title: Cystectomy and urinary diversion as management of treatment-refractory benign disease: the impact of preoperative urological conditions on perioperative outcomes.
abstract: OBJECTIVE
  To investigate perioperative outcomes associated with cystectomy and urinary diversion for treatment-refractory benign urological disease.
  
  
  METHODS
  A cohort of patients who underwent cystectomy for infection, fistula, bleeding, incontinence, neurogenic bladder or pain between January 2004 and June 2012 was established. Data included baseline demographics, indications for cystectomy and prior treatments, and complications at 30 and 90 days. Primary outcome measures were 30-day and 30 to 90-day complications.
  
  
  RESULTS
  The study group comprised eight males and 18 females. The mean age was 57.8 years (95% CI 50.8-64.7). A total of 19 patients (73%) had resolution of their underlying urological pathology at 90 days. A total of 19 patients (73%) experienced a complication in the first 30 days, of which nine (47%) were Clavien grade III or higher. The most common 30-day complications were urinary tract infection (n = 6, 23%) and wound infection (n = 6, 23%). A total of 44% (4/9) of patients with neurogenic bladder experienced a complication within the first 30 days of cystectomy compared with 100% (8/8) of patients with radiation-induced fistula (P = 0.03) and 78% (7/9) of non-neurogenic, non-radiation-induced fistula patients (P = 0.34).
  
  
  CONCLUSIONS
  Cystectomy with urinary diversion for benign disease might be successful, but is associated with a high rate of perioperative complications. Those with radiation-induced fistula are more likely to experience complications, whereas those with neurogenic bladder carry a lower risk. Patients should be counseled appropriately regarding expected postoperative outcomes.
authors.affiliation: Section of Urology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cohn
authors.forename: Michael C
authors.initials: MC
authors.lastname: Large
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
mesh_terms: D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods*; D014548:Urinary Fistula / Q000601:surgery; D014549:Urinary Incontinence / Q000601:surgery; D014552:Urinary Tract Infections / Q000601:surgery; D014570:Urologic Diseases / Q000601:surgery*
keywords: benign disease; complications; cystectomy; fistula; radiation; reconstruction