ICUD-EAU international consultation on bladder cancer 2012: Urinary diversion

Richard E. Hautmann, Hassan Abol-Enein, Thomas Davidsson, Sigurdur Gudjonsson, Stefan H. Hautmann, Henriette V. Holm, Cheryl T. Lee, Frederik Liedberg, Stephan Madersbacher, Murugesan Manoharan, Wiking Mansson, Robert D. Mills, David F. Penson, Eila C. Skinner, Raimund Stein, Urs E. Studer, Joachim W. Thueroff, William H. Turner, Bjoern G. Volkmer, Abai Xu

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.

Original languageEnglish
Pages (from-to)67-80
Number of pages14
JournalEuropean Urology
Volume63
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Urinary Diversion
Urinary Bladder Neoplasms
Cystectomy
Referral and Consultation
Patient Selection
High-Volume Hospitals
Urinary Retention
Postoperative Care
Expert Testimony
Urology
Comorbidity
Patient Care
Urinary Bladder
Language
Quality of Life
Urine
Morbidity
Kidney
Skin

Keywords

  • Bladder cancer
  • Conduit
  • Continence
  • Cutaneous diversion
  • Functional results
  • Neobladder
  • Orthotopic bladder substitute
  • Outcomes
  • Radical cystectomy
  • Ureterosigmoidostomy

ASJC Scopus subject areas

  • Urology

Cite this

Hautmann, R. E., Abol-Enein, H., Davidsson, T., Gudjonsson, S., Hautmann, S. H., Holm, H. V., ... Xu, A. (2013). ICUD-EAU international consultation on bladder cancer 2012: Urinary diversion. European Urology, 63(1), 67-80. https://doi.org/10.1016/j.eururo.2012.08.050

ICUD-EAU international consultation on bladder cancer 2012 : Urinary diversion. / Hautmann, Richard E.; Abol-Enein, Hassan; Davidsson, Thomas; Gudjonsson, Sigurdur; Hautmann, Stefan H.; Holm, Henriette V.; Lee, Cheryl T.; Liedberg, Frederik; Madersbacher, Stephan; Manoharan, Murugesan; Mansson, Wiking; Mills, Robert D.; Penson, David F.; Skinner, Eila C.; Stein, Raimund; Studer, Urs E.; Thueroff, Joachim W.; Turner, William H.; Volkmer, Bjoern G.; Xu, Abai.

In: European Urology, Vol. 63, No. 1, 01.01.2013, p. 67-80.

Research output: Contribution to journalArticle

Hautmann, RE, Abol-Enein, H, Davidsson, T, Gudjonsson, S, Hautmann, SH, Holm, HV, Lee, CT, Liedberg, F, Madersbacher, S, Manoharan, M, Mansson, W, Mills, RD, Penson, DF, Skinner, EC, Stein, R, Studer, UE, Thueroff, JW, Turner, WH, Volkmer, BG & Xu, A 2013, 'ICUD-EAU international consultation on bladder cancer 2012: Urinary diversion', European Urology, vol. 63, no. 1, pp. 67-80. https://doi.org/10.1016/j.eururo.2012.08.050
Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV et al. ICUD-EAU international consultation on bladder cancer 2012: Urinary diversion. European Urology. 2013 Jan 1;63(1):67-80. https://doi.org/10.1016/j.eururo.2012.08.050
Hautmann, Richard E. ; Abol-Enein, Hassan ; Davidsson, Thomas ; Gudjonsson, Sigurdur ; Hautmann, Stefan H. ; Holm, Henriette V. ; Lee, Cheryl T. ; Liedberg, Frederik ; Madersbacher, Stephan ; Manoharan, Murugesan ; Mansson, Wiking ; Mills, Robert D. ; Penson, David F. ; Skinner, Eila C. ; Stein, Raimund ; Studer, Urs E. ; Thueroff, Joachim W. ; Turner, William H. ; Volkmer, Bjoern G. ; Xu, Abai. / ICUD-EAU international consultation on bladder cancer 2012 : Urinary diversion. In: European Urology. 2013 ; Vol. 63, No. 1. pp. 67-80.
@article{1d362ba009274fe0895c2228915c2452,
title = "ICUD-EAU international consultation on bladder cancer 2012: Urinary diversion",
abstract = "Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90{\%} and 60-80{\%}, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7{\%} to 50{\%}. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.",
keywords = "Bladder cancer, Conduit, Continence, Cutaneous diversion, Functional results, Neobladder, Orthotopic bladder substitute, Outcomes, Radical cystectomy, Ureterosigmoidostomy",
author = "Hautmann, {Richard E.} and Hassan Abol-Enein and Thomas Davidsson and Sigurdur Gudjonsson and Hautmann, {Stefan H.} and Holm, {Henriette V.} and Lee, {Cheryl T.} and Frederik Liedberg and Stephan Madersbacher and Murugesan Manoharan and Wiking Mansson and Mills, {Robert D.} and Penson, {David F.} and Skinner, {Eila C.} and Raimund Stein and Studer, {Urs E.} and Thueroff, {Joachim W.} and Turner, {William H.} and Volkmer, {Bjoern G.} and Abai Xu",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.eururo.2012.08.050",
language = "English",
volume = "63",
pages = "67--80",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - ICUD-EAU international consultation on bladder cancer 2012

T2 - Urinary diversion

AU - Hautmann, Richard E.

AU - Abol-Enein, Hassan

AU - Davidsson, Thomas

AU - Gudjonsson, Sigurdur

AU - Hautmann, Stefan H.

AU - Holm, Henriette V.

AU - Lee, Cheryl T.

AU - Liedberg, Frederik

AU - Madersbacher, Stephan

AU - Manoharan, Murugesan

AU - Mansson, Wiking

AU - Mills, Robert D.

AU - Penson, David F.

AU - Skinner, Eila C.

AU - Stein, Raimund

AU - Studer, Urs E.

AU - Thueroff, Joachim W.

AU - Turner, William H.

AU - Volkmer, Bjoern G.

AU - Xu, Abai

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.

AB - Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.

KW - Bladder cancer

KW - Conduit

KW - Continence

KW - Cutaneous diversion

KW - Functional results

KW - Neobladder

KW - Orthotopic bladder substitute

KW - Outcomes

KW - Radical cystectomy

KW - Ureterosigmoidostomy

UR - http://www.scopus.com/inward/record.url?scp=84870558592&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870558592&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2012.08.050

DO - 10.1016/j.eururo.2012.08.050

M3 - Article

C2 - 22995974

AN - SCOPUS:84870558592

VL - 63

SP - 67

EP - 80

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 1

ER -