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Type: Artigo de periódico
Title: Cutaneous Ureterostomy With Definitive Ureteral Stent As Urinary Diversion Option In Unfit Patients After Radical Cystectomy [ureterostomia Cutânea Como Opção De Derivação Urinária Em Pacientes Em Condições Clínicas Após Cistectomia Radical]
Author: Nogueira L.
Dos Reis R.B.
Machado R.D.
Tobias-Machado M.
Carvalha G.
Freitas Jr. C.
Magnabosco W.
Leonel Menezes C.
Corradi C.
Reis L.O.
Cologna A.
Rodrigues A.A.
Faria E.F.
Abstract: 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.
Rights: aberto
Identifier DOI: 10.1590/S0102-86502013001300009
Date Issue: 2013
Appears in Collections:Unicamp - Artigos e Outros Documentos

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