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[Should one perform supravesical urinary diversions with excluded bladder in patients with cancer?]
E A Granados1, J Salvador, H Villavicencio
1Unidad Uro-oncología, Fundación Puigvert, Barcelona, España.
Objective:
To review our experience in 37 patients who had undergone supravesical urinary diversion with defunctionalized bladder left in situ.
Methods:
The pathological conditions that indicated surgery were advanced infiltrating bladder carcinoma and bladder irradiation due to other pelvic organ malignancies.
Results:
The analysis showed 70.25% of the patients had complications, the most common being hemorrhage (27.07%), followed by pyocyst (13.51%). Four patients (10.81%) required rehospitalization for treatment of complications. The patients were treated with a combination of parenteral antibiotics and continuous bladder irrigations using a variety of antiseptic solutions. One patient required a permanent cystostomy.
Conclusion:
There is a need to evaluate the benefit of the supravesical urinary diversion with defunctionalized bladder left in situ in patients with advanced infiltrating bladder carcinoma and bladder irradiation due to other pelvic organ malignancies. The type of diversion is unrelated to the complications that develop in the defunctionalized bladder. Patients with positive urine cultures and/or urethral stricture preoperatively have an increased risk of developing pyocyst.