Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

Acta Cirurgica Brasileira

Lucas Nogueira²  Rodolfo Borges Dos Reis¹  Roberto Dias Machado¹  Marcos Tobias-machado¹  Gustavo Carvalhal¹  Celso Freitas Jr¹  Wesley Magnabosco¹  Conrado Leonel Menezes²  Carlos Corradi²  Leonardo Oliveira Reis¹  Adauto Cologna¹  Antonio Antunes Rodrigues Junior¹  Eliney Ferreira Faria¹ 

[1] ,Federal University of Minas Gerais Clinics Hospital Division of Urologic OncologyBelo Horizonte MG ,Brazil

关键词: Posoperative Complication;    Survival;    ASA Score;    Morbidity;    Aged;    Bladder Cancer Neoplasms;    Complicação Pós-Operatória;    Sobrevida;    Risco Anestésico;    Morbidade;    Câncer de Bexiga;   

DOI  :  10.1590/S0102-86502013001300009

来源: SciELO

【 摘 要 】

PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.

【 授权许可】

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