Mitchell R Bassett1, Yahir Santiago-Lastra2, John T Stoffel2, Robert Goldfarb3, Sean P Elliott3, Scott C Pate4, Joshua A Broghammer4, Thomas Gaither5, Benjamin N Breyer5, Alex J Vanni6, Bryan B Voelzke7, Bradley A Erickson8, Christopher D McClung9, Angela P Presson10, Jonathan D Tward11, Jeremy B Myers12. 1. Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah. Electronic address: mitchell.bassett@hsc.utah.edu. 2. Department of Urology, University of Michigan, Ann Arbor, Michigan. 3. Department of Urology, University of Minnesota, Minneapolis, Minnesota. 4. Department of Urology, University of Kansas, Kansas City, Kansas. 5. Department of Urology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California. 6. Department of Urology, Lahey Clinic and Medical Center, Burlington, Massachusetts. 7. Department of Urology, University of Washington, Seattle, Washington. 8. Department of Urology, University of Iowa, Iowa City, Iowa. 9. Department of Urology, University of Ohio, Columbus, Ohio. 10. Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah. 11. Department of Radiation Oncology and the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. 12. Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah.
Abstract
PURPOSE: We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion. MATERIALS AND METHODS: We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center. RESULTS: Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months. CONCLUSIONS: Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.
PURPOSE: We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion. MATERIALS AND METHODS: We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center. RESULTS: Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obesemen (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months. CONCLUSIONS: Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.
Authors: Alaina Garbens; Christopher J D Wallis; Rano Matta; Ronald Kodama; Sender Herschorn; Steven Narod; Robert K Nam Journal: Can Urol Assoc J Date: 2018-12-03 Impact factor: 1.862
Authors: Jeremy B Myers; Christopher Martin; Philip J Cheng; Chong Zhang; Angela P Presson Journal: Neurourol Urodyn Date: 2019-03-22 Impact factor: 2.696