Excessive antidiuretic hormone secretion after radical cystectomy

Complications in radical cystectomy and their prevention

We wish to dedicate this review article on radical cystectomy, its complications and their prevention to the memory of Prof. Luciano Giuliani. The article is based on a work written originally by Jim Montie and many other authors for the consensus meeting on bladder cancer held in Antwerp in 1994 and recently published in a booklet entitled “Global strategy for bladder cancer” (1). With the consent of Montie and the other co-authors, we have prepared on updated Italian version, inserting some parts (such as vascular complications) which were treated more superficially in the preliminary text.

The risk of radical cystectomy

A review of the operative risk of cystectomy and urinary diversion performed by one surgeon at one institution over an 8 1/2-year period was performed. Operative mortality was 0.4% (1/229). There were no urinary leaks, 1 bowel leak, 2 bowel obstructions, no rectal injuries and 3 pelvic abscesses. Cystectomy is a safer operation than is usually appreciated, based on improvements in pre-operative preparation, intra-operative monitoring and blood product replacement, and post-operative support if a complication does occur.

Radical cystectomy for carcinoma of the bladder in the elderly patient

Between 1979 and 1984, 136 patients underwent radical cystectomy and urinary diversion for the treatment of invasive carcinoma of the bladder. Of the patients 38 were 70 years old or more and they were considered elderly. The mortality rates for those less than 70 compared to those more than 70 years old were 1 and 5 per cent, respectively, and the morbidity rates were 39 and 34 per cent, respectively, with wound separation being the most common complication. There was no statistically significant difference with respect to age in the morbidity or mortality rates. The median hospital stay was 14 days but if a complication occurred the hospital stay was significantly longer. For elderly patients in general good health, radical cystectomy and urinary diversion should not be withheld on the basis of age alone.