title: Cystectomy and Urinary Diversion for the Management of a Devastated Lower Urinary Tract Following Prostatic Cryotherapy and/or Radiotherapy.
abstract: BACKGROUND
  We investigated the outcomes and quality of life measures in men who underwent cystectomy and urinary diversion for devastating lower urinary tract toxicity after prostatic radiotherapy and/or cryotherapy for the treatment of prostate cancer.
  
  
  METHODS
  Records of patients who underwent cystectomy and urinary diversion for the management of a devastated lower urinary tract following prostatic radiotherapy or cryotherapy were reviewed retrospectively. A postoperative, retrospective quality of life (QOL) survey was designed specific to this patient subset and obtained by telephone interview.
  
  
  RESULTS
  Extirpative surgery with urinary diversion for management of a devastated lower urinary tract was performed on 15 patients with a mean age of 72 years (range 63-82). Toxicities leading to bladder removal included bladder neck contractures, prostatic necrosis, incontinence, osteomyelitis, bladder calculi, fistulae, urethral strictures, abscesses, necrotizing fasciitis, and radiation/hemorrhagic cystitis. The mean number of failed conservative, minimally invasive interventions per patients prior to cystectomy was 3.7 (range 1-12). The average time period from major complication following radiotherapy/cryotherapy to cystectomy was 29.1 months (range 5-65). The QOL survey showed all of the patients who completed the survey (n = 13) would undergo the procedure again and 11 (85%) would have undergone the procedure an average of 13.2 months sooner (range 5-36).
  
  
  CONCLUSIONS
  Toxicities secondary to prostatic radiotherapy or cryotherapy may be debilitating. Our results demonstrate that cystectomy with urinary diversion can improve QOL in patients with a devastated lower urinary tract.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Sack
authors.forename: Peter
authors.initials: P
authors.lastname: Langenstroer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Guralnick
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Jacobsohn
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017679:Cryotherapy / Q000009:adverse effects*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries* / Q000528:radiation effects / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*