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

Fredrik Liedberg*, Sigurdur Gudjonsson, Abai Xu, Pär Ola Bendahl, Thomas Davidsson, Wiking Månsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)530-536
Number of pages7
JournalBJU International
Volume120
Issue number4
DOIs
Publication statusPublished - Oct 2017

Bibliographical note

Funding Information:
Figure was previously published and is reproduced with the kind permission of Elsevier Limited, Oxford, UK. This research was supported by grants from the Swedish Cancer Society (CAN 2014/448) and Lund Medical Faculty (ALF).

Publisher Copyright:
© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd

Other keywords

  • complications
  • continent cutaneous diversion
  • functional outcome
  • Lundiana pouch
  • re-operation
  • urinary diversion
  • Þvagfærasjúkdómar
  • Þvagfæri
  • Skurðlækningar
  • Stómaaðgerðir
  • URO12
  • Urinary Reservoirs, Continent
  • Postoperative Complications

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