Incidental appendectomy during radical cystectomy: An interdepartmental survey and review of the literature

Objectives. To survey and review the incidence of appendectomy performed du ring radical cystectomy and urinary diversion. We were interested in the re asons behind the decision and if continent diversions have changed the poli cy. Methods. We performed a selective survey among urologists in academic cente rs throughout the United States regarding their practice of incidental appe ndectomy during radical cystectomy. We also reviewed the literature regardi ng the rationale for incidental appendectomy in general and during radical cystectomy in particular. Results. Among the 13 departments and 26 urologists replying to the survey, 9 (69%) departments and 20 (77%) individual clinicians are not performing routine incidental appendectomy. In 2 departments, it is considered a matte r of choice, and, in 4 (31%) departments, appendectomy is performed routine ly. Many believe that the low risk of subsequent appendicitis does not just ify the procedure and that the appendix may be useful for future reconstruc tion. A review of the literature suggests that incidental appendectomy duri ng radical cystectomy is not necessary. Conclusions. Incidental appendectomy during radical cystectomy is not neces sary and is no longer being performed in many academic centers. The risk of subsequent appendicitis is extremely low. The decision may depend on the f orm of urinary diversion planned. UROLOGY 56: 241-244, 2000. (C) 2000, Else vier Science Inc.