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Long-term third-party assessment of results after continent cutaneous diversion with Lundiana pouch

Liedberg, Fredrik LU ; Gudjonsson, Sigurdur LU ; Xu, Abai; Bendahl, Pär Ola LU ; Davidsson, Thomas LU and Månsson, Wiking LU (2017) In BJU International1999-01-01+01:00 120(4). p.530-536
Abstract

Objectives: To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Patients and Methods: Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files. Results: A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during... (More)

Objectives: To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Patients and Methods: Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files. Results: A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000-2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/188 patients (91%). In all, 16% of all patients required revisional surgery of the outlet to remain continent with an easily catheterisable pouch or to address stomal stenosis. The mean decrease in estimated glomerular filtration rate was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 mL/min/1.73 m2; P < 0.006). A disinterested third-party assessment revealed 10 postoperative complications, 17 re-operations during follow-up, and seven occasions of hospitalisation due to pyelonephritis (included in data above) not recorded at the primary data review. Conclusions: The Lundiana pouch is associated with a high risk of re-operation, although the functional results are good. Independent review by a third party increased the validity of the outcome data.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Complications, Continent cutaneous diversion, Functional outcome, Lundiana pouch, Re-operation, Urinary diversion
in
BJU International1999-01-01+01:00
volume
120
issue
4
pages
530 - 536
publisher
Blackwell Science Ltd
external identifiers
  • scopus:85018592053
  • wos:000411330700015
ISSN
1464-4096
DOI
10.1111/bju.13863
language
English
LU publication?
yes
id
2cacf118-7565-4e9f-9d29-0e296672de11
date added to LUP
2017-06-01 10:25:23
date last changed
2018-01-16 13:19:57
@article{2cacf118-7565-4e9f-9d29-0e296672de11,
  abstract     = {<p>Objectives: To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Patients and Methods: Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files. Results: A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000-2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/188 patients (91%). In all, 16% of all patients required revisional surgery of the outlet to remain continent with an easily catheterisable pouch or to address stomal stenosis. The mean decrease in estimated glomerular filtration rate was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 mL/min/1.73 m<sup>2</sup>; P &lt; 0.006). A disinterested third-party assessment revealed 10 postoperative complications, 17 re-operations during follow-up, and seven occasions of hospitalisation due to pyelonephritis (included in data above) not recorded at the primary data review. Conclusions: The Lundiana pouch is associated with a high risk of re-operation, although the functional results are good. Independent review by a third party increased the validity of the outcome data.</p>},
  author       = {Liedberg, Fredrik and Gudjonsson, Sigurdur and Xu, Abai and Bendahl, Pär Ola and Davidsson, Thomas and Månsson, Wiking},
  issn         = {1464-4096},
  keyword      = {Complications,Continent cutaneous diversion,Functional outcome,Lundiana pouch,Re-operation,Urinary diversion},
  language     = {eng},
  number       = {4},
  pages        = {530--536},
  publisher    = {Blackwell Science Ltd},
  series       = {BJU International1999-01-01+01:00},
  title        = {Long-term third-party assessment of results after continent cutaneous diversion with Lundiana pouch},
  url          = {http://dx.doi.org/10.1111/bju.13863},
  volume       = {120},
  year         = {2017},
}