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Clinical aspects of cystectomy and urinary diversion
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-4615-5238
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore different aspects of treatment of advanced urinary bladder cancer with radical cystectomy, pelvic lymph node dissection, and urinary diversion. Surgery that carry a high risk of complications as well as mortality. Aside from complications and risk of recurrance, patients have to cope with lifelong postoperative changes of body function, including sexual function, and body image, all affecting quality of life (QoL). The thesis comprises four papers. In the first paper, we compared functional outcome and QoL following two types of ileal orthotopic neobladder substitution. The results suggest that the S-shaped substitute entails better functional results than the U-shaped substitute, with better continence, especially at night. There was no difference in QoL. The second paper reports results from the first year of registration in the nation-wide Swedish Cystectomy Register. Analysis of risk factors for complications showed that high age and prolonged operation are associated with increased risk of short-term complications. The third paper investigated whether preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) affects the risk of shortterm complications after radical cystectomy, using data from the Cystectomy Register covering 1340 patients of whom 39 percent received preoperativevchemotherapy. We found no such increase in risk. In the fourth paper, we analysed the results of a validation study of the Cystectomy Register. The validation showed 17 percent more low grade complications, three percent more high grade complications, and five percent more readmissions, within 90 days of surgery. Hence, a third-party validation may improve the validity of the register

Place, publisher, year, edition, pages
Örebro: Örebro University , 2019. , p. 91
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 190
Keywords [en]
Bladder cancer, urinary diversion, orthotopic neobladder substitution, postoperative complications, neoadjuvant chemotherapy, induction chemotherapy
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-72379ISBN: 978-91-7529-275-5 (print)OAI: oai:DiVA.org:oru-72379DiVA, id: diva2:1287363
Public defence
2019-04-26, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-04-10Bibliographically approved
List of papers
1. Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
Open this publication in new window or tab >>Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
2010 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

Place, publisher, year, edition, pages
Taylor & Francis, 2010
Keywords
Functional outcome, neobladder, orthotopic bladder substitution, quality of life, urinary leakage
National Category
Urology and Nephrology Nursing
Research subject
Medicine; Nursing Science
Identifiers
urn:nbn:se:oru:diva-35176 (URN)10.3109/00365591003727577 (DOI)000282143600001 ()20367221 (PubMedID)2-s2.0-77955538348 (Scopus ID)
Available from: 2014-05-27 Created: 2014-05-27 Last updated: 2019-04-09Bibliographically approved
2. Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
Open this publication in new window or tab >>Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
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2014 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed) Published
Abstract [en]

Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
Bladder carcinoma, complications, radical cystectomy
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-56495 (URN)10.3109/21681805.2014.909883 (DOI)000340072700001 ()24844275 (PubMedID)2-s2.0-84904320467 (Scopus ID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2019-04-01Bibliographically approved
3. No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
Open this publication in new window or tab >>No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73417 (URN)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
4. Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
Open this publication in new window or tab >>Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73418 (URN)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved

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Jerlström, Tomas

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