ureterocutaneostomy is associated with a greater frequency of pyelonephritis due to the use of external stents and scarring of the ureterocutaneostomy. A transureteroureterostomy with a unilateral ureterocutaneostomy can be a definite alternative.Objective: to evaluate the effectiveness of cross ureteroureterostomy for urine derivation after radical cystectomy in patients with muscle-invasive bladder cancer and a high risk of perioperative complications.Materials and methods. The article analyzes 28 cystectomies for muscle-invasive bladder cancer in patients with severe concomitant pathology who underwent transureteroureterostomy with unilateral ureterocutaneostomy for urine derivation. Results. It was shown that this intervention does not have high morbidity, does not increase the incidence of early postoperative complications, and relieves patients from bilateral urostoma. Among late complications, inflammatory ones predominate due to obstruction of the external stent. The authors highlight the tactics and technical aspects of managing such patients with obstructive pyelonephritis and the experience of drainage-free management.Conclusion. Transureteroureterostomy with unilateral ureterocutaneostomy after cystectomy for muscle-invasive bladder cancer can be considered as the operation of choice in patients with a burdened comorbidity.