Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study
| Autor: | Yahir Santiago-Lastra, Bryan B. Voelzke, Christopher McClung, Jonathan D. Tward, Jeremy B. Myers, Scott C. Pate, John T. Stoffel, Joshua A. Broghammer, Benjamin N. Breyer, Angela P. Presson, Sean P. Elliott, Robert Goldfarb, Thomas W. Gaither, Alex J. Vanni, Mitchell Bassett, Bradley A. Erickson |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Urology Urinary system medicine.medical_treatment 030232 urology & nephrology Urinary Diversion 03 medical and health sciences Prostate cancer Postoperative Complications 0302 clinical medicine Prostate Humans Medicine External beam radiotherapy Adverse effect Aged Retrospective Studies Aged 80 and over Prostatectomy business.industry Urinary diversion Prostatic Neoplasms Retrospective cohort study Middle Aged Urination Disorders medicine.disease Combined Modality Therapy Radiation therapy Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis business human activities |
| Zdroj: | Journal of Urology. 197:744-750 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2016.10.091 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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