2018

VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY

followup imaging strategy, citing the benefits of decreased cost and reduced radiation exposure. A unique emphasis here is the use of ultrasound in the followup of grade IV injuries with collecting system involvement to assess for urinoma formation. Allen F. Morey, MD

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology Re: Cystectomy with Urinary Diversion for Benign Disease: Indications and Outcomes D. J. Osborn, R. R. Dmochowski, M. R. Kaufman, D. F. Milam, S. Mock and W. S. Reynolds Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee Urology 2014; 83: 1433e1437.

Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.075 available at http://jurology.com/ Editorial Comment: According to the authors, the most common benign conditions for which patients undergo cystectomy and urinary diversion are neurogenic bladder, radiation damage, interstitial cystitis and severe urinary incontinence. The authors analyzed a series of 139 consecutive patients undergoing cystectomy specifically with reference to the occurrence of complications graded by the Clavien-Dindo scale, specifically grade 2 or greater. Three methods of cystectomy are described, ie complete cystoprostatectomy (only males), simple cystectomy (actually subtrigonal cystectomydbladder neck left intact) and supratrigonal cystectomy (self-explanatory). Of the patients 57% experienced a grade 2 or higher complication. Median length of hospital stay was 7 days (range 3 to 74). Looking at a large number of variables ranging from age adjusted preoperative Charlson comorbidity index (average 4.6) to the type of cystectomy or diversion, and including estimated blood loss and surgery duration, only duration of surgery in 10-minute increments was statistically associated with an increased incidence of such complications. However, the odds ratio was only 1.07 (95% CI 1.02e1.12). Exact numbers are not given, but the authors concluded that longer duration surgery was associated with a higher incidence of moderate to serious adverse events, similar to other surgeries. The supratrigonal technique was associated with significantly less blood loss but, interestingly, there was no difference in the rate of moderate or serious complications between those patients who underwent supratrigonal cystectomy and those who did not. The final conclusion was that most patients undergoing cystectomy and urinary diversion for benign disease experienced some complications, the more serious ones being related to length of surgery, but “the vast majority of adverse events did not result in any long-term sequelae.” This particular topic is not one that is frequently reported on, but the authors do cite 5 other studies including patients with benign disease, 1 of which showed a similar rate of complications and 2 of which included only interstitial cystitis patients, showing a lower incidence of complications. Alan J. Wein, MD, PhD (hon)

Re: Cystectomy with urinary diversion for benign disease: indications and outcomes.

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