title: Long-term third-party assessment of results after continent cutaneous diversion with Lundiana pouch.
abstract: To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch.
  
  
  
  Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files.
  
  
  
  A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one re-operation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000-2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/188 patients (91%). In all, 16% of all patients required revisional surgery of the outlet to remain continent with an easily catheterisable pouch or to address stomal stenosis. The mean decrease in estimated glomerular filtration rate was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 mL/min/1.73 m2; P < 0.006). A disinterested third-party assessment revealed 10 postoperative complications, 17 re-operations during follow-up, and seven occasions of hospitalisation due to pyelonephritis (included in data above) not recorded at the primary data review.
  
  
  
  The Lundiana pouch is associated with a high risk of re-operation, although the functional results are good. Independent review by a third party increased the validity of the outcome data.
authors.affiliation: Department of Urology, Skåne University Hospital and Department of Translational Medicine, Lund University, Malmö, Sweden.
authors.forename: Fredrik
authors.identifier: 0000-0001-8193-0370
authors.initials: F
authors.lastname: Liedberg
authors.affiliation: Department of Urology, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Gudjonsson
authors.affiliation: Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Abai
authors.initials: A
authors.lastname: Xu
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden.
authors.forename: Pär-Ola
authors.initials: PO
authors.lastname: Bendahl
authors.affiliation: Department of Urology, Haukeland Sykehus, Bergen, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidsson
authors.affiliation: Department of Urology, Skåne University Hospital and Department of Translational Medicine, Lund University, Malmö, Sweden.
authors.forename: Wiking
authors.initials: W
authors.lastname: Månsson
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000517:prevention & control; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects*
keywords: Lundiana pouch; complications; continent cutaneous diversion; functional outcome; re-operation; urinary diversion