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Evaluating the Timing of Surgical Complications after Cystectomy
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Scientific Forum: 2016 Clinical Congress
CONCLUSIONS: CT volumetric error of <20% is considered acceptable in other areas of radiology, thus we demonstrated comparable results using the automated stone volume as measured on RD-NCCT compared to SD-NCCT. In the future we hope this provides a more accurate method of following stones with significantly lower radiation. Evaluating the Timing of Surgical Complications after Cystectomy Troy Sukhu, MD, Jason Lomboy, MD, Matthew Macey, MD, Allison Deal, Eric M Wallen, MD, FACS, Michael E Woods, MD, FACS, Raj S Pruthi, MD, FACS, Angela B Smith, MD, FACS University of North Carolina, Chapel Hill, NC INTRODUCTION: While complication rates after cystectomy are well-described, the timing with which each occurs is unclear. Our objective was to evaluate the median time-to-event for common 30-day postoperative complications after cystectomy to better define early and late complications. METHODS: Using the American College of Surgeons-NSQIP database, we performed a retrospective review of patients undergoing cystectomy from 2005-2013. We investigated 19 common complications occurring after cystectomy and assessed days from operation to complication to better define early (0-15 days) and late complications (16-30 days).
J Am Coll Surg
INTRODUCTION: We have studied 2 groups of patients, 1 with urethral stricture and the other with urethral injury confirmed on retrograde urethrography. In both we tried perurethral catheterization (PUC) over guide wire instead of suprapubic catheterization (SPC) because SPC is more invasive. We sought to find out if SPC can be avoided in the patients with urethral trauma and urethral stricture by passing PUC over guidewire. METHODS: A total of 50 patients (ie 17 with acute urinary retention due to urethral trauma and 33 with urethral stricture) were included in the study. Six (35.3%) patients of urethral trauma were managed by placing PUC over guidewire, 11 (64.7%) patients failed PUC over a guidewire attempt and managed with SPC. Among stricture patients, 30 (90.9%) patients were managed by placing PUC over a guide wire after dilation of urethra, 3 (9.1%) patients failed PUC over a guidewire were managed with SPC. RESULTS: Bulbar urethra 17 (51.5%) was the most common site of stricture in our study, followed by peno-bulbar 9 (27.3%), bulbomembranous 6 (18.3%), and pan anterior 1 (3%). In the PUC group, 18 (50%) patients complained of some pain/discomfort while in the SPC group, 11 (78.6%) patients complained of some pain/discomfort. Eighteen (50%) patients of the PUC group had a positive urine culture while in the SPC group 4 (28.5%) patients had a positive urine culture (Table). Table.
RESULTS: Overall, 4,121 patients underwent cystectomy with 70% undergoing an incontinent diversion, 16% continent diversion, and 15% unspecified. 56.7% of patients experienced a complication within 30 days, with 22% of patients experiencing 2 or more complications. Of patients who had at least 1 complication, most (91%) had their first within 15 days. Complications such as infection (wound, urinary, sepsis) were most likely to occur between 10-14 days post-procedure. Similarly, postoperative DVT and embolism were likely to occur between 13-14 days post-procedure. Cardiovascular, pulmonary, and neurologic complications occurred a median of 3-8 days following cystectomy.
Parameters Total patients Pain Anxiety/depression Positive urine culture Proteus u/c E. Coli u/c Mobility problem Complication as dislodgement of catheter, leakage discharge, blockage, hematuria, etc
CONCLUSIONS: The majority of 30-day complications after cystectomy occur within the first 15 days, with cardiovascular, pulmonary, and neurologic complications occurring early while wound and thrombosis-related complications occur several weeks later. Knowledge regarding timing of postoperative complications may better inform quality improvement measures for postoperative follow-up.
NS, not significant * Statistical significance was analyzed by student t-test. + Statistical significance was analyzed by the chi-square test.
A Prospective Study of Periuretheral Catheterisation Over a Guidewire in the Cases of Acute Urinary Retention Due to Uretheral Strictures and Uretheral Trauma: Can Suprapubic Catheterization be Avoided? Kumar Jayant, MBBS, Sandeep Kumar, Santosh Kumar, Shrawan Kumar Singh Postgaduate Institute of Medical Education and Research, Chandigarh, India
PUC over guidewire 36 18 (50%) 1 (2.8%) 18 (50%) 10 2 0 31
14 11 11 4 2 5 1 59
SPC
p Value
(78.6%) (78.6%) (28.5%)
NS .006+ NS
(2.8%)
NS .04*
CONCLUSIONS: PUC placement over a guidewire in urethral trauma cases avoids SPC and its complications and was shown to prevent complete obliteration of urethra and open urethroplasty. The urethral strictures that developed in these cases were passable and were managed with OIU or without any treatment. Preliminary in Vitro Comparison of Fixed and Variable Pulse Laser: Evidence for Decreased Retropulsion and Shortened Fragmentation Time John R Bell, MD, Kristina L Penniston, PhD, Sara L Best, MD, Stephen Y Nakada, MD, FACS University of Wisconsin at Madison, Madison, WI
Scientific Forum: 2016 Clinical Congress
CONCLUSIONS: CT volumetric error of <20% is considered acceptable in other areas of radiology, thus we demonstrated comparable results using the automated stone volume as measured on RD-NCCT compared to SD-NCCT. In the future we hope this provides a more accurate method of following stones with significantly lower radiation. Evaluating the Timing of Surgical Complications after Cystectomy Troy Sukhu, MD, Jason Lomboy, MD, Matthew Macey, MD, Allison Deal, Eric M Wallen, MD, FACS, Michael E Woods, MD, FACS, Raj S Pruthi, MD, FACS, Angela B Smith, MD, FACS University of North Carolina, Chapel Hill, NC INTRODUCTION: While complication rates after cystectomy are well-described, the timing with which each occurs is unclear. Our objective was to evaluate the median time-to-event for common 30-day postoperative complications after cystectomy to better define early and late complications. METHODS: Using the American College of Surgeons-NSQIP database, we performed a retrospective review of patients undergoing cystectomy from 2005-2013. We investigated 19 common complications occurring after cystectomy and assessed days from operation to complication to better define early (0-15 days) and late complications (16-30 days).
J Am Coll Surg
INTRODUCTION: We have studied 2 groups of patients, 1 with urethral stricture and the other with urethral injury confirmed on retrograde urethrography. In both we tried perurethral catheterization (PUC) over guide wire instead of suprapubic catheterization (SPC) because SPC is more invasive. We sought to find out if SPC can be avoided in the patients with urethral trauma and urethral stricture by passing PUC over guidewire. METHODS: A total of 50 patients (ie 17 with acute urinary retention due to urethral trauma and 33 with urethral stricture) were included in the study. Six (35.3%) patients of urethral trauma were managed by placing PUC over guidewire, 11 (64.7%) patients failed PUC over a guidewire attempt and managed with SPC. Among stricture patients, 30 (90.9%) patients were managed by placing PUC over a guide wire after dilation of urethra, 3 (9.1%) patients failed PUC over a guidewire were managed with SPC. RESULTS: Bulbar urethra 17 (51.5%) was the most common site of stricture in our study, followed by peno-bulbar 9 (27.3%), bulbomembranous 6 (18.3%), and pan anterior 1 (3%). In the PUC group, 18 (50%) patients complained of some pain/discomfort while in the SPC group, 11 (78.6%) patients complained of some pain/discomfort. Eighteen (50%) patients of the PUC group had a positive urine culture while in the SPC group 4 (28.5%) patients had a positive urine culture (Table). Table.
RESULTS: Overall, 4,121 patients underwent cystectomy with 70% undergoing an incontinent diversion, 16% continent diversion, and 15% unspecified. 56.7% of patients experienced a complication within 30 days, with 22% of patients experiencing 2 or more complications. Of patients who had at least 1 complication, most (91%) had their first within 15 days. Complications such as infection (wound, urinary, sepsis) were most likely to occur between 10-14 days post-procedure. Similarly, postoperative DVT and embolism were likely to occur between 13-14 days post-procedure. Cardiovascular, pulmonary, and neurologic complications occurred a median of 3-8 days following cystectomy.
Parameters Total patients Pain Anxiety/depression Positive urine culture Proteus u/c E. Coli u/c Mobility problem Complication as dislodgement of catheter, leakage discharge, blockage, hematuria, etc
CONCLUSIONS: The majority of 30-day complications after cystectomy occur within the first 15 days, with cardiovascular, pulmonary, and neurologic complications occurring early while wound and thrombosis-related complications occur several weeks later. Knowledge regarding timing of postoperative complications may better inform quality improvement measures for postoperative follow-up.
NS, not significant * Statistical significance was analyzed by student t-test. + Statistical significance was analyzed by the chi-square test.
A Prospective Study of Periuretheral Catheterisation Over a Guidewire in the Cases of Acute Urinary Retention Due to Uretheral Strictures and Uretheral Trauma: Can Suprapubic Catheterization be Avoided? Kumar Jayant, MBBS, Sandeep Kumar, Santosh Kumar, Shrawan Kumar Singh Postgaduate Institute of Medical Education and Research, Chandigarh, India
PUC over guidewire 36 18 (50%) 1 (2.8%) 18 (50%) 10 2 0 31
14 11 11 4 2 5 1 59
SPC
p Value
(78.6%) (78.6%) (28.5%)
NS .006+ NS
(2.8%)
NS .04*
CONCLUSIONS: PUC placement over a guidewire in urethral trauma cases avoids SPC and its complications and was shown to prevent complete obliteration of urethra and open urethroplasty. The urethral strictures that developed in these cases were passable and were managed with OIU or without any treatment. Preliminary in Vitro Comparison of Fixed and Variable Pulse Laser: Evidence for Decreased Retropulsion and Shortened Fragmentation Time John R Bell, MD, Kristina L Penniston, PhD, Sara L Best, MD, Stephen Y Nakada, MD, FACS University of Wisconsin at Madison, Madison, WI