Comparing the outcome of ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a retrospective cohort study

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.

Current scenario of tracheostomy: our experience

<p class="abstract"><strong>Background:</strong> Tracheostomy is an important surgical procedure done by ENT surgeons. In this study we have assessed the indications and complications encountered during tracheostomy and decannulation.</p><p class="abstract"><strong>Methods:</strong> 100 patients undergoing tracheostomy by the Department of Otolaryngology and Head and Neck Surgery between 1st January and 31st December 2015 in a tertiary care hospital in Central India were included in the study. The various indications of tracheostomy along with the complications encountered and decannulation following tracheostomy were studied. </p><p class="abstract"><strong>Results:</strong> In this study, most commonly (22%) tracheostomies were performed in young (31-40) years, male (73%) patients. This included 79% elective and 21% emergency tracheostomies. The indications of tracheostomy were retained secretions 61%, laryngopharyngeal obstruction 21%, and respiratory insufficiency 19%. 21 intra-operative complications included bleeding (18% cases) and apnoea (3% cases). Wound infection 19%; subcutaneous emphysema 10%; tube block 6% and haemorrhage 2% constituted 37 immediate post-operative complications. 17 late post-operative complications included stoma stenosis 9%; granuloma formation 4% and trachea-oesophageal fistula and aspiration 2% each. 33% of total patients were decannulated easily.</p><p class="abstract"><strong>Conclusions:</strong> In conclusion we found that elective tracheostomy is associated with lower morbidity and mortality and strapping of tracheostomy site is an easy, safe and effective method of tracheostomy closure in properly selected patients.</p>