[ניתוחים להטיית מערכת השתן עם או ללא כריתת שלפוחית השתן בהוריה של מחלה לא ממאירה: ניסיון רב שנים של מרכז שלישוני].

Abstract

Introduction: Urinary diversion, with or without cystectomy, is a radical option for individuals experiencing end-stage lower urinary tract dysfunction caused by non-malignant bladder conditions. Our aim was to highlight our experience with this procedure, focusing particularly on its safety.

Methods: Demographic, clinical, and surgical data were collected for patients who underwent the procedure. Postoperative complications were examined and classified into short-term (<30 days) and long-term (>30 days) complications.

Results: Twenty-three patients (48% women, median age 60 years (IQR:44-67 years)) underwent urinary diversion for benign indications. Eight (35%) and six (26%) patients, underwent urinary diversion without cystectomy and supra-trigonal cystectomy respectively. The most common indications for surgery were a non-functioning bladder due to, oncological treatments (39%), neurogenic bladder (17%) and refractory interstitial cystitis (13%). Postoperative complications were recorded in 60% of patients, with 87% of these being low-grade complications (Clavien-Dindo ≤2). Two patients experienced late complications, and one patient died three months after surgery due to septic shock. No complications or need for additional cystectomy were documented in patients who underwent urinary diversion alone.

Conclusions: Urinary diversion, with or without cystectomy, is an effective and relatively safe solution for refractory end-stage bladder dysfunction. The surgery improves the quality of life and coping for patients with a non-functioning bladder. Despite the potential surgical complications, it should be considered as a last resort when other conservative treatments have failed. Further studies with larger cohorts are needed to validate these findings.