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Lutz MA, Le QC, Müller M, Müller SC, Rosenbaum CM, Vetterlein MW, Kluth LA. [Urinary diversion with or without simple cystectomy as a salvage option for benign diseases of the lower urinary tract]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:34-42. [PMID: 38157068 DOI: 10.1007/s00120-023-02246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
Benign diseases of the lower urinary tract can occur as a result of oncological or neurological diseases or their respective therapies (e.g., surgery or radiation treatment) and can significantly reduce the quality of life for affected patients. Urinary diversion serves as a salvage option when all other therapeutic regimens have been carried out and proven unsuccessful. When selecting the suitable urinary diversion, a comprehensive clinical assessment of the patients is required in order to ensure long-term success. In some cases, a cutaneous, catheterizable pouch offers the last and only option for a long-term and definitive treatment of a patient's condition. Overall, a decreasing trend in the establishment of a continent urinary diversion is observed in Germany. Current data on benign indications for urinary diversion are limited. Therefore, further data collection and research are needed.
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Affiliation(s)
- Malin A Lutz
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Quynh Chi Le
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Matthias Müller
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - Stefan C Müller
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | | | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum der Goethe Universität in Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
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Aftreth OP, Tenggardjaja CF, Reyblat P. Cystectomy for Benign Indications. Curr Urol Rep 2022; 23:195-201. [PMID: 36057019 DOI: 10.1007/s11934-022-01100-1] [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] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This article evaluates the historical influences, current use, surgical techniques, and recent evidence on outcomes for cystectomy performed for benign indications. RECENT FINDINGS At the population level, cystectomy for benign indications has similar perioperative morbidity to radical cystectomy for cancer. Postoperative patient satisfaction is high and functional outcomes appear good, including sexual function. Patient regret about diversion choice is low provided decisions are well informed. Cystectomy is important both as a primary procedure for benign disease and as an adjunct to primary urinary diversion. Early morbidity remains high but long-term results are encouraging. Further studies are needed to guide patient decision-making, to help inform diversion choice, and to understand the long-term impact of surgery and diversion choice on quality of life.
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Affiliation(s)
- Owen P Aftreth
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA
| | - Christopher F Tenggardjaja
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA
| | - Polina Reyblat
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA.
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Haudebert C, Hascoet J, Freton L, Khene ZE, Dosin G, Voiry C, Samson E, Richard C, Neau AC, Drouet A, Mathieu R, Bensalah K, Verhoest G, Manunta A, Peyronnet B. Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches. Neurourol Urodyn 2021; 41:601-608. [PMID: 34962653 DOI: 10.1002/nau.24855] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/17/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
AIM The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). METHODS The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. RESULTS After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. CONCLUSION Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.
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Affiliation(s)
| | | | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | | | - Gilles Dosin
- Department of Urology, University of Rennes, Rennes, France
| | - Caroline Voiry
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France
| | - Emmanuelle Samson
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | - Anne-Cécile Neau
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Anais Drouet
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Andréa Manunta
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
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Aisen CM, Lipsky MJ, Tran H, Chung DE. Understanding Simple Cystectomy for Benign Disease: A Unique Patient Cohort With Significant Risks. Urology 2017; 110:239-243. [DOI: 10.1016/j.urology.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
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Kamel MH, Gardner R, Tourchi A, Tart K, Raheem O, Houston B, Bissada N, Davis R. Pyocystis: a systematic review. Int Urol Nephrol 2017; 49:917-926. [DOI: 10.1007/s11255-017-1562-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
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Isharwal S, Gupta S. Management of End-Stage Radiation Cystitis in the Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Stafford P, Prybys KM. Pyocystis and prostate abscess in a hemodialysis patient in the emergency department. West J Emerg Med 2015; 15:655-8. [PMID: 25247036 PMCID: PMC4162722 DOI: 10.5811/westjem.2014.5.22317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/09/2014] [Indexed: 11/16/2022] Open
Abstract
The urinary tract is an often forgotten and under-appreciated source of infection in anuric hemodialysis patients. Bladder abscess, also called pyocystis, is a severe complication of low urinary flow that can be difficult to detect, leading to delays in treatment and increased morbidity. The emergency physician should maintain a high suspicion for pyocystis, which can be quickly diagnosed by bedside ultrasound. We report a case of a hemodialysis patient with an initially minor presentation who developed sepsis secondary to pyocystis and prostate abscess.
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Affiliation(s)
- Phillip Stafford
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
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