Annals of Surgical Oncology, 2015, Vol.22(3), p.1032(11)
Byline: Marianne Schmid (1,2), Michael Rink (1), Miriam Traumann (1), Patrick J. Bastian (3), Georg Bartsch (4), Jorg Ellinger (5), Marc-Oliver Grimm (6), Boris Hadaschik (7), Axel Haferkamp (4), Oliver W. Hakenberg (8), Atiqullah Aziz (9), Florian Hartmann (6), Edwin Herrmann (10), Markus Hohenfellner (7), Gunter Janetschek (11), Michael Gierth (9), Sasc ha Pahernik (7), Chris Protzel (8), Jan Roigas (12), Murat Gorduk (12), Lukas Lusuardi (11), Matthias May (13), Quoc-Dien Trinh (2), Margit Fisch (1), Felix K.H. Chun (1) Abstract: Purpose The aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. Materials In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. Results Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3 % received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9 p = 0.002), American Society of Anesthesiologists score a[yen]3 (OR 2.3 p = 0.02), an age-adjusted Charlson Comorbidity Index a[yen]3 (OR 4.1 p 〈 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9 p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p 〈 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. Conclusions Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type. Author Affiliation: (1) Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (2) Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (3) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany (4) Department of Urology, Goethe University, Frankfurt am Main, Germany (5) Department of Urology, University of Bonn, Bonn, Germany (6) Department of Urology, University of Jena, Jena, Germany (7) Department of Urology, University of Heidelberg, Heidelberg, Germany (8) Department of Urology, University of Rostock, Rostock, Germany (9) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (10) Department of Urology, University of Munster, Munster, Germany (11) Department of Urology, Paracelsus Medical University, Salzburg, Austria (12) Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany (13) Department of Urology, St. Elisabeth Medical Center, Straubing, Germany Article History: Registration Date: 09/08/2014 Received Date: 20/04/2014 Online Date: 28/08/2014 Article note: Marianne Schmid and Michael Rink contributed equally to this article. PROMETRICS 2011 Research Group: The PROMETRICS 2011 Research Group: Hans Martin Fritsche, Maximilian Burger, Roman Mayr (Regensburg) Rein-Juri Palisaar, Joachim Noldus, Florian Roghmann (Herne) Christian Bolenz, Thomas Martini, Maurice Stephan Michel (Mannheim) Armin Pycha (Bozen) Christian Seitz (Wien) Manfred Wirth, Vladimir Novotny, Michael Frohner (Dresden) Sabine Brookman-May, Christian G. Stief, Philipp Nuhn, Alexander Buchner (LMU Munchen) Melanie Durschnabel, Florian Wagenlehner, Wolfgang Weidner (Gie[sz]en) Lothar Hertle, Rudolf Moritz (Munster) Bastian Keck, Bernd Wullich (Erlangen) Stefan Vallo (Frankfurt) Nicole Kraischits (Salzburg) Annerose Krausse (Jena) Stefan C. Muller, Isabella Syring, Jorg Ellinger (Bonn).
Medical Research – Health Aspects ; Medical Research – Analysis ; Bladder Cancer – Health Aspects ; Bladder Cancer – Analysis
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