Editorial Comment from Dr Schiavina et al. to Cystectomy and urinary diversion as management of treatment-refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes

In the context of challenging surgical procedures that are not so frequently executed, such as the simple cystectomy for treatment-refractory benign diseases, it is currently difficult to assess the risk of perioperative complications and to predict the outcome of the patients. Certainly, the numerous series of surgical complications after radical cystectomy for muscleinvasive bladder cancer could be considered as surrogates,1–3 but this evaluation can result as inadequate, as Cohn et al. brilliantly showed in their paper.4 In fact, even if the present series is quite small, the authors showed that the rate of complication after simple cystectomy for treatment-refractory benign disease is drastically higher in comparison with that after radical cystectomy for bladder cancer: the rate of global complications was 70%, with 50% for severe complications (Clavien grade III or IV) and 7% for perioperative death. Thus, this procedure should be considered extremely challenging, very far from the refined and unproblematic pelvic procedures that are commonly carried out5,6 by most urologists and rather inserted in the category of salvage, extreme pelvic surgeries. The use of standardized methodology in reporting surgical complications is also indispensable to evaluate possible predictors of complications.