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Muñiz Suárez L, Subirá Ríos J, Gayarre Abril P, Montero Martorán A, Hijazo Conejos JI, García Alarcón J, García-Magariño Alonso J, Medrano Llorente P, Ramírez Fabián M, Elizalde Benito FX, Murillo Pérez C, Utrilla Ibuarben M, Asensio Matas A, Marín Zaldívar C, Casans Francés R, Ramírez Rodríguez JM, Blasco Beltrán B, Carrera-Lasfuentes P. Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol. Actas Urol Esp 2024; 48:364-370. [PMID: 38191025 DOI: 10.1016/j.acuroe.2024.01.001] [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: 10/06/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION AND OBJECTIVE The implementation of Enhanced Recover After Surgery (ERAS) multimodal rehabilitation protocols in radical cystectomy has shown to improve outcomes in hospital stay and complications. The aim of this analysis is to evaluate the impact of laparoscopic surgery on radical cystectomy within a multimodal rehabilitation program. MATERIAL AND METHODS The study was carried out in a third level center between 2011 and 2020 including patients with bladder cancer submitted to radical cystectomy according to an ERAS (Enhanced Recovery After Surgery) protocol and the Spanish Multimodal Rehabilitation Group (GERM) with 20 items to be fulfilled. RESULTS A total of 250 radical cystectomies were performed throughout the study period, 42.8% by open surgery (OS) and 57.2% by laparoscopic surgery (LS). The groups are comparable in demographic and clinical variables (p > 0.05). Operative time was longer in the LS group (248.4 ± 55.0 vs. 286.2 ± 51.9 min; p < 0.001). However, bleeding was significantly lower in the LS group (417.5 ± 365.7 vs. 877.9 ± 529.7 cc; p < 0.001), as was the need for blood transfusion (33.6% vs. 58.9%; p < 0.001). Postoperative length of stay (11.5 ± 10.5 vs. 20.1 ± 17.2 days; p < 0.001), total and major complications were also significantly lower in this group (LS). The readmission rate was lower in the LS group but not significantly (36.4% vs. 29.4%; p = 0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; p = 0.546). The differences were maintained in the multivariate models. CONCLUSIONS Laparoscopic surgery within a multimodal rehabilitation program increases operative time but significantly decreases intraoperative bleeding, transfusion requirements, postoperative length of stay, and complications.
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Affiliation(s)
- L Muñiz Suárez
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - J Subirá Ríos
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Gayarre Abril
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Montero Martorán
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J I Hijazo Conejos
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J García Alarcón
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - P Medrano Llorente
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Ramírez Fabián
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - F X Elizalde Benito
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Murillo Pérez
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Utrilla Ibuarben
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Asensio Matas
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Marín Zaldívar
- Servicio de Anestesiología y Reanimación, Hospital MAZ, Zaragoza, Spain
| | - R Casans Francés
- Servicio de Anestesiología y Reanimación, Hospital MAZ, Zaragoza, Spain
| | - J M Ramírez Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - B Blasco Beltrán
- Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Domínguez García A, Centeno Álvarez C, Muñoz Rodríguez J, Bonfill Abella T, Capdevila Gonzalo M, de Verdonces Roman L, Mayordomo Ferrer O, Azuara Invernon P, Casado Burgos E, Prats López J, Serra Aracil X. Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects. Actas Urol Esp 2023; 47:494-502. [PMID: 37086841 DOI: 10.1016/j.acuroe.2023.04.010] [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: 12/27/2022] [Accepted: 03/06/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION AND OBJECTIVE Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. MATERIALS AND METHODS We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months. RESULTS MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878-0.95; p < 0.0001), proving a close correlation with venous bicarbonate values (r = 0.387, p < 0.001). CONCLUSIONS MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.
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Affiliation(s)
- A Domínguez García
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - C Centeno Álvarez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Muñoz Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - T Bonfill Abella
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - M Capdevila Gonzalo
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - L de Verdonces Roman
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - O Mayordomo Ferrer
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - P Azuara Invernon
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - E Casado Burgos
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Prats López
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - X Serra Aracil
- Servicio de Cirugía General y digestive, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we think we do? A systematic review. Actas Urol Esp 2023; 47:195-210. [PMID: 36427800 DOI: 10.1016/j.acuroe.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023]
Abstract
Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk.
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Affiliation(s)
- A Domínguez García
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - J Muñoz Rodríguez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Prats López
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - J Almirall Daly
- Servicio de Nefrología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Centeno Álvarez
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - L de Verdonces Roman
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - C Pla Terradellas
- Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - X Serra Aracil
- Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
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Robot-assisted vs open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp 2023:S2173-5786(23)00016-1. [PMID: 36842704 DOI: 10.1016/j.acuroe.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 02/26/2023]
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Domínguez García A, Muñoz Rodríguez J, Prats López J, Almirall Daly J, Centeno Álvarez C, de Verdonces Roman L, Pla Terradellas C, Serra Aracil X. Acidosis metabólica tras cistectomía radical con derivación urinaria ileal. ¿Sabemos tanto como creemos? Revisión sistemática. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ding W, Ji R, Abdelrahim MEA, Wang L. Enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy: A meta-analysis. Actas Urol Esp 2022; 46:447-455. [PMID: 36109315 DOI: 10.1016/j.acuroe.2022.06.005] [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: 11/02/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We performed a meta-analysis to evaluate the effect of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy. METHODS A systematic literature search up to April 2021 was done and 33 studies included 6596 subjects submitted to surgery for radical cystectomy at the start of the study; 3143 of them received enhanced pharmaceutical recovery after surgery and 3453 were controls. The studies reported relationships about the effects of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of enhanced pharmaceutical recovery as postoperative standard care after radical cystectomy using the dichotomous and continuous methods with a random or fixed-effect model. RESULTS Enhanced pharmaceutical recovery after surgery had significantly lower length of hospital stay (MD, -2.78; 95% CI, -3.59 to -1.97, p < 0.001), complications (OR, 0.75; 95% CI, 0.60-0.94, p = 0.01), readmission within 30 days (OR, 0.80; 95% CI, 0.69-0.94, p = 0.007), and time to defecation (MD, -1.30; 95% CI, -2.22 to -0.37, p = 0.006) compared to control in subjects submitted to radical cystectomy. CONCLUSIONS Enhanced pharmaceutical recovery after surgery may reduce the length of hospital stay, complications, readmission within 30 days, and time to first bowel movement compared to control in subjects with surgery for radical cystectomy. Furthers studies are required to validate these findings.
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Affiliation(s)
- W Ding
- Department of Urology, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou, Jiangsu, China
| | - R Ji
- Department of Urology, Linyi Third People's Hospital, Linyi, Shandong, China
| | - M E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - L Wang
- Department of Emergency Medicine, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China.
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Effect of Radical Laparoscopic Surgery and Conventional Open Surgery on Surgical Outcomes, Complications, and Prognosis in Elderly Patients with Bladder Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1681038. [PMID: 35832525 PMCID: PMC9273384 DOI: 10.1155/2022/1681038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
Background Bladder cancer is a common malignant tumor of the urinary system in the clinic. It has multiple lesions, easy recurrence, easy metastasis, poor prognosis, and high mortality. Objective The aim of this study is to investigate the impact of laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) on the surgical outcome, complications, and prognosis of elderly patients with bladder cancer. Materials and Methods One hundred elderly bladder cancer patients who underwent surgery in our hospital from June 2019 to June 2021 were selected for the retrospective study and were divided into 50 cases each in the ORC group and the LRC group according to the different surgical methods. The ORC group was treated with ORC, and the LRC group implemented LRC treatment. The differences in surgery, immune function, recent clinical outcomes, and complications between the two groups were observed and compared. Results The mean operative time, mean intraoperative bleeding, intraoperative and postoperative transfusion rate, and transfusion volume of patients in the LRC group were statistically significant when compared to the ORC group. The differences in the meantime to resume eating, time to get out of bed, mean number of days in hospital after surgery, and the amount of postoperative numbing analgesics used by patients in the LRC group after surgery were statistically significant compared to the ORC group (P < 0.05). There was no statistically significant difference in the comparison of immune function between the two groups before surgery (P > 0.05), while the comparison of CD8+ and B cells 1 week after surgery of the LRC group was significantly better than that of the ORC group (P < 0.05), and the operation time of the LRC group was longer than that of the ORC group (P < 0.05). Statistical analysis of postoperative complications showed that the overall incidence of postoperative complications in the LRC group was significantly lower than that in the ORC group (16.67% vs. 46.67%) (P < 0.05). Conclusion LRC has less surgical trauma and intraoperative bleeding, faster postoperative recovery, and fewer postoperative complications, providing some reference for clinical surgery for elderly bladder cancer patients.
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Ding W, Ji R, Abdelrahim M, Wang L. Metaanálisis sobre el protocolo de recuperación acelerada tras la cistectomía radical. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sarrio-Sanz P, Martinez-Cayuelas L, Gil-Guillen VF, Quesada JA, Gomez-Perez L. Mortality Trends Related to Bladder Cancer in Spain, 1999-2018. J Clin Med 2022; 11:jcm11040930. [PMID: 35207200 PMCID: PMC8880070 DOI: 10.3390/jcm11040930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/13/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Bladder cancer (BC) is an important cause of premature mortality (PM, <75 years). Spain has one of the highest BC mortality rates in Europe. The objective of this study was to analyse BC mortality trends between 1999 and 2018 in Spain. The study was based on data from the National Institute of Statistics (Instituto Nacional de Estadística-INE). Age-adjusted mortality rates (AAMRs) were calculated by sex and age group. A trend analysis was performed using Joinpoint regression models and years of potential life lost (YPLL). Mortality in men resulting from BC decreased in all age groups studied. This was not observed in women, for whom mortality only decreased in the ≥75 age group. Deaths due to BC occurred prematurely in 38.6% of men and in 23.8% of women, which indicated a greater impact on YPLL in men compared to women. Over the last 20 years, there has been a significant decrease in BC mortality rate, except in women under 75 years of age. Despite this temporal trend of decreasing mortality, BC continues to have a significant impact on YPLL, mainly in men. Given this context, it is important to direct more resources towards prevention and early diagnosis strategies to correct this situation.
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Affiliation(s)
- Pau Sarrio-Sanz
- Urology Department, University Hospital of San Juan de Alicante, San Juan de Alicante, 03550 Alicante, Spain; (P.S.-S.); (L.M.-C.); (L.G.-P.)
| | - Laura Martinez-Cayuelas
- Urology Department, University Hospital of San Juan de Alicante, San Juan de Alicante, 03550 Alicante, Spain; (P.S.-S.); (L.M.-C.); (L.G.-P.)
| | | | - José Antonio Quesada
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain;
- Correspondence:
| | - Luis Gomez-Perez
- Urology Department, University Hospital of San Juan de Alicante, San Juan de Alicante, 03550 Alicante, Spain; (P.S.-S.); (L.M.-C.); (L.G.-P.)
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain;
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