Table 4
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We retrospectively analyzed early postoperative complications in 293 consecutive patients withbladder cancer who underwent radical cystectomy with urinary diversion from 1990 to 2007 at the Department of Urology of the Sapporo Medical University School of Medicine. The Common Terminology Criteria for Adverse Events (ver 3.0) was used to evaluate co...
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Purpose: Ileus is the most common complication following radical cystectomy. Ileus causes prolonged fasting, significant patient discomfort and prolongation of the hospital stay. We retrospectively examined the risk factors for ileus following radical cystectomy. Materials and Methods: Between January, 2000 and June, 2007, 59 patients underwent rad...
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... Острый пиелонефрит был наиболее частым осложнением, обнаруженным у 96 (33 %) пациентов, кишечная непроходимость наблюдалась у 33 (11 %) больных. Опасные для жизни осложнения зафиксированы у 15 (5 %) пациентов, в том числе у 2 (0,7 %) больных, которые умерли от развившихся осложнений [4]. ...
Background . Radical cystoprostatectomy is currently considered the most time-consuming operation with a large number of possible complications. Over the past decades, heterotopic reconstruction of the bladder using a segment of the ileum has become the optimal method of urine derivation. To date, we have successfully used a modification of V-shaped heterotopic ileocystoplasty.
Objective : to compare early postoperative complications in patients who underwent radical cystoprostatectomy with the formation of a Bricker conduit and with a modified V-shaped heterotopic conduit.
Materials and methods . In order to study and compare the complications that occurred in the first 30 days after surgery, we retrospectively selected patients after radical cystoprostatectomy with heterotypic ileocystoplasty. Patients were divided into two groups: 1 st — patients with Bricker ileocystoplasty (n = 46), 2nd — patients with modified V-shaped heterotopic ileocystoplasty (n = 49).
Results . The greatest number of complications was registered in patients of 2nd group — 19 (41.3 %), in patients of 1 st group — 14 (28.6 %). Repeated surgical interventions were required in 6 (12.2 %) patients of 1 st group, in 5 (10.8 %) of 2 nd group. Fatal outcomes were registered in 3 (6.1 %) patients of 1 st group, in 2 (4.2 %) of 2 nd group. The number of pyelonephritis in the first 30 days in patients of 1 st group was 8.2 %, 2 nd group — 23.9 %.
Conclusion . Modified V-shaped heterotopic urine derivation is easily feasible. This method should be used in patients with chronic pyelonephritis against the background of previously diagnosed ureterohydronephrosis, which is a fairly frequent consequence of the invasive nature of the growth of bladder cancer with ureteral obstruction.
... Of these, the patients who were diagnosed as having SSI were analyzed in detail. All operations were performed in the standard aseptic manner and the details of perioperative management were described in our previous reports [4,5,10]. For urinary diversion, the intestinal tract was mechanically prepared with polyethylene glycol electrolyte solution or sodium picosulfate on the day before the operation. ...
... In this study, all patients who could be analyzed had an ileal conduit constructed for urinary diversion and 40 patients (49%) received urethrectomy accompanied by RC. The first administration of prophylactic antimicrobial agents was performed intravenously 30 min before the start of the operation and the agents were added every 3 h during the operation [4,5,10]. ...
... Based on the results of our previous reports [4,5,10], the incidence of SSI for RC is decreasing gradually due to advances in perioperative management; however, it remains relatively high. This relatively high incidence of SSI is a critical issue not only for urologists who conduct this surgery but also the patients with RC. ...
To clarify the discrepancy in the incidence and severity of surgical site infections (SSI) for radical cystectomy between reports based on the CDC guideline and those using the Clavien-Dindo classification we evaluated 449 consecutive patients who underwent radical cystectomy for bladder cancer between 1990 and 2012. Of the 115 (25.6%) patients with SSI defined by the CDC guideline, 89 could be analyzed. We compared the SSI rates and severity defined by the CDC guideline and Clavien-Dindo classifications. There were 58 patients with superficial SSI, 16 with deep SSI, and 15 with organ/space SSI according to the CDC guideline. All patients with organ/space SSI were judged as “not having SSI” by the Clavien-Dindo classification. They were classified as having “intestinal prolapse”, “intestinal fistula”, “abdominal abscess” and “pelvic abscess.” There was a significant association between the treatment duration and depth of SSI based on the CDC guideline by Spearman’s rank-correlation coefficient (p <0.001, r = 0.614) and with the grade of complications (p <0.001, r = 0.632) in the Clavien-Dindo classification. Multivariate analysis showed that patients with grade III SSI in the Clavien-Dindo classification needed a significantly longer treatment duration. It is necessary to be aware that a discrepancy can occur automatically due to the different natures of the definitions. Using the CDC guideline, we can effectively estimate the future treatment period when SSI occurs. With the Clavien-Dindo classification, grade III SSI requires a longer treatment duration.
... Radical cystectomy followed by urinary diversion or reconstruction (RC) is a standard treatment for patients with muscle-invasive bladder cancer. However, the frequency of postoperative complications, including postoperative infection, is relatively high compared with other types of urologic surgery [1]. Surgical-site infection (SSI) is one of the major complications in RC, and SSI and urinary tract infection (UTI) have been reported to occur in 0.14–46 % and 7.4–18 % of patients with such surgery, respectively23456789 . ...
Radical cystectomy followed by urinary diversion or reconstruction (RC) is a standard treatment for patients with muscle-invasive bladder cancer. In these operations, a high frequency of complications, especially postoperative infection, has been reported. However, there have only been a few studies about postoperative anaerobic bacterial infection. To clarify the significance and role of anaerobic bacteria in postoperative infection, we retrospectively analyzed cases in which postoperative infection by these organisms developed. A total of 126 patients who underwent RC from 2006 to 2010 were included in this study. Various types of postoperative infection occurred in 66 patients. Anaerobic bacterial infections were detected with cultures for urine and blood in one case, for blood in two cases, and for surgical wound pus in four. The frequency of postoperative anaerobic bacterial infection in RC was less than that of colon surgery. However, this study revealed the possible development of a nonnegligible number of postoperative anaerobic bacterial infections. Therefore, we should consider anaerobic bacteria as possible pathogens in postoperative infection after RC.
... Several retrospective series reported that the early complication rates were similar after limited and extended PLND [21,25,26]. In our institute, the rates of morbidity, including cardiovascular, respiratory, gastrointestinal, infectious and genitourinary complications within 30 days of RC in patients who underwent extended PLND were similar to those in patients who underwent limited or standard PLND [27], although extended PLND takes an average of 28 min longer operating time compared with standard PLND (unpublished data). These findings suggest that extended PLND increases the operating time but not morbidity after RC, although prospective studies with longterm follow-up should be carried out. ...
The aim of this study was to evaluate the distribution of lymph node metastasis in extended lymphadenectomy for patients with bladder cancer.
We analyzed 31 patients who underwent extended lymphadenectomy at radical cystectomy for bladder cancer between April 2008 and February 2010. Specimens were evaluated as 14 separate packages from predesignated anatomical locations. The lymph node mapping was prospectively registered.
The median lymph node count was 37 (range 19-68). Ten (32%) patients had lymph node metastasis. The positive rates at each lymph node site were 0% at the left internal iliac, 13% at the left obturator, 3.2% at the left external iliac, 6.5% at the right internal iliac, 10% at the right obturator, 16% at the right external iliac, 3.2% at the left common iliac, 3.2% at the right common iliac and 6.5% at the presacral node. No lymph node metastasis was detected in the Cloquet, paracaval, aortocaval or paraaortic nodes. One (3.2%) patient had a skip metastasis from the left obturator to the presacral node.
Extended lymphadenectomy provides more accurate lymph node staging. We suggest that it is better to perform lymphadenectomy at least below the aortic bifurcation including the presacral node.
