Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy

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Abstract


Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.

T N Musayev

Author for correspondence.
mic_amu@mail.ru
National Center of Oncology Baku, Azerbaijan

Z Sh Vezirova

mic_amu@mail.ru
National Center of Oncology Baku, Azerbaijan

  • Slenzl A., Cowan N.C., De Santis М. et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur. Urol. 2009; 55: 815-825. doi: 10.1016/j.eururo.2009.01.002.
  • Даренков С.П., Кривобородов Г.Г., Котов С.В. Тактика ведения раннего послеоперационного периода у пациентов после радикальной цистэктомии с кишечной пластикой мочевого пузыря. Мед. вестн. Башкортостана. 2013; (2): 234-237.
  • Shabsigh A., Korets R., Vora K. et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur. Urol. 2009; 55 (1): 164-174. doi: 10.1016/j.eururo.2008.07.031.
  • Buscarini M., Pasin E., Stein J.P. Complications of radical cystectomy. Minerva Urol. Nefrol. 2007; 59: 67-87. PMID: 17431372.
  • Красный С.А., Суконко О.Г., Поляков С.Л. и др. Предикторы ранних тяжёлых осложнений радикальной цистэктомии. Онкоурология. 2010; (4): 42-46. doi: 10.17650/1726-9776-2010-6-4-42-46.
  • Saber A. Urinary diversion: Historical aspect and patient’s satisfaction. Urol. Nephrol. Open Access J. 2014; (1): 14-21. doi: 10.15406/unoaj.2014.01.00020.
  • Hautmann R.E., Hautmann S.H. Complications associated with urinary diversion. J. Nat. Rev. Urology. 2011; (8): 667-677. doi: 10.1038/nrurol.2011.147.
  • Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of ients and results of a survey. J. Ann. Surg. 2004; 240: 205-213. doi: 10.1097/01.sla.0000133083.54934.ae.
  • Карицкий А.П., Чулкова В.А., Пестерова Е.В. Реабилитация онкологического больного как основа повышения качества его жизни. Вопр. онкол. 2015; (2): 180-184.
  • Семиглазова Т.Ю., Ткаченко Г.А., Чулкова В.А. Психологические аспекты лечения онкологических больных. Злокачеств. опухоли. 2016; (4-S1): 54-58.
  • Matulewicz R.S., Brennan J., Pruthi R.S. Radical cystectomy perioperative care redesign. J. Urol. 2015; 86 (6): 1076-1086. doi: 10.1016/j.urology.2015.09.001.
  • Tyson M.D., Chang S.S. Enhanced recovery pathways versus standard care after cystectomy: A meta-analysis of the effect on perioperative outcomes. J. Eur. Urol. 2016; 70 (6): 995-1003. doi: 10.1016/j.eururo.2016.05.031.
  • Ortega-Lucea S.M., Martínez-Ubieto J., Júdez-Legaristi D. The results of implementing a fast-track protocol in radical cystectomy in a tertiary hospital. Actas. Urol. Esp. 2015; 39 (10): 620-627. doi: 10.1016/j.acuro.2015.05.008.
  • Novara G., De Marco V., Aragona M. et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J. Urol. 2009; 182 (3): 914-921. doi: 10.1016/j.juro.2009.05.032.
  • Shuman E.K., Chenoweth C.E. Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit. J. Crit. Care Med. 2010; 38 (8 Suppl.): S373-S379. doi: 10.1097/CCM.0b013e3181e6ce8f.

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