Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center

Background: Radical cystectomy is associated with high morbidity, especially in elderly patients. Most of the associated complications are related to the urinary diversion. Cutaneous ureterostomy (CU) is usually an uncommon form of urinary diversion and is avoided because of the frequent complication of stomal stenosis.Methods: In this study the authors retrospectively analyzed 84 patients who underwent radical cystectomy. 17 Patients who underwent single stoma CU were included in the study who required lifelong monthly stent changes. Varied indication and outcome of these patients were analyzed.Results: Patients in which CU was used as a mode of urinary diversion had less blood loss, less operative time and discharged without ICU stay.Conclusions: It seems that single stoma CU is a viable option in elderly, high risk patients and in post radiotherapy patients who require radical cystectomy. Although the patient requires lifelong stent changes, postoperative complications are reduced.

Download Full-text

Contemporary Outcomes of Open Radical Cystectomy: a 5-Year Experience from a Tertiary Care Center

Indian Journal of Surgical Oncology ◽

10.1007/s13193-020-01226-z ◽

2021 ◽

Author(s):

Brusabhanu Nayak ◽

Harshit Garg ◽

Ritesh Goel ◽

Prabhjot Singh ◽

Rishi Nayyar ◽

...

Keyword(s):

Radical Cystectomy ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Open Radical Cystectomy

Download Full-text

To study the effectiveness of prophylactic use of ceftriaxone (single dose) in caesarean section in low risk patients in a tertiary care center, Moradabad, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175440 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5278

Author(s):

Ruby Kumari ◽

Arti Sharma ◽

. Sheetal ◽

Pratibha Roy ◽

. Anupriya

Keyword(s):

Single Dose ◽

Caesarean Section ◽

Surgical Site Infection ◽

Care Center ◽

Tertiary Care ◽

Infectious Complications ◽

Low Risk ◽

Tertiary Care Center ◽

Site Infection ◽

Risk Patients

Background: There is increasing incidence of caesarean section throughout the world. As caesarean section is associated with infectious complications which increase the rate of morbidity and mortality of mothers. For prevention of infectious complications antibiotics are used but careless use of antibiotics increasing incidence of antibiotic resistance. Many guidelines and studies recommend single dose antibiotic prophylaxis for women undergoing elective or non-elective caesarean section. The aim of this study was to assess the effectiveness of Ceftriaxone as prophylactic antibiotic (single dose) in caesarean section in low risk patients.Methods: A Prospective single blind study was carried out in the department of obstetrics and gynaecology, TMMC and RC Moradabad, a tertiary care center, in all low risk patients underwent for Elective and Emergency Lower segment caesarean section for 1 year from 1st June 2015 to May 2016 on 110 patients. Data was collected and analyzed by percentage and proportion.Results: Prevalence of caesarean section was maximum in women of 26-35years age group (52.72%),about 67.27% was emergency LSCS, most common indication of caesarean section was Fetal distress (29.09%),refusal for vaginal delivery after caesarean section (10.90%) was one of the cause for increasing rate of repeat caesarean section, 41.81% women in labour,72.27% cases were with intact membrane, in 9.09% cases, antibiotic had to change in post-operative period due to urinary tract infection and surgical site infection, most common post-operative complication was superficial surgical site infection with purulent discharge (2.72%). No major life-threatening complication occurred.Conclusions: Single dose of Ceftriaxone is effective for prevention of post-caesarean infectious complication.

Download Full-text

Short- and Long-Term Evaluation of Renal Function after Radical Cystectomy and Cutaneous Ureterostomy in High-Risk Patients

Journal of Clinical Medicine ◽

10.3390/jcm9072191 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2191

Author(s):

Massimiliano Creta ◽

Ferdinando Fusco ◽

Roberto La Rocca ◽

Marco Capece ◽

Giuseppe Celentano ◽

...

Keyword(s):

Renal Function ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Kidney Injury ◽

Risk Patients ◽

Term Evaluation ◽

Gfr Decline ◽

American Society ◽

American Society Of Anesthesiologists ◽

Cutaneous Ureterostomy

Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.

Download Full-text

Adenoma Detection Rates On Screening Colonoscopy in Average Risk Patients At a Large, Rural Tertiary Care Center

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2008.03.936 ◽

2008 ◽

Vol 67 (5) ◽

pp. AB315

Author(s):

Duane E. Deivert ◽

Amitpal Johal ◽

H. Lester Kirchner ◽

Nicholas A. Inverso

Keyword(s):

Care Center ◽

Tertiary Care ◽

Screening Colonoscopy ◽

Average Risk ◽

Tertiary Care Center ◽

Detection Rates ◽

Adenoma Detection ◽

Risk Patients ◽

Adenoma Detection Rates

Download Full-text

Impact of Chest Pain Protocol Targeting Intermediate Cardiac Risk Patients in an Observation Unit of an Academic Tertiary Care Center

Journal of Clinical Medicine Research ◽

10.14740/jocmr2441w ◽

2016 ◽

Vol 8 (2) ◽

pp. 111-115 ◽

Cited By ~ 2

Author(s):

Tariq Yousuf ◽

Hesam Keshmiri ◽

Jeffrey Ziffra ◽

Ankur Dave ◽

Shoeb Hussain ◽

...

Keyword(s):

Chest Pain ◽

Care Center ◽

Tertiary Care ◽

Cardiac Risk ◽

Tertiary Care Center ◽

Observation Unit ◽

Risk Patients ◽

Cardiac Risk Patients

Download Full-text

Feasibility of Pancreaticoduodenectomy in a Nonuniversity Tertiary Care Center: What Are the Key Elements of Success?

The American Surgeon ◽

10.1177/000313481107700511 ◽

2011 ◽

Vol 77 (5) ◽

pp. 545-551 ◽

Cited By ~ 2

Author(s):

Amit Khithani ◽

Derick Christian ◽

Kevin Lowe ◽

A. Joe Saad ◽

Jeffrey D. Linder ◽

...

Keyword(s):

Operative Time ◽

Care Center ◽

Tertiary Care ◽

High Volume ◽

Team Approach ◽

Tertiary Care Center ◽

Key Factors ◽

Estimated Blood Loss ◽

Volume Outcome ◽

The Mean

It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: 1) evaluate the outcome of PDs done at a NUTCC; 2) study the components of the process that are required to attain success in a NUTCC; and 3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.

Download Full-text