Vaginal Complications after Bladder Cystectomy: Results from a Medicare Sample. Vaginal Complications after Cystectomy: Results from a Medicare Sample. 

 -  2022 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006 
<br/><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.  MATERIALS AND METHODS: Women 65 or older undergoing cystectomy for any indication were identified by procedural codes in the Medicare Limited Data Set 5% sample from January 1st 2011 to December 31st 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 Kaplan-Meir estimates. Multivariable cause-specific Cox proportional hazards model assessed risk factors for vaginal complications.  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.  RESULTS: 481 women undergoing cystectomy were identified during the study period, 37.2% were less than 70 years old. The majority 378 (79%) had bladder cancer and 401 (83.4%) underwent an incontinent conduit or catheterizable channel diversion. Within two years of cystectomy, 93 patients (19.5%) had one 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/><br/><br/>English 
<br/><br/><label>ISSN: </label>0022-5347 
<br/><br/><label>Standard No.: </label>10.1097/JU.0000000000002336 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Cystectomy/ae [Adverse Effects]<br/>*Urinary Bladder Neoplasms/su [Surgery]<br/>*Vagina/in [Injuries]<br/>*Vaginal Diseases/et [Etiology]<br/>Aged<br/>Aged, 80 and over<br/>Dyspareunia/et [Etiology]<br/>Female<br/>Humans<br/>Medicare<br/>Postoperative Complications<br/>Retrospective Studies<br/>Surgical Wound Dehiscence/et [Etiology]<br/>United States<br/>Uterine Prolapse/et [Etiology]<br/>Vaginal Fistula/et [Etiology]
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Obstetrics and Gynecology/Urogynecology
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article