Simple cystectomy in patients requiring urinary diversion

Area of Science:

• Urology
• Surgical Oncology

Background:

• Urinary diversion is an alternative treatment for various bladder conditions.
• Retained nonfunctional bladders after diversion can lead to significant complications.
• Complications include pyocystis, hematuria, and pelvic pain, sometimes necessitating cystectomy.

Purpose of the Study:

• To describe a technique for simple cystectomy (bladder removal) performed with urinary diversion.
• To evaluate the safety and efficacy of simple cystectomy in patients with debilitating bladder conditions.
• To assess the benefits of avoiding complications associated with retained bladders post-diversion.

Main Methods:

• Simple cystectomy and urinary diversion (ileal conduit or continent) were performed in 19 patients (12 female, 7 male) with severe bladder symptoms.
• Patients had failed conservative treatments, with an average of 5 prior procedures.
• Simple cystectomy was performed concomitantly with diversion in 13 cases and separately in 6.

Main Results:

• Mean follow-up was 15 months with no surgical mortality.
• Simple cystectomy had a mean operative time of 30 minutes and blood loss of 300 cc.
• All patients experienced dramatic symptom alleviation with no morbidity directly linked to the simple cystectomy.

Conclusions:

• Simple cystectomy is a well-tolerated procedure that should be considered during urinary diversion.
• Performing simple cystectomy concurrently with diversion prevents later complications of the retained bladder.
• The technique is not technically demanding and is feasible even after pelvic radiation.