UROLOGICAL SURVEY

Urological Oncology

Prevention and management of complications following radical cystectomy for bladder cancer

Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP

Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada

Eur. Urol. 2010; 57: 983-1001

Context: This review focuses on the prevention and management of complications following radical cystectomy (RC) for bladder cancer (BCa). OBJECTIVE: We review the current literature and perform an analysis of the frequency, treatment, and prevention of complications related to RC for BCa.

Evidence acquisition: A Medline search was conducted to identify original articles, reviews, and editorials addressing the relationship between RC and short- and long-term complications. Series examined were published within the past decade. Large series reported on multiple occasions (Lee [1], Meyer [2], and Chang and Cookson [3]) with the same cohorts are recorded only once. Quality of life (QoL) and sexual function were excluded.

Evidence Synthesis: The literature regarding prophylaxis, prevention, and treatment of complications of RC in general is retrospective, not standardised. In general, it is of poor quality when it comes to evidence and is thus difficult to synthesise.

Conclusions: Progress has been made in reducing mortality and preventing complications of RC. Postoperative morbidity remains high, partly because of the complexity of the procedures. The issues of surgical volume and standardised prospective reporting of RC morbidity to create evidence-based guidelines are essential for further reducing morbidity and improving patients’ QoL.

Editorial Comment

Radical cystectomy (RC) is the treatment of choice for muscle-invasive bladder cancer. RC is a major procedure with an inherent rate of complications and morbidity. This collaborative multi-institutional international review of the literature on prevention and management of complication is recommended reading not only for surgeons involved in such operations but also for urologists in training. Many aspects are covered in detail and reflect the large experience of the authors and their institutions, e.g. fast-track surgery, bowel preparation, perioperative and postoperative complications. Recommendations for prevention and treatment of typical situations are given such as blood loss, urinary extravasation, pneumonia, ileus, lymphocele, metabolic disorders. In summary, it evolves that radical cystectomy is a procedure for experienced urologists only which should be performed in high-volume centers. Many factors before, during and after the operation have to be considered to provide good outcomes for our patients.

Dr. Andreas Bohle

Professor of Urology

HELIOS Agnes Karll Hospital

Bad Schwartau, Germany

E-mail: boehle@urologie-bad-schwartau.de

Publication Dates