PD9-05 ATTITUDES TOWARD THE USE OF CONTINENT URINARY DIVERSIONS IN PATIENTS UNDERGOING CYSTECTOMY: A SURVEY OF THE SOCIETY OF UROLOGIC ONCOLOGY

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2015PD9-05 ATTITUDES TOWARD THE USE OF CONTINENT URINARY DIVERSIONS IN PATIENTS UNDERGOING CYSTECTOMY: A SURVEY OF THE SOCIETY OF UROLOGIC ONCOLOGY Adam Mellis, Michael Cookson, and Joel Slaton Adam MellisAdam Mellis More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Joel SlatonJoel Slaton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.932AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our institution recently reported that despite tremendous enthusiasm towards the introduction of continent urinary diversions (CUD) 20 years ago, surprisingly few patients (only 15–19%) end up undergoing a CUD in the contemporary era. Our study goal was to survey members of the Society of Urologic Oncology (SUO) for attitudes towards the use of CUD. METHODS In conjunction with the SUO, our institution performed an electronic survey of physicians in the organization during the fall of 2014. Data collected included patient factors influencing decision making for use of CUD (gender, age, comorbidities, obesity, previous radiation or surgeries, hydronephrosis and renal dysfunction), intraoperative factors and surgical factors and stratified results by provider demographics and education. RESULTS Among the 93 responders to the survey. 88% were fellowship-trained and 82% were academically-based. Among the responders, 52% perform less than 20 cystectomies per year. 56% of responders created a neobladder in less than 20% of patients with providers of less than 10 years of experience less willing to perform a neobladder than more experienced providers. Physicians' choice of ileal neobladder was Studer (54%) over Hautmann (26%). A robotic cystectomy was a strong consideration among 36% of younger physicians compared to 18% of older physicians. Providers found female gender to be a negative influence compared to male gender in deciding to create a neobladder. A history of an myocardial infarction, poor dexterity, morbid obesity, a creatinine of greater than 2.0 mg/dl were all negative influences toward use of CUD. While nearly every provider utilizes ureteral stents, younger providers were more likely to use a suprapubic tube into the neobladder (62% vs 55%) and less likely to use a nasogastric tube (24% vs 34%) and to perform a mechanical bowel prep (29% vs 56%). CONCLUSIONS Most providers report performing CUD at a rate (20–30%) slightly above that reported in our previous study (15–19); this difference may reflect the SUO providers' strong association with academic institutions. As expect a number of factors tend to sway providers away shy away from use of CUD, including significant comorbidities and manual dexterity though remains a disparity in attitudes between use of neobladders in women vs men. The attitudes of younger providers toward specifics techniques (less use of bowel prep and nasogastric tubes) reflect adoption of evolving attitudes in the management of bowel during surgical resections. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e196 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Mellis More articles by this author Michael Cookson More articles by this author Joel Slaton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...