Introduction and Objectives
Radical cystectomy is standard therapy for muscle invasive bladder cancer. This kind of surgery can lead to numerous postoperative complications and prolonged hospitalization. Analyses of postoperative complications as well as classification according to Zurich method.
Material and Methods
The research included 82 patients who had been operated at the Urology Clinic. Zurich (Clavien) method has been used for classification of surgical complication, which implicates: GRADE I: any kind of normal postoperative course deviation, without need for pharmacologic therapy, and surgical, endoscopic or radiology intervention (therapeutic measures include prescribing: antiemetics, antipyretics, analgetics, diuretics and electrolytes). GRADE II: pharmacologic therapy which has not been mentioned in grade I (includes blood transfusion and complete parenteral nutrition). GRADE III: surgical, endoscopic or radiology intervention, a) without general anesthesia, b) in general anesthesia. GRADE IV: life endangering complications, a) single-organ dysfunction (including dialysis) b) multi-organ dysfunction. GRADE V: exitus letalis. This classification is based on complication grading according to prescribed therapy.
Results
Postoperative complications were reported with 15 patient (which is 18.29%). In total 23.15% continent bladders have been performed. Five patients had dehiscence of the operative wound, wound infection happened to 3 patients, prolonged lymphorea to 2 of them, dehiscence T-T anastomosis of ileum to one, sigmoid colon-vaginal fistula occurred to one female patient, fistula between ileum and an isolated part of the intestine for urine derivation occurred to one patient, and exitus letalis occurred to two patients. In the group of patients who suffered from complications (n = 15), incidence according to Zurich classification is: grade I 33.33%; grade IIIb 53.33; grade V 13.33%. Since Grade II complication implicate prescribing blood, transfusion usage was observed in each patient, derivation type, and sex. Results were recorded as: 2.19 blood units (n = 82) was used per patient; in total 62.13% male and 67.25% female patient. The average blood units number for continent derivations was 3.81 units and 3.5 units per patient with incontinent derivations.
Conclusions
Operative technique improvement has reduced frequency of postoperative complications, number of needed transfusions, as well as length of postoperative course. Blood usage is enhanced in the cases of continent urine derivations, which can be explained by more demanding and longer operative procedure.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
