Hautmann versus modified Studer orthotopic neobladder after radical cystectomy

To compare urinary diversion (UD)-specific complications, perioperative, and patient-reported outcomes between Hautmann and modified Studer orthotopic neobladder (ONB) configurations after radical cystectomy (RC).

We evaluated 340 patients who underwent open RC with either Hautmann (n = 161) or modified Studer (n = 179) ONB reconstruction at a high-volume RC centre and were followed for UD-specific complications and patient-reported outcomes. The primary endpoint was a composite of UD-specific complications within 3 years of RC. Secondary endpoints were perioperative outcomes and patient-reported outcome measures (PROMs), including intermittent self-catheterisation (ISC) burden. Propensity score matching was performed a priori to adjust for confounders and yielded 104 matched pairs (n = 208).

At a median follow-up of 3 years, UD-specific complications, including structural upper urinary tract complications, urinary anastomotic leakage, and infectious complications, did not differ significantly between the modified Studer and Hautmann ONB configurations. Perioperative outcomes, including major complications (Clavien-Dindo Grade ≥III) and short-term mortality, were comparable between groups, as were health-related quality of life and Decision Regret Scale scores. In contrast, ONB outlet obstruction occurred more frequently in modified Studer patients and was associated with the modified Studer configuration in an exploratory multivariable analysis (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.15-8.78; P = 0.032), as was 90-day readmission (OR 1.87, 95% CI 1.05-3.39; P = 0.036). Among ISC users, the modified Studer configuration was associated with higher Intermittent Self-Catheterisation Questionnaire ease-of-use scores (β = +17.4, 95% CI 1.40-33.5; P = 0.034).

The Hautmann and modified Studer ONB configurations demonstrated comparable UD-specific complications, perioperative outcomes, and PROMs at a median follow-up of 3 years after RC. In an exploratory analysis, the modified Studer configuration was associated with a significantly higher rate of ONB outlet obstruction, a finding that warrants validation in larger multicentre cohorts.