Abstract
Introduction: To compare perioperative and postoperative outcomes related to urinary diversion (UD) between ileal conduit and cutaneous ureterostomy following open radical cystectomy (ORC). Methods: This retrospective study included 232 patients with bladder cancer who underwent ORC and subsequent UD (ileal conduit, n = 123; cutaneous ureterostomy, n = 109) at Kobe University and related hospitals between January 2007 and December 2016. A propensity score method was used to adjust the preoperative status of the two groups, and the perioperative and postoperative outcomes were compared between matched cohorts. In addition, we evaluated several factors predicting renal deterioration. Results: In the matched cohorts, 87 patients were included in each group. While the operative time and postoperative fasting periods were significantly longer in patients with ileal conduit in comparison to those with cutaneous ureterostomy (both p < 0.001), there were no differences in blood loss or duration of hospitalization. Although the incidence of grade ≥III perioperative complications was similar between the two groups, the incidence of postoperative recurrent pyelonephritis in the cutaneous ureterostomy group was significantly higher than that in the ileal conduit group (25.3 and 11.4%, respectively; p = 0.030), and cutaneous ureterostomy was identified as a significant predictor of a decrease in the estimated glomerular filtration rate with an odds ratio of 2.13 (95% confidence interval, 1.19–3.85; p = 0.010). Conclusions: The perioperative safety of ileal conduit was comparable to that of cutaneous ureterostomy, and cutaneous ureterostomy was a significant risk factor for pyelonephritis and subsequent renal deterioration, suggesting that ileal conduit may be preferable to cutaneous ureterostomy.
References
1.
Spiess
PE
, Agarwal
N
, Bangs
R
, Boorjian
SA
, Buyyounouski
MK
, Clark
PE
, et al. Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology
. J Natl Compr Canc Netw
. 2017
;15
(10
):1240
–67
. 1540-14052.
Hussein
AA
, Elsayed
AS
, Aldhaam
NA
, Jing
Z
, Osei
J
, Kaouk
J
, et al.: Comparison of Long-Term Oncologic Outcomes among Historical Open and Minimally Invasive Retrospective Studies. J Urol 2019
:101097ju0000000000000386.3.
Hussein
AA
, May
PR
, Jing
Z
, Ahmed
YE
, Wijburg
CJ
, Canda
AE
, et al. Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
. J Urol
. 2018
;199
(5
):1302
–11
. 0022-53474.
Satkunasivam
R
, Tallman
CT
, Taylor
JM
, Miles
BJ
, Klaassen
Z
, Wallis
CJ
. Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Meta-analysis of Oncologic, Perioperative, and Complication-related outcomes
. Eur Urol Oncol
. 2019
;2
(4
):443
–7
. 5.
Toyoda
Y
. A new technique for catheterless cutaneous ureterostomy
. J Urol
. 1977
;117
(3
):276
–8
. 0022-53476.
Hirokawa
M
, Iwasaki
A
, Yamazaki
A
, Asakura
S
, Nozaki
A
, Yamagishi
T
. Improved technique of tubeless cutaneous ureterostomy and results of permanent urinary diversion
. Eur Urol
. 1989
;16
(2
):125
–32
. 0302-28387.
Kouba
E
, Sands
M
, Lentz
A
, Wallen
E
, Pruthi
RS
. A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer
. J Urol
. 2007
;178
(3
):945
–8
. 0022-53478.
McAlpine
K
, Lavallee
LT
, Stacey
D
, Moodley
P
, Cagiannos
I
, Morash
C
, et al.: Development and acceptability testing of a patient decision aid for urinary diversion with radical cystectomy. J Urol 2019
:101097ju0000000000000341.9.
Deliveliotis
C
, Papatsoris
A
, Chrisofos
M
, Dellis
A
, Liakouras
C
, Skolarikos
A
. Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit?
Urology
. 2005
;66
(2
):299
–304
. 0090-429510.
Tsaturyan
A
, Sahakyan
S
, Muradyan
A
, Fanarjyan
S
, Tsaturyan
A
. A new modification of tubeless cutaneous ureterostomy following radical cystectomy
. Int Urol Nephrol
. 2019
;51
(6
):959
–67
. 0301-162311.
Zubrod
CG
, Schneiderman
M
, Frei
E
3rd, Brindley
C
, Lennard Gold
G
, Shnider
B
, et al. Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide
. J Chronic Dis
. 1960
;11
(1
):7
–33
. 0021-968112.
Dindo
D
, Demartines
N
, Clavien
PA
. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey
. Ann Surg
. 2004
;240
(2
):205
–13
. 0003-493213.
Novotny
V
, Hakenberg
OW
, Wiessner
D
, Heberling
U
, Litz
RJ
, Oehlschlaeger
S
, et al. Perioperative complications of radical cystectomy in a contemporary series
. Eur Urol
. 2007
;51
(2
):397
–401
. 0302-283814.
Matsuo
S
, Imai
E
, Horio
M
, Yasuda
Y
, Tomita
K
, Nitta
K
, et al. Revised equations for estimated GFR from serum creatinine in Japan
. Am J Kidney Dis
. 2009
;53
(6
):982
–92
. 0272-638615.
Fontaine
E
, Leaver
R
, Woodhouse
CR
. The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up
. BJU Int
. 2000
;86
(3
):195
–8
. 1464-409616.
Wen Wu
FM
, Burkhard
F
, Turri
F
, Furrer
M
, Loeffel
L
, Thalmann
G
, et al. Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial
. Urol Oncol
. 2017
;35
(10
):602.e611
–7
. 1078-143917.
Kanda
Y
. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics
. Bone Marrow Transplant
. 2013
;48
(3
):452
–8
. 0268-336918.
Nieuwenhuijzen
JA
, de Vries
RR
, Bex
A
, van der Poel
HG
, Meinhardt
W
, Antonini
N
, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions
. Eur Urol
. 2008
;53
(4
):834
–42
. 0302-283819.
Lee
RK
, Abol-Enein
H
, Artibani
W
, Bochner
B
, Dalbagni
G
, Daneshmand
S
, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes
. BJU Int
. 2014
;113
(1
):11
–23
. 1464-409620.
Hollenbeck
BK
, Miller
DC
, Taub
D
, Dunn
RL
, Khuri
SF
, Henderson
WG
, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy
. J Urol
. 2005
;174
(4 Part 1
):1231
–7
. 0022-534721.
Lassen
K
, Soop
M
, Nygren
J
, Cox
PB
, Hendry
PO
, Spies
C
, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations
. Arch Surg
. 2009
;144
(10
):961
–9
. 0004-001022.
Cerantola
Y
, Valerio
M
, Persson
B
, Jichlinski
P
, Ljungqvist
O
, Hubner
M
, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS((R))) society recommendations
. Clin Nutr
. 2013
;32
(6
):879
–87
. 0261-561423.
Longo
N
, Imbimbo
C
, Fusco
F
, Ficarra
V
, Mangiapia
F
, Di Lorenzo
G
, et al. Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy
. BJU Int
. 2016
;118
(4
):521
–6
. 1464-409624.
Wuethrich
PY
, Vidal
A
, Burkhard
FC
. There is a place for radical cystectomy and urinary diversion, including orthotopic bladder substitution, in patients aged 75 and older: results of a retrospective observational analysis from a high-volume center
. Urol Oncol
. 2016
;34
(2
):58.e19
–27
. 1078-143925.
Shimko
MS
, Tollefson
MK
, Umbreit
EC
, Farmer
SA
, Blute
ML
, Frank
I
. Long-term complications of conduit urinary diversion
. J Urol
. 2011
;185
(2
):562
–7
. 0022-534726.
Hautmann
RE
, de Petriconi
RC
, Volkmer
BG
. 25 years of experience with 1,000 neobladders: long-term complications
. J Urol
. 2011
;185
(6
):2207
–12
. 0022-534727.
Cohen
E
, Nardi
Y
, Krause
I
, Goldberg
E
, Milo
G
, Garty
M
, et al. A longitudinal assessment of the natural rate of decline in renal function with age
. J Nephrol
. 2014
;27
(6
):635
–41
. 1121-842828.
Jin
XD
, Roethlisberger
S
, Burkhard
FC
, Birkhaeuser
F
, Thoeny
HC
, Studer
UE
. Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution
. Eur Urol
. 2012
;61
(3
):491
–7
. 0302-283829.
Eisenberg
MS
, Thompson
RH
, Frank
I
, Kim
SP
, Cotter
KJ
, Tollefson
MK
, et al. Long-term renal function outcomes after radical cystectomy
. J Urol
. 2014
;191
(3
):619
–25
. 0022-534730.
Nishikawa
M
, Miyake
H
, Yamashita
M
, Inoue
TA
, Fujisawa
M
. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion
. Int J Clin Oncol
. 2014
;19
(6
):1105
–11
. 1341-962531.
Alfred Witjes
J
, Lebret
T
, Comperat
EM
, Cowan
NC
, De Santis
M
, Bruins
HM
, et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
. Eur Urol
. 2017
;71
(3
):462
–75
. 0302-2838© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
