Complications associated with urinary diversion
Radical cystectomy (RC) with subsequent urinary diversion has been assessed to be the most difficult surgical procedure in the field of urology. No randomized trials have been performed to compare the outcomes of noncontinent conduit diversion, neobladder construction and continent cutaneous diversi...
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| Format: | Article |
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2010
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| author | Hautmann, R.E. Hautmann, S.H. Hautmann, O. |
| author_facet | Hautmann, R.E. Hautmann, S.H. Hautmann, O. |
| author_sort | Hautmann, R.E. |
| collection | UM |
| description | Radical cystectomy (RC) with subsequent urinary diversion has been assessed to be the most difficult surgical procedure in the field of urology. No randomized trials have been performed to compare the outcomes of noncontinent conduit diversion, neobladder construction and continent cutaneous diversion. Almost all studies are of level 3 evidence, meaning the recommendations given in this Review are of grade C only. Until recently, significant disparity in the quality of surgical complication reporting, as well as the lack of universally accepted reporting guidelines, definitions and grading systems, have made it impossible to compare the surgical morbidity and outcomes of RC. There is a clear case for the standardized reporting of complications. The Clavien system is a straightforward and validated instrument that has already been successfully adopted by several urological centers. Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for more long-term studies to determine the full morbidity spectrum. In general, renal function after construction of continent detubularized reservoirs compares favorably with ileal conduit diversion, although the literature is insufficient to recommend one over the other. The challenge of optimum care for elderly patients with comorbidities is best mastered at a high-volume hospital by a high-volume surgeon. |
| first_indexed | 2024-03-06T05:37:04Z |
| format | Article |
| id | um.eprints-14696 |
| institution | Universiti Malaya |
| last_indexed | 2024-03-06T05:37:04Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | um.eprints-146962015-11-09T01:46:28Z http://eprints.um.edu.my/14696/ Complications associated with urinary diversion Hautmann, R.E. Hautmann, S.H. Hautmann, O. R Medicine Radical cystectomy (RC) with subsequent urinary diversion has been assessed to be the most difficult surgical procedure in the field of urology. No randomized trials have been performed to compare the outcomes of noncontinent conduit diversion, neobladder construction and continent cutaneous diversion. Almost all studies are of level 3 evidence, meaning the recommendations given in this Review are of grade C only. Until recently, significant disparity in the quality of surgical complication reporting, as well as the lack of universally accepted reporting guidelines, definitions and grading systems, have made it impossible to compare the surgical morbidity and outcomes of RC. There is a clear case for the standardized reporting of complications. The Clavien system is a straightforward and validated instrument that has already been successfully adopted by several urological centers. Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for more long-term studies to determine the full morbidity spectrum. In general, renal function after construction of continent detubularized reservoirs compares favorably with ileal conduit diversion, although the literature is insufficient to recommend one over the other. The challenge of optimum care for elderly patients with comorbidities is best mastered at a high-volume hospital by a high-volume surgeon. 2010 Article PeerReviewed Hautmann, R.E. and Hautmann, S.H. and Hautmann, O. (2010) Complications associated with urinary diversion. Nature Reviews Urology, 8 (12). pp. 667-677. |
| spellingShingle | R Medicine Hautmann, R.E. Hautmann, S.H. Hautmann, O. Complications associated with urinary diversion |
| title | Complications associated with urinary diversion |
| title_full | Complications associated with urinary diversion |
| title_fullStr | Complications associated with urinary diversion |
| title_full_unstemmed | Complications associated with urinary diversion |
| title_short | Complications associated with urinary diversion |
| title_sort | complications associated with urinary diversion |
| topic | R Medicine |
| work_keys_str_mv | AT hautmannre complicationsassociatedwithurinarydiversion AT hautmannsh complicationsassociatedwithurinarydiversion AT hautmanno complicationsassociatedwithurinarydiversion |