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Continent cutaneous urinary diversion (CCUD) leads to high continence rates for patients post-cystectomy. However, most patients require reintervention within five years, highlighting a trade-off in urinary diversion management.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Limited data exists on functional outcomes of continent cutaneous urinary diversions (CCUD).
  • This study aims to provide insights for shared decision-making in urinary diversion.
  • Investigating long-term outcomes after cystectomy with CCUD construction is crucial.

Purpose of the Study:

  • To investigate long-term functional outcomes of continent cutaneous urinary diversions (CCUD).
  • To guide shared decision-making for patients undergoing urinary diversion.
  • To assess continence rates, reintervention risks, complications, and kidney function post-cystectomy with CCUD.

Main Methods:

  • Retrospective review of 50 medical records of patients who underwent cystectomy with CCUD (2010-2023).
  • Primary outcome: continence rate. Secondary outcomes: late reinterventions, complications, and kidney function.
  • Competing risks analysis was used to calculate the cumulative risk of reintervention.

Main Results:

  • Median follow-up was 5.7 years.
  • 92% of patients achieved 3-hour continence within a median of 167 days post-surgery.
  • An absolute five-year cumulative risk of reintervention was 71%, with 2/3 patients needing at least one reintervention.

Conclusions:

  • Continent cutaneous urinary diversion (CCUD) enables high continence rates for patients post-cystectomy.
  • The majority of patients (71%) require reintervention within five years.
  • Shared decision-making should consider the high reintervention rate alongside continence achievement.