Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy

Abstract

Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.