Associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy: results from the Alberta Urology Institute Radical Cystectomy database.

PURPOSE: We determined the associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy. MATERIALS AND METHODS: The Alberta Urology Institute Radical Cystectomy database is an ongoing multi-institutional computerized database containing data on all adult patients with a diagnosis of primary bladder cancer treated with radical cystectomy in Edmonton, Canada from April 1994 forward. The current study is an analysis of consecutive database patients treated between April 1994 and September 2007. Comorbidity information was obtained through a medical record review using the Adult Comorbidity Evaluation 27 instrument. The outcome measures were overall survival and bladder cancer specific survival. Cox proportional regression analysis was used to determine the associations between comorbidity, and overall survival and bladder cancer specific survival. RESULTS: Of the database patients 160 (34%), 225 (48%) and 83 (18%) had no/mild comorbidity, moderate comorbidity and severe comorbidity, respectively. Compared to patients with no or mild comorbidity, multivariate Cox proportional regression analyses that included age, adjuvant chemotherapy, surgeon procedure volume, pathological T stage, pathological lymph node status, total number of lymph nodes removed, surgical margin status and lymphovascular invasion showed that increased comorbidity was independently associated with overall survival (moderate HR 1.59, 95% CI 1.16-2.18, p = 0.004; severe HR 1.83, 95% CI 1.22-2.72, p = 0.003) and bladder cancer specific survival (moderate HR 1.50, 95% CI 1.04-2.15, p = 0.028; severe HR 1.65, 95% CI 1.04-2.62, p = 0.034). CONCLUSIONS: Increased comorbidity was independently associated with an increased risk of overall mortality and bladder cancer specific mortality after radical cystectomy.

A population based assessment of complications following outpatient hydrocelectomy and spermatocelectomy.

PURPOSE: We determine the incidence of complications following outpatient scrotal surgery for the treatment of hydroceles and spermatoceles. MATERIALS AND METHODS: A retrospective study of all patients undergoing hydrocelectomy or spermatocelectomy between April 1, 1997 and March 31, 1999 at 1 institution was performed. The hospital and office charts were reviewed, and postoperative complications (infection, persistent swelling, chronic pain) were recorded. The type of preoperative antiseptic preparation (iodine based versus chlorhexidine) and the presence or absence of surgical drains were also recorded. RESULTS: A total of 161 patients were included in the study with an average age of 53.7 years. The overall complication rate was 19.2%. Infection/scrotal abscess formation occurred in 9.3% of patients, persistent swelling (treatment failure) in 9.3% and chronic pain in 0.6%. There was no significant difference in the complication rate when the preoperative preparations and the presence or absence of surgical drains were compared. CONCLUSIONS: The most common complications following scrotal surgery for hydroceles and spermatoceles are persistent scrotal swelling, inflammation and postoperative infection. Further prospective investigation is required to study factors such as the use of drains, preoperative and/or perioperative antibiotics and the type of surgical preparations, which may have a role in complication rates.