Trends in Urinary Diversion After Radical Cystectomy for Urothelial Carcinoma

Overview

Journal World J Urol

Specialty Urology

Date 2018 Jan 5

PMID 29299664

Citations 10

Authors

Kinan Bachour

Izak Faiena

Amirali Salmasi

Andrew T Lenis

David C Johnson

Aydin Pooli

Alexandra Drakaki

Allan J Pantuck

Karim Chamie

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess how trends in urinary diversion (UD) type following radical cystectomy (RC) have changed in recent years and investigate pre-operative predictors of UD type.

Methods: Data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011 to 2015. We quantified the percentages of continent diversions (CD) versus incontinent diversions (ID) completed over this time frame. Using univariate and multivariable logistic regression analyses, we compared UD type across year of operation as well as predictors of type of diversion.

Results: We identified 4790 patients in the cohort, of which 81% underwent an incontinent diversion. Patients undergoing incontinent diversions were older (p < 0.001), more likely to be female (p < 0.001), had higher American Society of Anesthesiologists (ASA) classification (p < 0.001) and had more comorbidities with worse preoperative lab values. On multivariable analysis, the odds of incontinent diversion increased per year (OR 1.16, 95% CI 1.06-1.26; p = 0.001). Neoadjuvant chemotherapy (NAC) was associated with lower odds of receiving an ID (OR 0.33, 95% CI 0.17-0.64; p = 0.001). Being male, healthy and young were associated with higher odds of CD.

Conclusion: We demonstrate that there has been a decrease in continent diversion use in recent years. Neoadjuvant chemotherapy, proxies of life expectancy and gender are significant predictors of continent diversion. Further investigation to determine the underlying cause of decreased utilization of CD is warranted.

Citing Articles

Choosing between Orthotopic Neobladder and Ileal Conduit after Radical Cystectomy: Tools for Assessing Patient-Specific Characteristics and Enhancing the Decision-Making Process-A Review of Current Studies.

Trzciniecki M, Kowal P, Kolodziej J, Szydelko T, Kolodziej A J Clin Med. 2024; 13(12).

PMID: 38930035 PMC: 11205234. DOI: 10.3390/jcm13123506.

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review.

Barone B, Napolitano L, Reccia P, Calace F, De Luca L, Olivetta M J Pers Med. 2024; 14(4).

PMID: 38673019 PMC: 11051023. DOI: 10.3390/jpm14040392.

Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation.

McNicholas D, El-Taji O, Siddiqui Z, Hanchanale V J Robot Surg. 2024; 18(1):100.

PMID: 38413496 PMC: 10899269. DOI: 10.1007/s11701-024-01850-9.

Percutaneous Ureteral Stent Insertion in Patients with Benign Uretero-Ileal Anastomosis Strictures Who Underwent Radical Cystectomy: Assessing Risk Factors for Stent Patency.

Kim Y, Oh C, Choi S, Kim S J Clin Med. 2023; 12(24).

PMID: 38137790 PMC: 10744104. DOI: 10.3390/jcm12247721.

The sex gap in bladder cancer survival - a missing link in bladder cancer care?.

Toren P, Wilkins A, Patel K, Burley A, Gris T, Kockelbergh R Nat Rev Urol. 2023; 21(3):181-192.

PMID: 37604983 DOI: 10.1038/s41585-023-00806-2.

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