About difficulties in the examination of the quality of medical care in the complicated course of the postoperative period after cystectomy

Cystectomy, as a type of surgical treatment, is performed for various diseases of the bladder. Most often — with malignant tumors, as well as with benign pathological conditions. Complications in the postoperative period in patients undergoing cystectomy are mainly caused by the need to ensure adequate urine derivation. One of the options for solving this problem is the implementation of ileocystoplasty, which, in turn, is associated with the performance of technically difficult and large-scale manipulations during the operation. Successful prevention of severe complications of cystectomy (or their elimination) is probably possible only in those multidisciplinary medical organizations in which the provision of medical care to patients with urological oncology is a daily programmed activity. Outpatient health care specialists play a special role in routing patients with bladder diseases, and not only their formal referral and delivery to multidisciplinary medical and prophylactic institutions in an emergency mode with “on-duty” syndromic diagnoses such as “renal colic or hematuria”. At present, in St. Petersburg, all conditions have been created for the concentration of patients with severe diseases of the bladder in a number of specialized medical organizations, in which a large number of cystectomies with intestinal plastic are routinely performed annually, which makes it possible with a high probability to guarantee a favorable clinical outcome without discrediting method of the rarity of its implementation.

1. Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez M, et al. Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol. 2009 Nov;182(5):2195–203. https://doi.org/10.1016/j.juro.2009.07.016

2. Stenzl, A. Bladder substitution. Curr Opin Urol. 1999 May;9(3):241–245. https://doi.org/10.1097/00042307-199905000-00009

3. Darenkov SP, Krivoborodov GG, Kotov SV, Dzitiev VK, Proskokov AA, Pinchuk IS. Postoperative complications of radical cystectomy with orthoand heterotopic intestinal plasticity (review). Bulletin of the Russian state medical University. 2013;(4):49–53. (In Russian).

4. Spitsin IM, Perepechay VA, Kogan MI. Complications in the surgery of heterotopic urinary reservoirs. Ural Medical Journal. 2017;(2 (146)):114-117. (In Russian).

5. May M, Fuhrer S, Braun K-P, Brookman-Amissah S, Richter W, Hoschke B, et al. Results from three municipal hospitals regarding radical cystectomy on elderly patients. Int Braz J Urol. 2007 Dec;33(6):764–773; discussion 774-776. https://doi.org/10.1590/s1677-55382007000600004

6. Russian clinical guidelines. Urology. Ed. by Alyaeva Yu.G., Glybochko P.V., Pushkarya D.Yu. Moscow: "GEOTAR-Media" Publ., 2016, 496 p. (In Russian).

7. Zasukhina TN. et al. The main results of work in the healthcare sector in Saint Petersburg in 2017 and the main tasks for 2018. Saint Petersburg: SPb GBUZ MIAC. 2018, 60 p. (In Russian).

8. Shevtsov VD, Dmitrieva OA. On the issue of medical error as one of the types of defects in medical care during surgical interventions. Problems of Expertise in Medicine. 2007;7(3(27)):4–7. (In Russian).

9. Chavpetsov VF, Mikhailov SM, karachevtseva MA. Automated technology of medical care quality examination: structure, results and application prospects. Saint Petersburg: KOPI-R, 2007, 65 p. (In Russian).