Perioperative Outcomes in Simple Cystectomy for Neurogenic Lower Urinary Tract Dysfunction: A Comparison of Surgical Approach, Surgical Teams, and Alvimopan Use.

Abstract

Purpose: Limited data exist on factors influencing surgical outcomes in simple cystectomy for refractory neurogenic lower urinary tract dysfunction (NLUTD). We evaluated the impact of alvimopan use, surgical approach (robotic vs. open), and single vs. multiple surgeons on peri- and postoperative outcomes.

Methods: We conducted a retrospective study of patients undergoing simple cystectomy for refractory NLUTD. Patient demographics, surgical details, and postoperative outcomes, including bowel function recovery, postoperative ileus, nasogastric tube use, and total parenteral nutrition use, were analyzed.

Results: A total of 44 patients were included in the study, with 68% being female. The median age was 57 years, and the median body mass index was 28.3 kg/m2. The majority were Caucasian (86%) with spinal cord injury (55%) history. In comparing single-surgeon versus multiple-surgeon procedures, the latter had significantly higher estimated blood loss. Thirty-three patients (73%) received alvimopan, with no significant differences between alvimopan and nonalvimopan groups in operative and postoperative factors.

Conclusion: NLUTD patients undergoing simple cystectomy represent a distinct surgical cohort. While multiple-surgeon procedures resulted in greater blood loss, they did not affect other perioperative outcomes. Additionally, alvimopan did not significantly improve bowel function recovery or reduce postoperative ileus, likely due to underlying neurogenic bowel dysfunction.