Long-term third-party assessment of results after continent cutaneous diversion with Lundiana pouch

Research output: Contribution to journalArticle

Abstract

Objectives: To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Patients and Methods: 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. Results: 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. Conclusions: 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.

Details

Authors
Organisations
External organisations
  • Skåne University Hospital
  • National University Hospital of Iceland
  • Haukeland University Hospital
  • Guangzhou Medical University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery
  • Urology and Nephrology

Keywords

  • Complications, Continent cutaneous diversion, Functional outcome, Lundiana pouch, Re-operation, Urinary diversion
Original languageEnglish
Pages (from-to)530-536
JournalBJU International
Volume120
Issue number4
Early online date2017
Publication statusPublished - 2017
Publication categoryResearch
Peer-reviewedYes