Abstract
BackgroundMost of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC.MethodsThis retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications.ResultsDemographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups.ConclusionsBoth of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.
Highlights
Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion
Full list of author information is available at the end of the article
Both groups were similar in terms of age, gender, American Society of Anesthesiologist (ASA) score, Body mass index (BMI), staging, and comorbidities
Summary
Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC. Most of the complications after RC are directly associated with the type of urinary diversion [4]. In 1852, Simon first described the urinary diversion procedure and Bricker in 1950 popularized the ileal conduit (IC) technique [5]. Johnston described uretero-cutaneostomy in 1963 for a patient with congenital urinary obstruction [7] Later this procedure, called transuretero-cutaneostomy (TUC), was used with pelvic malignancy. Called transuretero-cutaneostomy (TUC), was used with pelvic malignancy Both of these techniques have been discussed in several studies regarding advantages and disadvantages [8]. Several clinical considerations remain problematic, including the time of procedure, postoperative complications, and length of stay
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