Unilateral cutaneous ureterostomy with separate stomata vs ileal conduit after radical cystectomy

Urinary diversion (UD) after radical cystectomy (RC) is a complex surgery that has effects on different patient aspects. The optimal UD method should be technically simple, functionally effective, and socially satisfying. The persistent controversy over the optimal method of UD is the rationale for conducting this study, given the characteristics of the population in our region. Simple UD methods include ureterocutaneous and ileal conduit (IC).

To compare the surgical outcomes and to identify the factors influencing quality-of-life (QoL) after RC with cutaneous ureterostomy (CU) with separate stomata or IC.

A prospective non-randomized study was performed on patients who underwent RC from October 2020 to March 2022. The demographic and clinical characteristics and QoL were compared in patients with IC and unilateral CU with separate stomata. The primary outcome was the difference in the QoL scores between patients with CU (group A) and those with IC (group B). QoL was assessed 6 months after surgery, using the validated Functional Assessment of Cancer Therapy-Bladder questionnaire.

This study included 32 patients with a median age (range) of 61 (48-83) years and a median (range) body mass index of 23.95 (19.2-30.2) kg/m². Wound infections (68.8%) and paralytic ileus (50%) were the commonest complications. The mortality rate was 18.8%, and the main cause was septicemia. The median time of the shunt procedure was significantly longer in group B (P < 0.001). Also, the postoperative anemia (P = 0.029), the days between appliance base changes (P < 0.001), and the rate of febrile urinary tract infections (P = 0.017) were higher in group A. However, the score of QoL (P = 0.025) and survival rate (P = 0.004) were significantly better in group B than in group A. The median QoL score for group A was 68 (52-90) while the median QoL score for group B was 80.50 (62-103) (P = 0.029). Serum creatinine level (P = 0.045), recurrent urinary tract infections (P = 0.025), and the number of re-interventions (P = 0.010) had a significant inverse association with QoL. However, the estimated glomerular filtration rate showed a significant proportional relation (P = 0.006).

Unilateral CU with separate stomata may be associated with higher rates of postoperative anemia and urinary tract infections. However, IC seems to be associated with better QoL and febrile urinary tract infections. Increased serum creatinine level, recurrent infections, and re-interventions may influence the QoL score. Unilateral CU with separate stomata may still represent an option for patients undergoing RC.