Confirming routine stentograms after cystectomy is unnecessary

Authors

  • Naji Touma Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.
  • Jeffrey Spodek Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.
  • James Kuan Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.
  • Robert R. Shepherd Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.
  • W. Philip Hayman Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.
  • Joseph L. Chin Division of Urology, London Health Sciences Centre, University of Western Ontario, London, Ont.

DOI:

https://doi.org/10.5489/cuaj.51

Abstract

Objective: In the current trend of earlier discharge from hospital and minimizingcosts with selective intervention instead of routine “standard” orders, mostinstitutions have abolished routine radiographic imaging of the collecting system before stent removal in postcystectomy patients, although clear supportivedata from the recent literature is scarce. We retrospectively reviewed ourexperience with routine postoperative stentograms in 100 cystectomies to confirmthat our decision to omit the stentogram procedure does not compromisepatient safety and well-being.

Methods: We retrospectively reviewed the records of 100 patients who underwentradical cystectomy for bladder cancer. All 100 patients (87 with ileal conduitand 13 with orthotopic neobladder reconstruction) had their ureteroenteric anastomosesstented with feeding tubes that were exteriorized. Retrograde stentogramwas performed under fluoroscopic monitoring on postoperative days 7 to 9. Theradiology reports were reviewed for any mention of extravasation.

Results: Extravasation was detected on the stentograms of 5 of 197 (2.5%) ureteroentericanastomoses. Clinical signs suggestive of an anastomotic leak had precededthe imaging studies in 4 of the 5 cases. After expectant management, only 1patient (1.0%) required intervention with percutaneous nephrostomy.

Conclusions: The relatively low extravasation rate and the infrequent need foractive intervention coupled with the fact that an anastomotic leak can usuallybe diagnosed on clinical grounds confirms that routine use of stentogram afterureteroenteric anastomoses is not justified. Our decision to perform postoperativestentograms selectively is appropriate.

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Published

2012-12-10

How to Cite

Touma, N., Spodek, J., Kuan, J., Shepherd, R. R., Hayman, W. P., & Chin, J. L. (2012). Confirming routine stentograms after cystectomy is unnecessary. Canadian Urological Association Journal, 1(2). https://doi.org/10.5489/cuaj.51

Issue

Vol. 1 No. 2 (2007): CUAJ June

Section

Original Research

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