The Long-Term Follow-Up and Complications Associated with Urinary Diversion in the Cancer Survivor

Abstract

Over 60 % of patients can experience some type of long-term complication after radical cystectomy and urinary diversion (UD). However, assessment of late complications is challenging due to limited long-term available data for follow-up, different surgical techniques of UD, and selection bias towards diversion type. The aim of this article was to perform a systematic review and classify long-term complications from UD after radical cystectomy for bladder cancer. Renal insufficiency is the most commonly reported high grade adverse event, followed by ureteroenteric anastomotic strictures and bowel complications. Urinary infections are very common and challenging to assess given the presence of colonization and vague symptoms that can be associated to this diagnosis and pyelonephritis if presence of flank pain. Common complications by diversion type include stones, stomal stenosis, or parastomal hernia for urinary conduit and continent cutaneous urinary diversions, as well as urinary incontinence for orthotopic neobladder. Long-term complications are common after radical cystectomy and urinary diversion. Follow-up should be implemented for life to survey for complications. Improving access to these patients and communication with their local practitioners or local urologists when referred back to specialized urology clinic is fundamental to manage these long-term complications.