Intestinal Urinary Diversion Research Articles

Unraveling the Complexities of Uretero-Enteric Strictures: A Modern Review.

The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.

Significance of urinary liver-type fatty acid-binding protein in patients with normal renal function after undergoing intestinal urinary diversion: a preliminary study.

Liver-type fatty acid-binding protein (L-FABP) in urine is one of the early diagnostic biomarkers for acute and chronic kidney injuries. Although this protein is also identified in the intestine, there is no verified reference value for patients with intestinal urinary diversion (UD). The aim of the present study was to measure L-FABP values in such patients and compare them with the results for patients without UD. Spot urine specimens were collected from 41 patients with UD and 50 subjects without UD with estimated glomerular filtration rates of over 60ml/min/1.73m2, and the L-FABP values were measured. The normal upper cutoff value in healthy subjects without UD is considered to be 7.24μg/g Cr. First, the median values of the two groups were compared. Next, the subjects with negative proteinuria and without comorbidities associated with renal function were further selected and the median values of the groups were compared. The mean age was significantly higher in the UD group. The types of UD were ileal conduit (38 patients) and ileal neobladder (three patients). The median L-FABP value in the UD group was significantly higher than that in the non-diversion group (89.1μg/g Cr vs. 2.0μg/g Cr, p < 0.0001). After adjustment for their backgrounds, the median value remained higher in the UD group. L-FABP values in subjects with UD are higher than in those without UD. By this result, to develop a reference value in patients with intestinal UD population, further studies are required.

Impact of Intestinal Urinary Diversion on the Risk of Fracture and Loss of Bone Mass: A Systematic Review.

Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and decrease of intestinal absorption surface. We performed a systematic review of the available literature on the impact of IUD on bone demineralization. We systematically searched PubMed®, for original articles published before April 2020. Primary end points were the risk of fracture and loss of bone density. Secondary outcomes were the metabolic changes in biochemical and urine parameters related to calcium metabolism and histological changes. Our electronic search identified a total of 2417 articles. After a detailed review, we selected 11 studies that addressed the impact of IUD on bone health in 10369 patients. The risk of bone fracture was studied in 3 articles, showing a higher risk in the IUD population. Of the 9 articles evaluating the relation between intestinal urinary diversion and bone density, 5 did find a positive association. One article evaluated the bone metabolism at a cellular level after IUD showing a decrease in bone turnover in this population. Three of the eight studies reporting data on serum parameters related to calcium and phosphate metabolism showed differences. Finally, a correlation between concentration of pyridolines in urine and loss of bone density was found in two of the three studies. Although published data on BMD are contradictory, patients undergoing IUD seem to be at higher risk of bone fractures. Our finding support the need to implement accessible strategies on osteoporosis screening and prevention in IUD patients.

A new index (A/G) associated with early complications of radical cystectomy and intestinal urinary diversion

ObjectivesTo put forward a new index (A/G, the postoperative ratio of albumin to blood glucose) associated with complications occurring within 30-day of radical cystectomy and intestinal urinary diversion (RC-IUD). Patients and methodsThe charts of 565 patients undergoing RC-IUD at our single center between 2008 and 2018 were reviewed. All baseline information and perioperative data were collected. We finally picked up 360 of them with complete postoperative laboratory test results to find a new index. Early complications (within 30-day) after surgery were graded using the standardized Clavien-Dindo scale. Single and multivariate logistic regression determined the association between perioperative variables and post RC-IUD complications. ResultsA total of 485 men and 80 women with a median age of 61 years and BMI of 24.8 were included. As for intestinal urinary diversion, most patients (n = 513, 90.8%) received ileal conduits, 47 (8.3%) received Ileal orthotopic neobladders and 5 received Mainz pouch bladders (0.9%). Robotic surgeries were conducted in 311(55.0%) patients and other 254 (45.0%) accepted laparoscopic surgeries. Available laboratory markers were obtained from 359 cases. Postoperative complications occurred in 129 patients (22.8%), including 117 (90.7%) Minor (Clavien I or Clavien II events) complications, and 12 (9.3%) major (Clavien III or greater events) complications. A single logistic regression identified 4 variables associated with postoperative complications, including hypertension, surgical procedures, postoperative A/G, operating time, and blood loss. A further multivariate logistic regression identified 2 significant indices: operating time and postoperative A/G. Moreover, we built a receiver operating characteristic curve of A/G to identify a threshold of 3.65 as a new indicator of postoperative complication. ConclusionsWe put forward a new index named A/G associated with complications after radical cystectomy, not singular considering albumin or blood glucose any more. This novel related index may provide an early alert for RC-IUD patients thus aiding in directing individual rehabilitation and improving postoperative outcomes after RC-IUD.

Intraoperative Only versus Extended Duration Use of Antimicrobial Prophylaxis for Infectious Complications in Radical Cystectomy with Intestinal Urinary Diversion

Introduction: In spite of the high incidence of infectious complications (ICs), appropriate duration of antimicrobial prophylaxis (AMP) for radical cystectomy (RC) with intestinal urinary diversion (IUD) has not been established. We compared the incidence of ICs after RC with IUD in patients using only intraoperative AMP or extended duration AMP. Risk factors for ICs were also investigated. Patients and Methods: One hundred twenty-three consecutive patients who underwent RC with IUD were divided into 2 groups based on the AMP duration (intraoperative only vs. extended duration for a median of 3 days). Between the groups, the incidence of ICs was compared. Risk factors for ICs were investigated in multivariate analysis. Results: The IC rate was 44%. No significant difference was found in the rate of ICs between the groups. The IC rate was significantly higher in patients with lower estimated glomerular filtration rate (eGFR). Rates of ICs were 60 and 38% in patients with eGFR of less than 60 and equal or more than 60 mL/min/1.73 m², respectively. Conclusions: Our result indicates that AMP that is administered more than intraoperatively may be excessive in RC with IUD. Patients with a lower eGFR should be particularly cared for postoperative ICs.

Robot-assisted radical cystectomy with urinary intestinal diversion (literature review)

Radical cystectomy (RC) remains the main surgical treatment for patients with muscle-invasive bladder cancer. Currently, robot-assisted access is actively used along with the open one. The review analyzes the main results of robot-assisted RC and compares them with those after open RC. We evaluated the following parameters of robot-assisted RC: surgery duration, volume of blood loss, terms of patients’ hospitalization, 30- and 90-day complications. We also compared the results of extra- and intracorporeal urine diversion and found out that intracorporeal ileal conduit formation and orthotopic cystoplasty are more advantageous. Gaining experience allows us to reduce the number of postoperative complications, especially severe ones according to Clavien classification, and to improve the functional results of robot-assisted RC.

Transitional cell carcinoma recurrence impacting intestinal diversion after radical cystectomy. Oncologic outcomes of a rare site of recurrence.

IntroductionTransitional cell carcinoma recurrence within an intestinal urinary diversion (TCCUD) after radical cystectomy (RC) is a rare condition with unknown origin, prognosis and treatment. The aim of this study was to describe treatment options and oncologic outcomes of this understudied site of recurrence in a multi-institutional case series.Material and methodsTCCUD relapse cases after RC were investigated in a retrospective, multi-institutional study. Surgical approach and adjuvant chemotherapy were discussed. Early and late complications were described according to the Clavien-Dindo classification. Kaplan-Meier method was used to assess progression-free and cancer-specific survival.ResultsA total of 19 patients were selected. The most common presentation was gross hematuria. The median interval between RC and TCCUD was 51.2 months. Fifteen patients (78.9%) underwent surgical excision, and two underwent concomitant radical nephroureterectomy. In 12 (63.1%) cases the site of TCCUD was the uretero-ileal anastomosis. Tumor invading the muscularis of the intestinal diversion was described in 10 (52.6%) cases. Surgical complications occurred in 7/15 (46.6%) patients, of these two with Clavien-Dindo Grade III. Four patients (21.0%) underwent adjuvant chemotherapy and two (10.5%) both chemotherapy and radiation therapy. During follow-up 15 patients (78.9%) presented with other sites of recurrence, with lymph nodes (21.0%) and liver (15.7%) being the most common localizations. Recurrence free and overall survival rates were 36.8% and 15.8%, and 56.5% and 24.2%, respectively at 12 and 18 months.ConclusionsMost patients with TCCUD have invasive disease and a substantial percentage experience upper tract cancer during their disease course. TCCUD is often the herald of advanced disease and systemic progression, with poor progression-free and overall survival rates.

SC206 - Perioperative outcomes of fast track protocol applied to patients treated with radical cystectomy and intestinal urinary diversion: A comparison with standard management in a high-volume center

SC206 - Perioperative outcomes of fast track protocol applied to patients treated with radical cystectomy and intestinal urinary diversion: A comparison with standard management in a high-volume center

Radical cystectomy for bladder cancer: early and late postoperative complications

Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world. Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion. Materials and methods . Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis. Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%. Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types.

P91 - Fast track protocol applied to patients treated with radical cystectomy and intestinal urinary diversion: An update of a two year prospective randomized study in a high-volume center

P91 - Fast track protocol applied to patients treated with radical cystectomy and intestinal urinary diversion: An update of a two year prospective randomized study in a high-volume center

Complications within 90days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan.

We prospectively evaluated the 90-day postoperative mortality and morbidity of open radical cystectomy by using a standardized reporting methodology. Additionally, we assessed the preoperative characteristics to determine risk factors for major complications. This multicenter prospective study included 185 consecutive patients undergoing open radical cystectomy from October 2010 through March 2014. Postoperative complications within 90days were recorded and graded according to the modified Clavien-Dindo classification. Totally, 328 postoperative complications were observed in 149 patients (80.5%). Of these events, 73 (22.2%) were high grade (≥Grade III), and developed in 46 patients (24.9%). Three patients (1.6%) died postoperatively. Urinary tract infection, wound complications, and paralytic ileus were common complications that occurred in 55 (29.7%), 42 (22.7%) and 41 (22.2%) patients, respectively. Ureteroenteric stricture was diagnosed in 13 of the 151 patients (8.6%) undergoing intestinal urinary diversion. Emergency room visits were required for 13 patients (7.0%) and readmission after discharge was needed for 36 (19.5%). A body mass index≥25kg/m2, smoking history and Charlson Comorbidity Index≥2 were independent risk factors for high-grade complications, and their odds ratios (95% confidence intervals) were 2.357 (1.123-4.948), 2.843 (1.225-6.596) and 3.025 (1.390-6.596), respectively. Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.

Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy

Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.

MP23-16 TARGETED ANTIBIOTIC PROPHYLAXIS CAN PREVENT FEBRILE URINARY TRACT INFECTION AFTER REMOVAL OF URETERAL STENTS IN RADICAL CYSTECTOMY PATIENTS WITH INTESTINAL URINARY DIVERSION.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2017MP23-16 TARGETED ANTIBIOTIC PROPHYLAXIS CAN PREVENT FEBRILE URINARY TRACT INFECTION AFTER REMOVAL OF URETERAL STENTS IN RADICAL CYSTECTOMY PATIENTS WITH INTESTINAL URINARY DIVERSION. Yoshitsugu Nasu, Tadashi Murata, Morito Sugimoto, Atsushi Takamoto, and Noriaki Ono Yoshitsugu NasuYoshitsugu Nasu More articles by this author , Tadashi MurataTadashi Murata More articles by this author , Morito SugimotoMorito Sugimoto More articles by this author , Atsushi TakamotoAtsushi Takamoto More articles by this author , and Noriaki OnoNoriaki Ono More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with intestinal urinary diversion has the high incidence of post-operative infective complication. Some patients encountered febrile urinary tract infection (UTI) after removal of the ureteral stents. We started targeted antibiotic prophylaxis, which was chosen appropriate susceptible antibiotics based on urine culture. We evaluated the efficacy of the targeted antibiotic prophylaxis for prevention of febrile UTI after removal of the ureteral stents. METHODS From January 2009 to April 2016, a total of 54 patients who underwent radical cystectomy with intestinal urinary diversion were included. In the first half of the study period (January 2009 to December 2011) included 21 patients, ureteral stents were removed without administration of antibiotic agent. In the last half (January 2012 to April 2016) included 33 patients, targeted antibiotic prophylaxis was done. Prior to removal ureteral stents on post-operative day 7, urine obtained from ureteral stents was cultured and determined the susceptibility of isolated bacteria. Patient received antibiotics for which the isolates were susceptible before the stent removal. Patients were followed up for 2 weeks and febrile UTI were recorded. We compared the incidence of febrile UTI between two study periods. RESULTS Overall the incidence of febrile UTI after stent removal was 22.2% (12/54). In the first half of the study period, the incidence of febrile UTI was 47.6% (10/21) and that of in the last half was 6.1% (2/33). The incidence of febrile UTI was significantly decreased in the last half period (Fisher′s test, p=0.006). Urine cultures positive for bacteria were found in 29 out of 33 patients in the last half period and 33 strains of 11 bacteria species were isolated. The predominant bacteria were E.coli in 5 patients, S. aureus in 4 patients, K.peumoniae in 4 patients and E.cloacae in 4 patients. Five strains (15.2%) of methicillin resistant Staphyococci, 2 strains (6.1%) of extended spectrum β-lactamase producing bacteria and 14 strains (42.4%) of fluoroquinolone-resistant bacteria were isolated. CONCLUSIONS The susceptibility test had an advantage of appropriate antibiotics choice, because 29 out of 33 patients had urine cultures positive for bacteria and miscellaneous and drug-resistant strains were isolated. This targeted antibiotic choice based on urine culture is more effective prophylaxis in radical cystectomy patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e299 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yoshitsugu Nasu More articles by this author Tadashi Murata More articles by this author Morito Sugimoto More articles by this author Atsushi Takamoto More articles by this author Noriaki Ono More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

133 - Targeted antibiotic prophylaxis can prevent febrile urinary tract infection after removal of ureteral stents in radical cystectomy patients with intestinal urinary diversion

133 - Targeted antibiotic prophylaxis can prevent febrile urinary tract infection after removal of ureteral stents in radical cystectomy patients with intestinal urinary diversion

Fifteen years of experience radical cystectomy and intestinal urinary diversion

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy. Materials and method s. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve. Result s. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy. Conclusions . Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications.

P132 - Transitional cell carcinoma recurrence in intestinal urinary diversions: A multicentric cases series

P132 - Transitional cell carcinoma recurrence in intestinal urinary diversions: A multicentric cases series

Preoperative determinant of early postoperative renal function following radical cystectomy and intestinal urinary diversion.

To identify preoperative factors correlated with postoperative early renal function in patients who had undergone radical cystectomy (RC) and intestinal urinary diversion. We retrospectively identified 201 consecutive bladder cancer patients without distant metastasis who had undergone RC at our institution between 2003 and 2012. The estimated glomerular filtration rate (eGFR) was calculated using the modified Chronic Kidney Disease Epidemiology equation before RC and 3months following RC. Univariate and stepwise multiple linear regression analyses were applied to estimate postoperative renal function and to identify significant preoperative predictors of postoperative renal function. Patients who had undergone intestinal urinary diversion and were available for the collection of follow-up data (n=164) were eligible for the present study. Median preoperative and postoperative eGFRs were 69.7 (interquartile range [IQR] 56.3-78.0) and 70.7 (IQR 57.3-78.1), respectively. In univariate analyses, age, preoperative proteinuria, thickness of abdominal subcutaneous fat tissue (TSF), preoperative serum creatinine level, preoperative eGFR, and urinary diversion type were significantly associated with postoperative eGFR. In a stepwise multiple linear regression analysis, preoperative eGFR, age, and TSF were significant factors for predicting postoperative eGFR (p<0.001, p=0.02, and p=0.046, respectively). The estimated postoperative eGFRs correlated well with the actual postoperative eGFRs (r=0.65, p<0.001). Preoperative eGFR, age, and TSF were independent preoperative factors for determining postoperative renal function in patients who had undergone RC and intestinal urinary diversion. These results may be used for patient counseling before surgery, including the planning of perioperative chemotherapy administration.

Predictors for morbidity of radical cystectomy and different types of urine derivation: 20-year experience of a surgery center

Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation. Objective: to search for risk factors for complications after RCE with different types of urine derivation. Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43). Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p &lt; 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up. In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho- and/or heterotopic urine derivations rather than to the former. Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeon’s insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation.

Metabolic Changes Developing During Urinary Intestinal Diversion after Radical Cystectomy

Metabolic Changes Developing During Urinary Intestinal Diversion after Radical Cystectomy

Risk of fracture after radical cystectomy and urinary diversion for bladder cancer.

Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture. Population-based study using SEER-Medicare-linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics. The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage. Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture.