Orthotopic Neobladder Following Radical Cystectomy in Patients with High Perioperative Risk and Co-morbid Medical Conditions

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2002Orthotopic Neobladder Following Radical Cystectomy in Patients with High Perioperative Risk and Co-morbid Medical Conditions DIPEN J. PAREKH, TRAVIS CLARK, JEFFREY O’CONNOR, CHARLIE JUNG, SAM S. CHANG, MICHAEL COOKSON, and JOSEPH A. SMITH DIPEN J. PAREKHDIPEN J. PAREKH , TRAVIS CLARKTRAVIS CLARK , JEFFREY O’CONNORJEFFREY O’CONNOR , CHARLIE JUNGCHARLIE JUNG , SAM S. CHANGSAM S. CHANG , MICHAEL COOKSONMICHAEL COOKSON , and JOSEPH A. SMITHJOSEPH A. SMITH View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64166-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A significant number of patients requiring radical cystectomy for bladder cancer have substantial co-morbidity. Nonetheless, these patients often prefer orthotopic neobladder reconstruction to avoid an abdominal stoma. We performed a retrospective study to determine perioperative morbidity in this group of patients. Materials and Methods: We used the American Society of Anesthesiologists physical status classification to assign perioperative risk. Of 250 patients undergoing orthotopic neobladder reconstruction after radical cystectomy during a 5-year period we identified 84 with an American Society of Anesthesiologists score of 3 or greater. Charts were available for review for all patients and none was lost to followup. Results: Median operative time (calculated from anesthesia ready time to completion of surgery and application of a dressing) was 256 minutes. In 14 patients (16.6%) transfusion of a median of 2 units of allogeneic blood was required. A total of 79 patients (94%) were transferred directly from the recovery room to the general urology floor without a need for postoperative cardiac monitoring. Median hospital stay was 7 days. One patient (1.1%) died on postopera-tive day 9 of a presumed pulmonary embolus after having been discharged home on postoperative day 6. Minor complications occurred in 16 patients (19%). Only 1 patient required a return to the operating room for endoscopic removal of a retained stent fragment. Conclusions: In experienced hands radical cystectomy and orthotopic neobladder can be offered to patients with co-morbid conditions. Expeditious performance of the surgical procedure, minimization of blood loss, restricting the surgical incision to an infraumbilical location, and avoidance of intraoperative complications all contribute to decreasing morbidity and mortality. Although orthotopic reconstruction is more complex than performance of an ileal conduit, there is no apparent increase in perioperative morbidity or mortality. Therefore, orthotopic reconstruction can be offered to patients who want to avoid an abdominal stoma even in the face of significant co-morbid conditions. References 1 : Assessment of morbidity and functional results in bladder replacement with Hautmann ileal neobladder after radical cystectomy: a clinical experience in 55 highly selected patients. Urology2001; 58: 707. Crossref, Medline, Google Scholar 2 : The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol1999; 161: 422. Link, Google Scholar 3 : Comparison of Studer ileal neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications. J Urol1998; 160: 721. Link, Google Scholar 4 : Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality. Urology2000; 55: 852. Crossref, Medline, Google Scholar 5 : Experience in 100 patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. J Urol1995; 154: 49. Link, Google Scholar 6 : [Vesica ileale Padovana (VIP): surgical technique, long-term functional evaluation, complications and management.]. Arch Esp Urol1997; 50: