Continent urinary diversion using a Modified Indiana Pouch in elderly patients.
A total of 25 patients at least 75 years old underwent continent urinary diversion via a modified Indiana Pouch during a 68-month period, 21 of these with simultaneous radical cystectomy or anterior exenteration. The preoperative medical conditions as well as the early and late operative morbidity and mortality are reviewed with a mean follow up of 27 months. Average age of patients was 78.5 years, and the mean age of survivors is 81 years. There were two early mortalities attributed to ileal gangrene with secondary sepsis and aspiration pneumonia. Postoperative complications (superficial wound infection, middle colic vein bleed, right ureteral leak, ileus) occurred in five patients, two of whom required re-operation. Mean hospital stay was 12.4 days and ranged from 9-20. There were only six late complications [ureteral stricture (3), small bowel obstruction (1), incontinence (1)] necessitating re-hospitalization and surgical intervention. Late infectious complications included recurrent urinary tract infections (3), pyelonephritis (2), and C. Difficile enterocolitis (2) all managed medically. In addition, 10 other patients have died, 9 from metastatic disease and 1 from intercurrent medical problems. Of the 13 remaining patients, 11 are disease free and all are continent with a mean follow-up time of 33 months. We conclude that continent urinary diversion via a modified Indiana pouch with radical cystectomy or anterior exenteration can be performed with minimal morbidity or mortality, even in an elderly population.
Navon
J D
JD
University of California Irvine Medical Center, Orange.
Weinberg
A C
AC
Ahlering
T E
TE
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D015996:Survival Rate; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects / Q000379:methods* / Q000401:mortality