Articles

Prevention and Management of Complications Following Radical Cystectomy for Bladder Cancer

By: Nathan Lawrentschuka lowast , Renzo Colombob, Oliver W. Hakenbergc, Seth P. Lernerd, Wiking Månssone, Arthur Sagalowskyf and Manfred P. Wirthg

Published online: 01 June 2010

Keywords: Bladder carcinoma, Cystectomy, Adverse effects, Urology, Surgery, Review

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Abstract

Context

This review focuses on the prevention and management of complications following radical cystectomy (RC) for bladder cancer (BCa).

Objective

We review the current literature and perform an analysis of the frequency, treatment, and prevention of complications related to RC for BCa.

Evidence acquisition

A Medline search was conducted to identify original articles, reviews, and editorials addressing the relationship between RC and short- and long-term complications. Series examined were published within the past decade. Large series reported on multiple occasions (Lee [1], Meyer [2], and Chang and Cookson [3]) with the same cohorts are recorded only once. Quality of life (QoL) and sexual function were excluded.

Evidence synthesis

The literature regarding prophylaxis, prevention, and treatment of complications of RC in general is retrospective, not standardised. In general, it is of poor quality when it comes to evidence and is thus difficult to synthesise.

Conclusions

Progress has been made in reducing mortality and preventing complications of RC. Postoperative morbidity remains high, partly because of the complexity of the procedures. The issues of surgical volume and standardised prospective reporting of RC morbidity to create evidence-based guidelines are essential for further reducing morbidity and improving patients’ QoL.

Take Home Message

Despite progress in reducing mortality and preventing complications of radical cystectomy (RC), postoperative morbidity remains high, in part because of the complexity of the procedures. However, the issues of surgical volume and the standardised prospective reporting of RC morbidity to create evidence-based guidelines are essential to further reducing morbidity and improving patients’ quality of life.

Keywords: Bladder carcinoma, Cystectomy, Adverse effects, Urology, Surgery, Review.

Footnotes

a Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada

b Department of Urology, University “Vita-Salute” - San Raffaele Hospital, Milan, Italy

c Department of Urology, Rostock University, Rostock, Germany

d Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA

e Department of Urology, Skåne University Hospital, Lund, Sweden

f Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

g Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

lowast Corresponding author. University of Toronto, Surgical Oncology, 610 University Ave, Ste 3-130, Princess Margaret Hospital, Toronto, M5G2M9 Canada.