MP25-05 URINARY DIVERSION WITH OR WITHOUT CONCOMITANT BENIGN CYSTECTOMY FOR RADIOGENIC AND NON-RADIOGENIC CONDITIONS: A COMPARATIVE MORBIDITY ASSESSMENT ACCORDING TO THE UPDATED EAU GUIDELINES ON STANDARDIZED COMPLICATION REPORTING

Abstract

You have accessJournal of UrologyCME1 May 2022MP25-05 URINARY DIVERSION WITH OR WITHOUT CONCOMITANT BENIGN CYSTECTOMY FOR RADIOGENIC AND NON-RADIOGENIC CONDITIONS: A COMPARATIVE MORBIDITY ASSESSMENT ACCORDING TO THE UPDATED EAU GUIDELINES ON STANDARDIZED COMPLICATION REPORTING Malte W. Vetterlein, Hang Yu, Maria Buhné, Philipp Gild, Mara Kölker, Armin Soave, Roland Dahlem, Margit Fisch, and Michael Rink Malte W. VetterleinMalte W. Vetterlein More articles by this author , Hang YuHang Yu More articles by this author , Maria BuhnéMaria Buhné More articles by this author , Philipp GildPhilipp Gild More articles by this author , Mara KölkerMara Kölker More articles by this author , Armin SoaveArmin Soave More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Margit FischMargit Fisch More articles by this author , and Michael RinkMichael Rink More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As opposed to radical cystectomy for cancer, few studies have focused on morbidity after urinary diversion (UD) ± benign cystectomy (BC). We here provide an in-depth evaluation of 30-d morbidity in patients undergoing UD±BC using the updated EAU guidelines for standardized reporting. METHODS: We performed a chart review of patients undergoing UD±BC in 2009-17. We tabulated 30-d complications by a predefined catalog and graded them by the Clavien-Dindo classification (CDC) and each individual Comprehensive Complication Index (CCI®). Traditional morbidity endpoints were used to compare UD+BC vs. UD alone. By multivariable regression models we evaluated the impact of the ablative part (BC) vs. the reconstructive part (UD) on cumulative perioperative morbidity. Multivariable analyses were repeated in a subgroup of irradiated patients. RESULTS: Of 97 patients, 46 (47%) and 51 (53%) underwent UD+BC and UD alone, respectively. Patients with UD+BC were older (median 66 vs. 56 yr) and more comorbid (median Charlson index 4.0 vs. 3.0) vs. UD alone (p≤0.020). Other baseline characteristics (gender, BMI, ASA status, kidney function, hx of radiotherapy) were comparable (all p≥0.4). In 49 (51%) patients, surgery was indicated by radiogenic issues, neurogenic bladder (12%), interstitial cystitis (12%), and genital disorders (10%). Non-radiogenic incontinence (2.1%), fistula (3.1%), bladder contracture (5.2%), and outlet obstruction (4.1%) were rare. Overall, 69 (71%) received continent UD and 26 (27%) a Mitrofanoff procedure, of which 12 (46%) had augmentation cystoplasty. We found 390 complications in 97 patients (100%), with 7 (7.2%) major complications (CDC ≥IIIb), 3 (3.1%) readmissions, and no deaths. There was no difference between the groups regarding the incidence of complication subgroups (gastrointestinal, infectious, etc.; all p≥0.05; Figure 1). The median CCI® was higher for UD+BC compared to UD alone (32 vs. 24; p=0.005). In multivariable analyses, neither BC in addition to UD (p=0.2) nor a hx of pelvic radiotherapy (p=0.2) were associated with a higher morbidity burden as measured by the CCI® after adjusting for confounders. Similar results were found in the subgroup of irradiated patients. CONCLUSIONS: Neither the ablative part nor prior radiotherapy did impact morbidity in our series. Hence, BC should be considered in patients who might benefit from the procedure to avoid long-term sequelae of the retained bladder. Source of Funding: n/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e429 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte W. Vetterlein More articles by this author Hang Yu More articles by this author Maria Buhné More articles by this author Philipp Gild More articles by this author Mara Kölker More articles by this author Armin Soave More articles by this author Roland Dahlem More articles by this author Margit Fisch More articles by this author Michael Rink More articles by this author Expand All Advertisement PDF DownloadLoading ...