Urinary Diversion-Specific Morbidity After Radical Cystectomy: A Ten-Year Institutional Experience.

Area of Science:

• Urology
• Oncology
• Surgical Complications

Background:

• Radical cystectomy (RC) for bladder cancer (BC) necessitates urinary diversion.
• Various diversion techniques carry distinct complication profiles.
• Understanding these risks is crucial for patient management.

Purpose of the Study:

• To investigate correlations and risk factors for complications following different urinary diversion methods post-RC.
• To identify predictors of early and late complications.
• To compare complication rates across diversion types.

Main Methods:

• Retrospective analysis of 574 BC patients (2012-2022).
• Categorization of complications into early and late occurrences.
• Multistate Cox regression, stepwise logistic regression, and heat map analysis.

Main Results:

• Ureterostomy linked to higher rates of late urinary tract infections (UTIs), nephrolithiasis, and psychological distress.
• Bricker conduits associated with small-bowel obstruction and ureteroenteric strictures.
• Orthotopic neobladders correlated with incontinence and urinary retention; robot-assisted laparoscopy reduced certain complications.

Conclusions:

• Ureterostomy requires vigilant monitoring for UTIs, renal issues, and psychological disorders.
• Bricker conduits necessitate surveillance for gastrointestinal complications; orthotopic neobladders demand careful patient selection due to incontinence and metabolic concerns.
• Advanced age, smoking, advanced tumor stage, and prolonged hospitalization are key predictors of complications.