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Continent urinary diversion using a Modified Indiana Pouch in elderly patients
J D Navon1, A C Weinberg, T E Ahlering
1University of California Irvine Medical Center, Orange.
The American Surgeon
|October 1, 1994
Summary
Continent urinary diversion using a modified Indiana Pouch is safe and effective for elderly patients undergoing radical cystectomy or anterior exenteration, demonstrating low morbidity and mortality rates.
Area of Science:
- Urology
- Geriatric Surgery
Background:
- Elderly patients present unique challenges for major oncologic surgery.
- Urinary diversion is often necessary after radical cystectomy or anterior exenteration.
Purpose of the Study:
- To evaluate the safety and efficacy of modified Indiana Pouch continent urinary diversion in patients aged 75 years and older.
- To assess early and late operative morbidity and mortality in this elderly cohort.
Main Methods:
- Retrospective review of 25 patients (≥75 years) undergoing modified Indiana Pouch urinary diversion.
- 21 patients had simultaneous radical cystectomy or anterior exenteration.
- Mean follow-up of 27 months.
Main Results:
- Two early mortalities (ileal gangrene/sepsis, aspiration pneumonia).
- Five early complications (wound infection, bleed, ureteral leak, ileus); two required re-operation.
- Six late complications (ureteral stricture, bowel obstruction, incontinence); three required re-operation.
- 11 of 13 surviving patients are disease-free and continent at a mean follow-up of 33 months.
Conclusions:
- Modified Indiana Pouch continent urinary diversion is feasible in elderly patients.
- The procedure can be performed with acceptable morbidity and mortality in this population.
- Continent urinary diversion offers a viable option for elderly patients requiring radical cystectomy or anterior exenteration.