Critical Evaluation of 1-Stage Cystectomy—reducing Morbidity and Mortality

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Abstract
Although it is a major surgical effort removal of the bladder can be done with reasonable safety. Cystectomy and urinary diversion by an ileal conduit can be performed as a conjoined procedure without need for staging to reduce risks. Mortality up to 3 mo. postoperatively was 3.9% and the major complication rate for surviving patients was 18.6%. Minor complications occurred in 28.7% of all patients but were treated easily. Increased morbidity after radical cystectomy was not noted when compared to other types of cystectomy. A higher complication rate was noted in patients who had undergone preoperative radiation treatment, and wound infection rate was higher in patients with neurogenic bladder dysfunction and chronic cystitis. The advantages of 1-stage compared to 2-stage cystectomy would include the fact that it eliminates the need for a 2nd operation, saves considerable expense by virtue of shortened hospitalization and an earlier resumption of the patient''s productivity, achieves early removal of the malignancy, decreases the chances of infection by avoiding a second laparotomy in the presence of a stoma and allows better exposure in the absence of previous ureteroileal anastomoses.