ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary Diversion |
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Authors: | Richard E. Hautmann Hassan Abol-Enein Thomas Davidsson Sigurdur Gudjonsson Stefan H. Hautmann Henriette V. Holm Cheryl T. Lee Frederik Liedberg Stephan Madersbacher Murugesan Manoharan Wiking Mansson Robert D. Mills David F. Penson Eila C. Skinner Raimund Stein Urs E. Studer Joachim W. Thueroff William H. Turner Bjoern G. Volkmer Abai Xu |
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Affiliation: | 1. University of Ulm, Ulm, Germany;2. Department of Urology, Mansoura University, Mansoura, Egypt;3. Division of Urology, Department of Surgery, Haukeland University Hospital, Bergen, Norway;4. Department of Urology, Skane University Hospital, Malmö, Sweden;5. Department of Urology, Märkische Kliniken Lüdenscheid, Lüdenscheid, Germany;6. Department of Urology, Oslo University Hospital, Oslo, Norway;g Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI, USA;h Department of Urology, Donauspital, Vienna, Austria;i Department of Urology, University of Miami, Miami, FL, USA;j The Norfolk and Norwich University Hospital, Norwich, UK;k Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;l Keck USC School of Medicine, University of Southern California, Los Angeles, CA, USA;m Department of Urology, Johannes Gutenberg University, Mainz, Germany;n Department of Urology, Inselspital Bern, Bern, Switzerland;o Department of Urology, Addenbrooke''s Hospital, Cambridge University, Cambridge, UK;p Department of Urology, Klinikum Kassel, Kassel, Germany;q Department of Urology, Zhujiang Hospital, Guangzhou, P.R. China |
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Abstract: | ContextA summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications.ObjectiveTo review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD).Evidence acquisitionAn English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis.Evidence synthesisIndications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85–90% and 60–80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%.ConclusionsRC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results. |
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Keywords: | Bladder cancer Orthotopic bladder substitute Neobladder Continence Cutaneous diversion Conduit Ureterosigmoidostomy Continence Functional results Outcomes Radical cystectomy |
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