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Is incidental appendectomy necessary during radical cystectomy?

N P Gupta1, G Nabi, A K Hemal

  • 1Department of Urology and Pathology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@hotmail.com

Urologia Internationalis
|October 10, 2002
PubMed
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This study found that acute appendicitis requiring surgery is extremely rare in patients following radical cystectomy and urinary diversion. Therefore, incidental appendectomy is not recommended during these procedures.

Area of Science:

  • Urology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Radical cystectomy with urinary diversion is a major surgical procedure.
  • The potential for abdominal complications, including appendicitis, exists post-operatively.
  • The necessity of incidental appendectomy during radical cystectomy remains a clinical question.

Purpose of the Study:

  • To determine the incidence of acute appendicitis requiring appendectomy in patients after radical cystectomy and urinary diversion.
  • To evaluate the risk of developing acute appendicitis in this specific patient population.

Main Methods:

  • A prospective review of 160 consecutive patients undergoing radical cystectomy and urinary diversion without appendectomy.
  • Patients were followed for a mean of 6 years (range: 4 months to 10 years).

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  • Data collected included age, sex, type of urinary diversion, and incidence of acute abdominal pain causes.

    • Main Results:

    • The most common causes of acute abdominal pain were intestinal obstruction (11%) and acute pyelonephritis (16%).
    • Other causes included neobladder perforation, parastomal hernia, urinary retention, and renal colic.
    • Crucially, no patients developed acute appendicitis requiring appendectomy during the follow-up period.

    Conclusions:

    • The risk of developing acute appendicitis after radical cystectomy and urinary diversion is exceptionally low.
    • Incidental appendectomy is not warranted during radical cystectomy due to the minimal risk of subsequent appendicitis.