Mini-laparotomy radical cystectomy with limited bowel externalization during ileal conduit urinary diversion reduces the rate of postoperative complications: a match-paired, single centered analysis

Abstract Background Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC. Methods This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications. Results Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups. Conclusions Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.

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300: Prospective Assessment of Health Related Quality of Life (HRQOL) Urinary Diversion Following Radical Cystectomy and Urinary Diverision: Comparison of Orthotopic Neobladder Versus Ileal Conduit Patients

The Journal of Urology ◽

10.1016/s0022-5347(18)37562-1 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 79-79 ◽

Cited By ~ 5

Author(s):

Travis M. Clark ◽

Nancy Wells ◽

Sam S. Chang ◽

Sajal Dutta ◽

Joseph A. Smith ◽

...

Keyword(s):

Quality Of Life ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Ileal Conduit ◽

Health Related Quality ◽

Orthotopic Neobladder ◽

Related Quality ◽

Prospective Assessment ◽

Health Related

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A Comparative Study on Quality of Life between Ileal Conduit Urinary Diversion and Orthotopic Neobladder Reconstruction after Radical Cystectomy

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2019/39729.12537 ◽

2019 ◽

Author(s):

Ranjan Kumar Dey ◽

Md Dawood Khan ◽

Ranjit Kumar Das ◽

Vishnu Agrawal

Keyword(s):

Quality Of Life ◽

Comparative Study ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Ileal Conduit ◽

Orthotopic Neobladder

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A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

Journal of Clinical Urology ◽

10.1177/20514158211041483 ◽

2021 ◽

pp. 205141582110414

Author(s):

Francesco Chiancone ◽

Francesco Persico ◽

Marco Fabiano ◽

Maurizio Fedelini ◽

Clemente Meccariello ◽

...

Keyword(s):

Bladder Cancer ◽

Postoperative Complications ◽

Blood Loss ◽

Radical Cystectomy ◽

Ileal Conduit ◽

Intraoperative Complications ◽

Perioperative Outcomes ◽

Multivariate Logistic Regression Model ◽

Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

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Retrosigmoid Versus Traditional Ileal Conduit for Urinary Diversion After Radical Cystectomy

European Urology ◽

10.1016/j.eururo.2018.06.023 ◽

2019 ◽

Vol 75 (2) ◽

pp. 294-299 ◽

Cited By ~ 3

Author(s):

Vincenzo Ficarra ◽

Gianluca Giannarini ◽

Alessandro Crestani ◽

Vito Palumbo ◽

Marta Rossanese ◽

...

Keyword(s):

Radical Cystectomy ◽

Urinary Diversion ◽

Ileal Conduit

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Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9072236 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2236 ◽

Cited By ~ 2

Author(s):

Jihion Yu ◽

Bumsik Hong ◽

Jun-Young Park ◽

Yongsoo Lee ◽

Jai-Hyun Hwang ◽

...

Keyword(s):

Propensity Score ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Filtration Rate ◽

Ileal Conduit ◽

Significant Decline ◽

Ileal Neobladder ◽

Renal Function Impairment ◽

Function Impairment ◽

Gfr Decline

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

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