Dehiscence in urological open surgery - Hiroshima City Hospital experience

Sometimes dehiscence occurs in relation to open surgery, and it has been thought to occur because of the patient's own factors and/or the technical factors of the surgery. Furthermore, since multidrug-resistant bacteria such as MRSA, have spread recently, wound infections are now occurring easily and dehiscence has become troublesome. In this report, we investigated those patients who underwent surgery at our hospital. Open surgery under spinal or general anesthesia was performed in 280 cases between January 1993 and December 1997. Operative methods included nephrectomy for RCC in 72 cases, total cystectomy in 46 cases, total nephroureterectomy in 41 cases and suprapubic prostatectomy in 33 cases, among others. The incidence of dehiscence was high (45.6%) with regard to total cystectomy, especially in the cases of urinary diversion using the GI tract where the incidence of dehiscence was very high (65.4%). Most of the sites of dehiscence were wounds associated with infections. The risk factors of dehiscence following total cystectomy comprised male, urinary diversion using GI tract, prolongation of operative time, increased blood loss, blood transfusion and neoadjuvant chemotherapy. In clean-contaminated operations, wound infection occurs during the operation. We think a reduction in the operating time and anti-infection prophylaxis during surgery are most important.