Assessment of complications following urinary diversion for benign indications

To evaluate complications following urinary diversion for non-malignant conditions.

We performed a retrospective review of patients undergoing urinary diversion for benign indications between 2000 and 2017. Data collected including patient demographic and clinical characteristics, surgical characteristics, and complications. Complications were graded using Clavien-Dindo classification and were categorized as early versus delayed (≤ versus > 90 day postoperatively). Logistic regression assessed for predictors of developing any postoperative complication.

A total of 68 patients were identified for study analysis with median follow up of 24 (7-72) months. Sixty-eight and 25% of patients underwent diversion for neurogenic bladder and complications related to pelvic radiation, respectively. A majority (90%) underwent ileal conduit with the remainder undergoing continent diversion. A total of 121 complications were identified, comprising 50 early and 72 delayed. Overall, 77% of patients had at least one complication during the follow up period. Fifty-one percent of patients experienced early complication, while 66% of patients experienced delayed complications. Complications of Clavien-Dindo Score ≥ IIIB were seen in 48% of patients. The most common early complication was wound infection (12%); delayed was urinary tract infection (39%). Multivariable logistic regression modeling found no independent predictors of complication, although the best-fit model included BMI, diabetes, presence of multiple comorbidities, and operative time (hr) as positive predictors of complication.

Our study demonstrates that urinary diversion for benign etiologies is associated with a significant rate of complication. A large percentage of these complications occur in the delayed period and are classified as severe complications.