title: Urological complications after cystectomy as part of pelvic exenteration are higher than that after cystectomy for primary bladder malignancy.
abstract: BACKGROUND
  Total cystectomy and subsequent reconstruction of the urinary tract may be required for primary malignancy of the bladder, or in the context of multi-visceral resection for more advanced pelvic tumors. Complications following urinary diversion are a major source of morbidity, particularly in pelvic exenteration (PE) patients.
  
  
  METHODS
  All patients who underwent radical cystectomy alone or during PE at a single tertiary referral centre between 2008 and 2014 were reviewed. Postoperative urological complications were collected and compared between groups.
  
  
  RESULTS
  Two hundred and thirty-one patients underwent en bloc cystectomy (98 cystectomy alone, 133 as part of a PE). Postoperative urological complications occurred in 33% of the cystectomy alone group and 59% of the PE group (P < 0.001). PE for recurrence had higher complications than PE for primary malignancy (67% vs. 48%, P = 0.035). Urological leaks occurred in 3%, 6%, and 14% of patient who had cystectomy alone, PE for primary malignancy and PE for recurrence. Major blood loss and previous pelvic radiotherapy independently predicted conduit-associated complications in PE patients (P = 0.002 and 0.035).
  
  
  CONCLUSIONS
  Urological complications of cystectomy, particularly urine leaks and sepsis, are more common in patients undergoing PE compared to those with cystectomy alone. Prior pelvic radiotherapy, the extent of surgical resection and major blood loss may contribute to urological morbidity. J. Surg. Oncol. 2017;115:307-311. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, Australia.|The Institute of Academic Surgery at RPA, Sydney, Australia.
authors.forename: Kilian G M
authors.initials: KG
authors.lastname: Brown
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, Australia.|The Institute of Academic Surgery at RPA, Sydney, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.|University of Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Solomon
authors.affiliation: Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Latif
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, Australia.|The Institute of Academic Surgery at RPA, Sydney, Australia.|Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Cherry E
authors.initials: CE
authors.lastname: Koh
authors.affiliation: Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Arthur
authors.initials: A
authors.lastname: Vasilaras
authors.affiliation: Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Eisinger
authors.affiliation: University of Sydney, New South Wales, Australia.|Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Sved
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014570:Urologic Diseases / Q000209:etiology*
keywords: cystectomy; ileal conduit; pelvic exenteration; urinary diversion; urine leak