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Special surgical aspects of radical cystectomy in spinal cord injury patients with bladder cancer

World Journal of Urology volume 40, pages 1961–1970 (2022)Cite this article

Abstract

Purpose

Radical cystectomy in people with spinal cord injury (SCI) provides numerous additional difficulties, compared to able-bodied people. Therefore, it is important to obtain information from an experienced team about optimally managing these patients.

Methods

Surgical procedures, based on the experience of 12 radical cystectomies in SCI patients with bladder cancer between January 1st, 2001, and December 31st, 2020, were recorded and the operative and perioperative clinical data were evaluated. Surgery was performed in a high-volume center by the surgeon most experienced in radical cystectomies, assisted by the neuro-urologist, involved in the care of the patient from the spinal cord center. Furthermore, a checklist based on the experience of the surgeon and the assisting neuro-urologist was developed.

Results

SCI patients mostly suffered from an advanced disease and were always operated by the same team. The hospital stays ranged from 23 to 134 days (median 42 days). Four of the patients suffered from a postoperative paralytic ileus. Otherwise, both the operation time and the intraoperative blood loss as well as intraoperative and postoperative complications were basically comparable with those in able-bodied patients. The special features of radical cystectomy in SCI bladder cancer patients are described. Furthermore, a checklist addressing preoperative red flags, intra-operative challenges and post-operative challenges is presented.

Conclusion

Radical cystectomy in SCI patients should be performed in a high-volume department by the most experienced surgical team. The inclusion of the urologist caring for the patient from the spinal cord injury center is highly recommended.

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Author notes

  1. Ralf Böthig and Clemens Rosenbaum contributed equally to this work.

Authors and Affiliations

  1. Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany

    Ralf Böthig & Kai Fiebag

  2. Department of Urology, Asklepios Klinik Barmbek, Hamburg, Germany

    Clemens Rosenbaum & Holger Böhme

  3. Biomechanical Laboratory, BG Klinikum Hamburg, Hamburg, Germany

    Birgitt Kowald

  4. Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany

    Roland Thietje

  5. Urological Practice, Sankt Augustin, Germany

    Wolfgang Schöps

  6. Specialist Clinic for Psychosomatic Rehabilitation, Mittelrhein-Klinik, Boppard - Bad Salzig, Germany

    Thura Kadhum

  7. Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany

    Klaus Golka

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  1. Ralf Böthig
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Contributions

RB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: RB, KF, WS, and KG. Acquisition of data: RB, CR, HB, KF, and RT. Analysis and interpretation of data: RB, CR, BK, and KG. Drafting of the manuscript: RB, CR, TK, and KG. Critical revision of the manuscript for important intellectual content: WS, HB, KF, and RT. Obtaining funding: None. Statistical analysis: BK. Administrative, technical, or material support: RT. Supervision: KG and TK. Other: none.

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Correspondence to Ralf Böthig.

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Böthig, R., Rosenbaum, C., Böhme, H. et al. Special surgical aspects of radical cystectomy in spinal cord injury patients with bladder cancer. World J Urol 40, 1961–1970 (2022). https://doi.org/10.1007/s00345-022-03939-y

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  • DOI: https://doi.org/10.1007/s00345-022-03939-y

Keywords

  • Denervation of the urinary bladder
  • Chronic neurogenic bladder dysfunction
  • Chronic neurogenic bowl dysfunction
  • Spina bifida
  • Autonomic dysreflexia
  • Checklist