Radikal sistektomi sonrasi erken üriner kaçaǧa yaklaşim

Introduction: Invasive transitional cell carcinoma of the bladder is often treated by radical cystectomy and urinary diversion. With the routine use of soft silastic stents, the rate of urinary leakage is reported to be 2% to 8.3%. And thus the aim of this study is to evaluate our clinical approach to urinary leakage occurring in the early postoperative period in patients with radical cystectomy and urinary diversion. This article formulates a treatment outline emphasizing an initial conservative approach that offers optimal management of urinary leakage after urinary diversion. Materials and methods: Hospital records of a total of 212 patients who underwent radical cystectomy and urinary diversion between January 1998 and May 2004 were retrospectively reviewed. We specifically focused on the patients with urinary leakage in the early post-operative period (within the first 30 days after the operation). The patients with urinary leakage were evaluated in two groups as patients with open surgical intervention (group 1) and patients followed-up conservatively with placement of bilateral nephrostomy tubes (group 2). Both groups were evaluated in terms of clinical parameters such as mortality (any death within the first 30 days or before discharge home), morbidity and duration of hospitalization. Treatment of complications related to urinary leakage after urinary diversion in the early post-operative period was defined as conservative (including percutaneous intervention), or requiring open surgical reoperation or abdominal exploration. Results: Urinary leakage in the early post-operative period occurred in 17 (8.9%) of the patients. 10 patients with ileal conduit (58.8%), 6 patients with ureterosigmoidostomy (35.3%) and 1 patient with orthotopic bladder (5.88%) had urinary leakage. Five patients (%29.4) underwent early open surgical intervention without any change in the urinary diversion type. The remaining 12 patients were followed-up with bilateral nephrostomy tubes. 3 patients in surgically treated group were lost because of intraabdominal sepsis due to intestinal leakage to abdominal cavity. Mortality rate in group 1 was 60% (3), while no patients was lost in group 2.3 patients (25%) in group 2 had urosepsis managed without any significant morbidity. Hospital stay was significantly higher in group 1 compared to group 2. Conclusion: Most often the management of patients with urinary leakage after urinary diversion is conservative, involving adequate drainage and placement of percutaneous nephrostomy tube, continued close suction drainage adequate nutrition, avodiance of sepsis and close monitoring. Despite the placement of nephrostomy tubes, patients with peritoneal irritation findings and urosepsis should be managed surgically.