Morbidity and mortality of cystectomy for neurogenic lower urinary tract dysfunction. Comparison of laparoscopy and open surgery

Seance of wednesday 18 october 2006 (pas de sujet Principal)

Abstract

Objective : To compare morbidity and mortality of cystectomy bylaparoscopy versus open surgery, in patients with neurogenic lowerurinary tract dysfunction.Materials and Methods : From January 1993 to May 2006, weperformed cystectomy with urinary derivation on 49 patients, 26women and 23 men, presenting neurogenic urinary lower tract dysfunction.32 cystectomies were performed by laparoscopy versus 17by Open surgery. Neurological pathology was a multiple sclerosis(MS) in 26 cases, a paraplegia in 11 cases, a peripheral neuropathyin 7 cases, a transverse myelitis in 2 cases and a spina bifida in 3cases. The median preoperative ASA score was 3 (2-3). For the MS,the median EDSS score was 8 (7-8,5). A noncontinent derivationaccording to Bricker procedure was performed in 36 cases and anileal neobladder in 8 cases. Median level of creatinin clearance wasof 69 ml/min (26-228). The quantitative values were compared by atest T of student. The qualitative values were compared by a chisquare test.Results: There was a statistically significant difference in bloodloss (p=0,006) and complication rates (Major Complications,p=0,0001 ; Minor Complications, p= 0.005) between the Laparoscopicand Open Surgery groups. Postoperative analgesic use wassignificantly lower in the Laparoscopic group (Level of Use,p=0,038 ; Time of Use, p =0,03). Time to start of a liquid diet(p=0,008), solid diet (p=0,002) and length of hospitalization(p=0,003) were also significantly lower in the Laparoscopic groupvs the Open Surgery group.Conclusions : Laparoscopic cystectomy to treat neurogenic lowerurinary tract dysfunction is less morbid than open cystectomy. Itdecreases narcotic use, facilitates earlier return of bowel functionand it is associated with a shorter time of hospital stay.