Adult urologyUrinary diversion in high-risk elderly patients: Modified cutaneous ureterostomy or ileal conduit?
Section snippets
Material and methods
Between 1993 and 2002, 481 patients with bladder cancer underwent radical cystectomy and urinary diversion at our institution by the same group of surgeons (C.D. and A.S.). Muscle-invasive disease (clinical Stage T2 or worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for radical cystectomy. The TNM classification system was used for staging. 15 All candidates, even in an emergency case, were assessed preoperatively in
Results
No statistically significant difference was found between the two groups regarding the definitive pathologic tumor stage (Table I). The mean follow-up for both groups was 5.7 years (range 1.1 to 10.2). Both groups had patients with similar comorbidities. Cardiovascular disorders were the most common comorbidity (16 patients in group 1 and 13 patients in group 2, P = 1.000), followed by chronic obstructive airway disease (9 and 5 patients, respectively; P = 0.535), diabetes mellitus (6 patients
Comment
Radical cystectomy is considered a definite treatment of invasive bladder cancer. 2, 4 Owing to progress in surgical technique, anesthesia, and intensive care monitoring, it has been applied successfully in elderly patients, achieving mortality and morbidity rates similar to those reported in younger patients. 2, 7, 9 The indications for cystectomy and the selection of urinary reconstruction are not dependent on the patient’s age, provided that rigorous preoperative assessment and anesthetic
Conclusions
We suggest that in high-risk elderly patients with invasive bladder cancer, urologists should consider the performance of a modified cutaneous ureterostomy more frequently.
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