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Tillu N, Zaytoun O, Kolanukuduru K, Venkatesh A, Dovey Z, Choudhary M, Petitti T, Autorino R, Buscarini M. Analysis of early perioperative outcomes of robot-assisted radical cystectomy and colonic diversion. J Robot Surg 2024; 18:286. [PMID: 39025997 DOI: 10.1007/s11701-024-02047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
Studies of right colon pouch urinary diversion have widely varying estimates of the risk of perioperative complications, reoperation, and readmission. We sought to describe the association between specific risk factors and complication, readmission, and reoperation rates following right colon pouch urinary diversion. Patients undergoing robot-assisted right colon pouch urinary diversion from July 2013 to December 2022 were analyzed. Outcome measures include high-grade (Clavien-Dindo grade ≥ 3) complications within 90 days, readmission within 90 days, and reoperation at any time during follow-up. Specific risk factors such as age, gender, body mass index (BMI), diabetes, Charlson comorbidity index (CCI), and prior radiation were analyzed to establish an association with these outcomes. During the study period, 77 patients underwent the procedure and were eligible to study. The average follow-up was 88.7 (SD 14) months. 90-day high-grade complications were 24.67%, and 90-day readmission was 33.76%. The cumulative rate of any reoperation was 40.2%, and major reoperation was 24.67%. Female gender (OR 3.3, p = 0.015), 1 kg/m2 increase in BMI (OR 3.77, p = 0.014), diabetes (OR 3.49, p = 0.021), higher CCI (OR 1.59, p = 0.034), prior radiation (OR 1.97, p = 0.026), lower eGFR (OR 0.99, p = 0.032) and BMI ≥ 25 kg/m2 (OR 3.9, p value 0.02) was associated with Clavien III-IV complications. Female gender (OR 3.3, p = 0.015), diabetes (OR 3.97, p = 0.029), higher Charlson Comorbidity Index (OR 1.73, p = 0.031), prior radiation (OR 1.45, p = 0.029), lower eGFR (OR 0.87, p = 0.037) and BMI ≥ 25 kg/m2 (OR 3.86, p = 0.031) were predictive of reoperation. Overall, the rate of postoperative complications, readmissions, and reoperation was high but consistent with other studies. This study helps further characterize surgical outcomes after right colon pouch urinary diversion and highlights patients who may benefit from enhanced preoperative management for minimising complications.
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Affiliation(s)
- Neeraja Tillu
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA.
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA
| | - Kaushik Kolanukuduru
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | - Zachary Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA
| | - Manish Choudhary
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Maurizio Buscarini
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 1427 Madison Ave, New York, NY, 10029, USA
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Management of the Transitional Urology Patient: the Role of the Adult Reconstructive Urologist. Curr Urol Rep 2021; 22:15. [PMID: 33534013 DOI: 10.1007/s11934-021-01035-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.
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