Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Acta Cirúrgica Brasileira (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502013001300009 |
Resumo: | PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted. |
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Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomyPosoperative ComplicationSurvivalASA ScoreMorbidityAgedBladder Cancer NeoplasmsPURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia2013-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502013001300009Acta Cirúrgica Brasileira v.28 suppl.1 2013reponame:Acta Cirúrgica Brasileira (Online)instname:Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (SBDPC)instacron:SBDPC10.1590/S0102-86502013001300009info:eu-repo/semantics/openAccessNogueira,LucasReis,Rodolfo Borges dosMachado,Roberto DiasTobias-Machado,MarcosCarvalhal,GustavoFreitas Jr,CelsoMagnabosco,WesleyMenezes,Conrado LeonelCorradi,CarlosReis,Leonardo OliveiraCologna,AdautoRodrigues Junior,Antonio AntunesFaria,Eliney Ferreiraeng2013-02-01T00:00:00Zoai:scielo:S0102-86502013001300009Revistahttps://www.bvs-vet.org.br/vetindex/periodicos/acta-cirurgica-brasileira/https://old.scielo.br/oai/scielo-oai.php||sgolden@terra.com.br0102-86501678-2674opendoar:2013-02-01T00:00Acta Cirúrgica Brasileira (Online) - Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (SBDPC)false |
dc.title.none.fl_str_mv |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
title |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
spellingShingle |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy Nogueira,Lucas Posoperative Complication Survival ASA Score Morbidity Aged Bladder Cancer Neoplasms |
title_short |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
title_full |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
title_fullStr |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
title_full_unstemmed |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
title_sort |
Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy |
author |
Nogueira,Lucas |
author_facet |
Nogueira,Lucas Reis,Rodolfo Borges dos Machado,Roberto Dias Tobias-Machado,Marcos Carvalhal,Gustavo Freitas Jr,Celso Magnabosco,Wesley Menezes,Conrado Leonel Corradi,Carlos Reis,Leonardo Oliveira Cologna,Adauto Rodrigues Junior,Antonio Antunes Faria,Eliney Ferreira |
author_role |
author |
author2 |
Reis,Rodolfo Borges dos Machado,Roberto Dias Tobias-Machado,Marcos Carvalhal,Gustavo Freitas Jr,Celso Magnabosco,Wesley Menezes,Conrado Leonel Corradi,Carlos Reis,Leonardo Oliveira Cologna,Adauto Rodrigues Junior,Antonio Antunes Faria,Eliney Ferreira |
author2_role |
author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Nogueira,Lucas Reis,Rodolfo Borges dos Machado,Roberto Dias Tobias-Machado,Marcos Carvalhal,Gustavo Freitas Jr,Celso Magnabosco,Wesley Menezes,Conrado Leonel Corradi,Carlos Reis,Leonardo Oliveira Cologna,Adauto Rodrigues Junior,Antonio Antunes Faria,Eliney Ferreira |
dc.subject.por.fl_str_mv |
Posoperative Complication Survival ASA Score Morbidity Aged Bladder Cancer Neoplasms |
topic |
Posoperative Complication Survival ASA Score Morbidity Aged Bladder Cancer Neoplasms |
description |
PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502013001300009 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502013001300009 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0102-86502013001300009 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia |
publisher.none.fl_str_mv |
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia |
dc.source.none.fl_str_mv |
Acta Cirúrgica Brasileira v.28 suppl.1 2013 reponame:Acta Cirúrgica Brasileira (Online) instname:Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (SBDPC) instacron:SBDPC |
instname_str |
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (SBDPC) |
instacron_str |
SBDPC |
institution |
SBDPC |
reponame_str |
Acta Cirúrgica Brasileira (Online) |
collection |
Acta Cirúrgica Brasileira (Online) |
repository.name.fl_str_mv |
Acta Cirúrgica Brasileira (Online) - Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (SBDPC) |
repository.mail.fl_str_mv |
||sgolden@terra.com.br |
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1752126442183852032 |