Reoperation Rate in Patients with a Continent Urinary Diversion or Neobladder Is Influenced by the Oncological or Functional Indication for Cystectomy

Abstract

Purpose: Continent urinary diversion following a cystectomy has become a standard procedure in suitable patients, because of its potentially favorable aspects. Reports concerning long-term complications necessitating reoperation are mainly based on patients with cystectomy for carcinoma. We reviewed the reoperation rate in patients with a continent diversion for both oncological and interstitial cystitis. Materials and Methods: A retrospective study was performed at our department on 63 patients in whom a continent diversion was created in the period from 1984 to 2002. Mean follow-up period was 73.9 months. Statistical analysis for the postoperative complication rate was performed using a multivariate linear stepwise regression, and Cox proportional hazard model. Results: Mean patient-age for the whole group was 53.8 years. Types of diversion used were Indiana (n = 31), Hautmann (n = 21) and Kock (n = 11). The group with an oncological indication for cystectomy consisted of 40 patients (31 male, 9 female) with a mean age of 58.5 years. Reasons for cystectomy were transitional cell carcinoma of the bladder (n = 39) and clear cell vaginal carcinoma (n = 1). The cystitis group was comprised of 23 patients (2 male, 21 female) with a mean age of 45.7 years. Cystectomy was performed for interstitial cystitis (n = 20) and chronic cystitis (n = 3). Multivariate linear stepwise regression of the summed side-effect score yielded a significant association, with the oncological group having less postoperative complications. The Cox proportional hazard model yielded a highly significant difference in revision of the urinary diversion. Reoperation rate in functional patients was 78.3 vs. 22.5% in oncological patients (p < 0.001). Conclusions: Postoperative complication and reoperation rates of continent diversion (or orthotopic neobladder) were significantly higher in patients with non-oncological indications for cystectomy. Therefore, results of continent diversion based on studies with oncological patients should not be used in counselling patients who may need a urinary diversion because of functional reasons such as interstitial cystitis.