Multi-institutional Outcomes for Simultaneous and Staged Urinary and Fecal Diversions in Patients Without Cancer

To compare the morbidity and postoperative recovery between patients treated with urinary diversion after colostomy with patients undergoing simultaneous double diversion (DD). A multi-institutional retrospective review was performed in patients treated with urinary diversion after colostomy or simu...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2018-08, Vol.118, p.202-207
Main Authors: Barboglio Romo, Paholo G., Santiago-Lastra, Yahir, Myers, Jeremy B., Pathak, Piyush, Elliott, Sean P., Cotter, Katherine J., Stoffel, John T.
Format: Article
Language:English
Subjects:
Colostomy - adverse effects
Colostomy - methods
Female
Humans
Male
Middle Aged
Postoperative Complications - epidemiology
Retrospective Studies
Time Factors
Treatment Outcome
Urinary Diversion - adverse effects
Urinary Diversion - methods
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Summary:To compare the morbidity and postoperative recovery between patients treated with urinary diversion after colostomy with patients undergoing simultaneous double diversion (DD). A multi-institutional retrospective review was performed in patients treated with urinary diversion after colostomy or simultaneous DD between 2007 and 2014 for noncancerous indications. The Clavien-Dindo system was used to classify complications occurring within 90 days of surgery, and high-grade adverse events (HGAE) were classified grade 3 or higher. A total of 46 patients were identified with fecal and urinary diversions (19 in the after colostomy (AC) group, 27 in the DD group). Common indications for urinary diversion were neurogenic bladder (54%) and urinary fistula (44%). Mean hospital stay and return of bowel function after surgery for entire cohort was 13 and 7 days, respectively, with no differences between AC and DD groups. Almost 50% of patients in the cohort experienced an HGAE but there was no difference in HGAE incidence (8/19 AC, 13/27 DD; P = .69) or complication type between the groups. Increased operative time (5% risk per every 15 minutes over 7 hours, P = .03) was the only independent variable associated with increased risk of HGAE. DD was not independently associated with increased risk of HGAE compared with staged urinary diversion. Morbidity and postoperative recovery appeared similar whether urinary diversion is performed after colostomy or during a DD.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2017.11.057