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Vaginal Complications after Cystectomy: Results from a Medicare Sample.

Authors :
Richter LA
Osazuwa-Peters OL
Routh JC
Handa VL
Source :
The Journal of urology [J Urol] 2022 Apr; Vol. 207 (4), pp. 789-796. Date of Electronic Publication: 2021 Dec 02.
Publication Year :
2022

Abstract

Purpose: Cystectomy with a vaginal-sparing approach may be associated with unique complications specific to the female population. The objective of this study was to estimate the incidence of vaginal complications (defined to include vaginal prolapse, vaginal fistula, dyspareunia and vaginal cuff dehiscence/evisceration) after cystectomy and to determine risk factors for these complications.<br />Materials and Methods: Women 65 years or older undergoing cystectomy for any indication were identified by procedural codes in the Medicare Limited Data Set 5% sample from January 1, 2011 to December 31, 2017. Patients experiencing a vaginal complication after cystectomy were compared to those who did not. Demographic and biological factors that could increase likelihood of complications were identified and time to development of complications determined. Cumulative incidence was calculated using cumulative incidence function. Multivariable cause-specific Cox proportional hazards model assessed risk factors for vaginal complications.<br />Results: In all, 481 women undergoing cystectomy were identified during the study period, and 37.2% were younger than 70 years old. The majority (378, 79%) had bladder cancer, and 401 (83.4%) underwent an incontinent conduit or catheterizable channel diversion. Within 2 years of cystectomy, 93 patients (19.5%) had 1 or more complications on record. Vaginal cuff dehiscence had the highest cumulative incidence, occurring in 49 patients (10.2%). Over the entire study period (2011-2017), 102 women (21.2%) were diagnosed with a vaginal complication, and 27 (5.6%) received an intervention.<br />Conclusions: Among women who undergo cystectomy, vaginal complications occur at rates higher than expected with over 20% of women experiencing a complication and over a quarter of those diagnosed undergoing intervention.

Details

Language :
English
ISSN :
1527-3792
Volume :
207
Issue :
4
Database :
MEDLINE
Journal :
The Journal of urology
Publication Type :
Academic Journal
Accession number :
34854750
Full Text :
https://doi.org/10.1097/JU.0000000000002336