Department of Urology, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY, 40536, USA.
Department of Pharmacy Services, University of Kentucky Chandler Medical Center, Lexington, KY, USA.
Int Urol Nephrol. 2021 Jan;53(1):77-82. doi: 10.1007/s11255-020-02621-9. Epub 2020 Aug 31.
To analyze the use of alvimopan, a peripheral mu-opioid receptor antagonist, in expediting gastrointestinal recovery after benign abdominal urinary tract reconstruction. Alvimopan use has been well defined in the management of radical cystectomy and urinary diversion for oncologic indications. It has not been studied in benign abdominal genitourinary reconstruction.
Patients who underwent urinary reconstruction utilizing harvested bowel segments for benign conditions from 12/2014-7/2019 were retrospectively reviewed. From 5/2018-7/2019 our institution approved the use of perioperative alvimopan in the aforementioned patients (N = 11), who were paired 1:2 with patients from a cohort of alvimopan-eligible patients who did not receive the drug (N = 22). Patients were paired by (1) type of reconstruction and (2) presence of neurogenic bowel-bladder (NBB).
Of the 70 patients who underwent urinary reconstruction during the study period, 46 patients (66%) were eligible to receive alvimopan. Length of stay was shorter for the alvimopan group compared to the non-alvimopan group (median 5 days [IQR 4-5 days] vs. 8 days [IQR 6-11 days]; P = 0.002). Time to first bowel movement was shorter for the alvimopan group (median 4 days [IQR 3-4 days] vs. 6 days [IQR 4-7], P = 0.001). No patient treated with alvimopan required a nasogastric (NG) tube for post-operative ileus compared to 7 (32%) patients in the non-treatment group (P = 0.035). Post-operative complications and 30-day readmissions were similar between the two groups.
The use of perioperative alvimopan in benign abdominal urinary tract reconstruction expedited return of bowel function and decreased length of stay compared to a matched cohort of untreated patients.
分析外周型阿片受体拮抗剂奥曲肽在促进良性腹部尿路重建后胃肠道恢复方面的应用。奥曲肽在根治性膀胱切除术和出于肿瘤适应证的尿流改道的管理中得到了充分的研究。但它在良性腹部泌尿生殖系统重建中尚未进行研究。
回顾性分析了 2014 年 12 月至 2019 年 7 月期间因良性疾病接受利用采集的肠段进行尿路重建的患者。自 2018 年 5 月至 2019 年 7 月，我院批准在上述患者（n=11）中使用围手术期奥曲肽，这些患者与一组未使用该药的奥曲肽合格患者（n=22）进行了 1:2 配对。患者通过（1）重建类型和（2）是否存在神经源性肠膀胱（NBB）进行配对。
在研究期间接受尿路重建的 70 名患者中，有 46 名（66%）符合接受奥曲肽的条件。与未接受奥曲肽治疗的患者相比，奥曲肽组的住院时间更短（中位数 5 天[IQR 4-5 天]vs. 8 天[IQR 6-11 天]；P=0.002）。奥曲肽组首次排便时间更短（中位数 4 天[IQR 3-4 天]vs. 6 天[IQR 4-7 天]；P=0.001）。与非治疗组（7[32%]例）相比，接受奥曲肽治疗的患者无一例因术后肠梗阻而需要放置鼻胃管（P=0.035）。两组患者的术后并发症和 30 天再入院率相似。
与未接受治疗的患者相比，在良性腹部尿路重建中使用围手术期奥曲肽可加快肠道功能恢复并缩短住院时间。
