Ileal Conduit Group Research Articles

Reliability and Preliminary Validation of a Body Image Scale Survey for Use in Bladder Cancer Patients

Introduction Extirpative bladder surgery for bladder cancer requires urinary diversion which causes cosmetic and functional changes that affect a patient’s body image and quality of life. Current health-related quality of life (HRQOL) surveys validated for use in bladder cancer patients have no dedicated domain evaluating body image. We sought to validate the ten-item Body Image Scale (BIS) for use in bladder cancer patients. The BIS is scored on a 4-point Likert scale with a maximum score of 30. Higher scores represent increasing distress. Methods With Institutional Review Board approval, native English or Spanish speaking patients who had undergone radical cystectomy and urinary diversion with either ileal conduit formation or orthotopic neobladder creation within the past 5 years for muscle-invasive bladder cancer were identified. The survey was conducted via telephone or e-mail. Surveys were scored and analyzed for reliability and validity. Results 32 patients were identified (22 men, 10 women). 25 patients had ileal conduits and 7 had orthotopic neobladders. Cronbach’s alpha reliability coefficient measuring internal consistency for the BIS instrument in this group was 0.926. All ten items met the response criteria (score of >0 by >30% respondents) in our study population. Though the ileal conduit group mean (17.4) and median (16) scores were lower than the neobladder (mean=19.1 and median=22), there was no statistically significant difference in BIS scores between the two cohorts (p=0.755). Conclusions We present a validation study for use of BIS in bladder cancer patients to be utilized in future clinical trials or psycho-oncology research.

Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis.

Urinary diversion in bladder cancer treatment has been a distinguished topic of interest due to varying approaches available. Amongst them, ileal conduit (IC) and transuretero-ureterostomy (TUU) have been popular options in clinical practice. This study would like to compare the long-term outcomes of IC and TUU in patients undergoing RC procedures. Literature searches were conducted in MEDLINE, CENTRAL, and EMBASE. Duration of hospitalization, complication rate, quality of life, and survival rate were selected as outcomes. Risk of bias was assessed using the ROBINS-I tool. Outcome measure was pooled using forest plot in Review Manager V.5 for Macintosh. Heterogeneity was measured using the DerSimonian and Laird random-effects model. Eighteen matching interventional studies were included, 3 were prospective studies. The total number of included samples was 3,689; 1,172 patients of the TUU and 2,517 of IC group. The IC procedure associates with longer hospitalization [mean difference 3.80 [95% confidence interval (CI): 2.27-5.32), p < 0.001, I2 = 92%]. Duration of intensive care did not differ significantly. There were no differences in major complication rates [odds ratio (OR) = 1.45, 95% CI: 0.74-2.84, p = 0.27, I2 = 54%]: stone formation (OR = 1.07, 95% CI: 0.51-2.23, p = 0.48, I2 = 0%), and renal function deterioration (OR = 0.81, 95% CI: 0.39-1.68, p = 0.57, I2 = 0%) between the TUU and IC groups. Quality of life decreased in both groups, and only occurred in the early days after the stoma placement phase. Survival rates were not different among the groups. TUU is a better UD option as it offers shorter time of hospitalization, with the similar major complications, quality of life, and survival rate compared to IC.

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Introduction: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. Results: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9–12 with HS-IA vs. 13 days range 12–16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. Conclusion: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.

Analysis of the efficacy of a single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy

BackgroundRadical cystectomy and urinary diversion are the standard surgical treatments for patients with muscle-invasive or high-risk, or recurrent non-muscle-invasive bladder cancer. Although this approach significantly prolongs patient survival, it can lead to postoperative complications. This study aims to compare the efficacy and complications of bilateral cutaneous ureterostomy with a single subumbilical stoma to those of cutaneous ureterostomy with two stomas and an ileal conduit as a means of urinary diversion after radical cystectomy. The findings of this study will provide valuable information for healthcare providers in selecting the appropriate urinary diversion method for their patients.MethodsThe clinical data for 108 patients who received bilateral cutaneous ureterostomy with a single subumbilical stoma (ureterostomy with a single stoma group), cutaneous ureterostomy with two stomas (ureterostomy with two stomas group), or an ileal conduit (ileal conduit group) after radical cystectomy were retrospectively analysed. The operative time, pathological stage, survival status, perioperative complication rate, rate of successful first extubation, rehospitalization rate at 6 months after surgery,ostomy-related medical costs,and postoperative quality of life were compared between the three groups of patients.ResultsA significant difference in the operative time was found between the three groups (P = 0.001). No significant differences in pathological stage, survival status, perioperative complication rate, rehospitalization rate at 6 months after surgery, or bladder cancer index (BCI) score were identified among the three groups. The difference in the successful first extubation rate between the three groups of patients was significant (P = 0.001). Significant differences in ostomy-related medical costs were observed among the three groups of patients (P = 0.006).ConclusionA single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy may result in shorter surgery time, increased success rates for initial catheter removal, and lower medical expenses. However, to confirm these findings, further prospective randomized clinical trials are necessary.

Minimizing the learning curve for robotic-assisted radical cystectomy: A single-surgeon, retrospective, cohort study.

Studies published to date have suggested non-inferiority of robotic-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC), while few centers in Canada have adopted this approach. Though multifactorial, the learning curve and operative time are often discussed barriers. Herein, we present outcomes from the largest Canadian cohort of RARC performed to date. We conducted a retrospective chart review of all patients undergoing RARC by a single surgeon with greater than 1500 robot-assisted radical prostatectomy (RARP) experience at our institution from May 2020 to December 2021. Clinicopathological, intraoperative, and postoperative data, as well as complications in the first 90 days were collected. Regression analysis was used to determine the relationship between case volume and operative time/lymph node yield. A total of 31 patients underwent RARC during the study period, 26 of which were male. The median length of stay was six days (Q1-Q3 5-10), while days alive and out of hospital at 90 days were 83 days (Q1-Q3 80-85). Soft tissue margins were positive in 9.6% (3/31) of patients. Median lymph node yield was 17.0 lymph nodes (Q1-Q3 11-23). Median operative time was 241 minutes (Q1-Q3 228-252) in the ileal conduit group and 320 minutes (Q1-Q3 302-337) in the neobladder group. We observed four Clavien-Dindo grade >3 complications. The 90-day readmission rate and mortality rate were 17.2% (5) and 0% (0), respectively. There was no correlation between case volume and any outcome variables. Previous high-volume experience performing RARP reduces the learning curve for preforming RARC, with similar short-term outcomes to high-volume centers.

Double barrelled uro-colostomy versus Ileal conduit for urinary diversion following pelvic exenteration: a single centre experience.

The ideal method for urinary diversion following total pelvic exenteration (TPE) remains unclear. This study compares the outcomes of double-barrelled uro-colostomy (DBUC) and ileal conduit (IC) in a single Australian centre. All consecutive patients who underwent pelvic exenteration with the formation of either a DBUC or an IC between 2008 and November 2022 were identified from the prospective database from the Royal Adelaide Hospital and St. Andrews Hospital. Demographic, operative characteristics, general perioperative, long-term urological and other relevant surgical complications were compared via univariate analyses. Of 135 patients undergoing exenteration, 39 patients were eligible for inclusion: 16 patients with a DBUC, and 23 patients with an IC. More patients in the DBUC group had previous radiotherapy (93.8% vs. 65.2%, P = 0.056) and flap pelvic reconstruction (93.7% vs. 45.5%, P = 0.002). The rate of ureteric stricture trended higher in the DBUC group (25.0% vs. 8.7%, P = 0.21), but in contrast, urine leak (6.3% vs. 8.7%, P>0.999), urosepsis (43.8% vs. 60.9%, P = 0.29), anastomotic leak (0.0% vs. 4.3%, P>0.999), and stomal complications requiring repair (6.3% vs. 13.0%, P = 0.63) trended lower. These differences were not statistically significant. Rates of grade III or greater complications were similar; however, no patients in the DBUC group died within 30-days or had grade IV complications requiring ICU admission compared with two deaths and one grade IV complication in the IC group. DBUC is a safe alternative to IC for urinary diversion following TPE, with potentially fewer complications. Quality of life and patient-reported outcomes are required.

MP32-05 PERIOPERATIVE OUTCOMES OF CUTANEOUS URETEROSTOMY AND ILEAL CONDUIT URINARY DIVERSION WITH RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP32-05 PERIOPERATIVE OUTCOMES OF CUTANEOUS URETEROSTOMY AND ILEAL CONDUIT URINARY DIVERSION WITH RADICAL CYSTECTOMY Justin Refugia, Lily Velet, Parth Thakker, Randy Casals, Corey Able, and Matvey Tsivian Justin RefugiaJustin Refugia More articles by this author , Lily VeletLily Velet More articles by this author , Parth ThakkerParth Thakker More articles by this author , Randy CasalsRandy Casals More articles by this author , Corey AbleCorey Able More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is a highly morbid procedure with room for improvement. The choice of urinary diversion between ileal conduit (IC) or cutaneous ureterostomy (CU) following RC is controversial and warrants investigation. In this study, we present our experience with IC and CU urinary diversions and their perioperative outcomes. METHODS: We retrospectively reviewed patients who underwent IC or CU urinary diversion following RC. For CU, using a modified Ariyoshi technique, a single urostomy was created with eversion of the ureteral nipple over a triangular skin flap. Data were collected on patient demographics, pathology, operative details, and post-operative outcomes. Comorbidity was calculated using the Elixhauser-Index (EI). Primary objectives were length-of-stay (LOS) and operative time. Secondary objectives were 30-day post-operative Clavien-Dindo complications (Major: grades III-V) and 30-day readmissions. RESULTS: Between 2020 and 2022, we identified 52 patients that had IC (50%) or CU (50%) following RC. The median (IQR) age was 71 years (62-77) with 77% men and 23% women. Age and sex were similar between both groups. The overall median EI was 4 (0-8.7). The median EI was higher in the CU group at 5 (2.3-10) compared to IC group at 3.5 (0-6.3) (p=0.06). The median BMI was lower in the CU group at 25 (22-29) compared to IC group at 29 (25-34) (p=0.03). The median operative time was shorter for the CU group at 237 minutes (198-282) compared to IC group at 326 minutes (289-395) (p<0.01). The median LOS was shorter for the CU group at 3 days (3-7) compared to IC group at 4 day (4-6) (p=0.049). The 30-day overall complication rate was identical at 73%. The 30-day major complication rates were similar with CU group at 19% and IC group at 16% (p>0.99). The 30-day readmission rates were similar with CU group at 35% and IC group at 31% (p>0.99). CONCLUSIONS: Our results suggest that CU is a safe and feasible urinary diversion that compares favorably to IC. The advantage of decreased operative time and length of stay with CU may expand indications for RC in more comorbid patients while maintaining similar complication rates to IC. Further studies are expected to clarify these associations. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e441 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Refugia More articles by this author Lily Velet More articles by this author Parth Thakker More articles by this author Randy Casals More articles by this author Corey Able More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-18 SPECTRUM AND INCIDENCE OF URINARY TRACT INFECTIONS (UTI) IN PATIENTS UNDERGOING RADICAL CYSTECTOMY: RESULTS FROM A SINGLE CENTER STUDY AND PROPOSAL FOR ERAS PROTOCOL

You have accessJournal of UrologyCME1 Apr 2023MP46-18 SPECTRUM AND INCIDENCE OF URINARY TRACT INFECTIONS (UTI) IN PATIENTS UNDERGOING RADICAL CYSTECTOMY: RESULTS FROM A SINGLE CENTER STUDY AND PROPOSAL FOR ERAS PROTOCOL Vito Lorusso, Antoine Le Quellec, Claire Rion, Andrea Pacchetti, Laure Doisy, François Lannes, Davidson Sypre, Nicolas Branger, Thomas Maubon, Stanislas Rybikowski, Antonio Granata, Andrea Gregori, Geraldine Pignot, and Jochen Walz Vito LorussoVito Lorusso More articles by this author , Antoine Le QuellecAntoine Le Quellec More articles by this author , Claire RionClaire Rion More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Laure DoisyLaure Doisy More articles by this author , François LannesFrançois Lannes More articles by this author , Davidson SypreDavidson Sypre More articles by this author , Nicolas BrangerNicolas Branger More articles by this author , Thomas MaubonThomas Maubon More articles by this author , Stanislas RybikowskiStanislas Rybikowski More articles by this author , Antonio GranataAntonio Granata More articles by this author , Andrea GregoriAndrea Gregori More articles by this author , Geraldine PignotGeraldine Pignot More articles by this author , and Jochen WalzJochen Walz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) has a high rate of postoperative complications. Our aim was to assess the spectrum of UTI and efficacy of our ERAS protocol. METHODS: We analyzed prospectively collect data from 206 patients (Pts) undergoing RC at our Institution from 2015 to 2020. A fully comprehensive ERAS protocol was applied. Urine cultures (UCs) were taken before surgery and Pts treated accordingly. One-shot intraoperative antibiotic (ABT) prophylaxis was used. UCs were collected from urinary drains (UD) at POD 4. Pts with positive UCs and Ileal conduit (IC) were not treated if asymptomatic whilst all Neobladder (NB) pts with positive UCs received ABT based on reports till complete removal of UDs (POD 10). Pts with NB and negative UCs received short-term ABT 24h prior and after neobladder catheter ablation. Rate of in-hospital UTIs was recorded, differentiated and defined as Systemic inflammatory Response Syndrome (SIRS) and Sepsis (SEP) according to Sepsis-3 Consensus Definitions. RESULTS: Clinicopathological characteristics are in Table 1. Pathogens are shown in Figure 1. Overall, 17/178 (9.4%) of Pts experienced SIRS, 18/178 (9.9%) sepsis whilst the remainder 147/178 (80.7%) did not have any UTI. In the IC group, occurred 7/75 (9.3%) and 8/75 (10.7%) cases of SIRS and SEP respectively. In same group, 56/75 (74.5%) had bacteriuria, of them 32/75 (57%) did not receive ABT as per protocol, resulting in only 1/75 (1%) case of UTI-SIRS. There was no significant difference in rate of SIRS (p=0.6) and SEP (p=0.4) in pts with UC+ and UC- for IC Pts. In the Neobladder (NB) group, there were 10/103 (9.7%) and 10/103 (9.7%) of SIRS and SEP respectively. 81/103 (78.6%) of NB pts had bacteria in at last one UD. There was no significant difference in rate of SIRS (p=0.6) and SEP (p=0.3) in Pts with UC+ and UC- for NB patients. No statistically significant difference (p>0.5) was observed in both groups in the rate of UTI considering surgical approach (Open vs Robotic). CONCLUSIONS: UTI-related complications represent a challenge after RC. Our protocol is safe and effective to maintain the rate of UTIs low allowing for effective use of ABT according to the principles of antimicrobial stewardship and ERAS. Our protocol seems to be effective for both urinary reconstructions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e639 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vito Lorusso More articles by this author Antoine Le Quellec More articles by this author Claire Rion More articles by this author Andrea Pacchetti More articles by this author Laure Doisy More articles by this author François Lannes More articles by this author Davidson Sypre More articles by this author Nicolas Branger More articles by this author Thomas Maubon More articles by this author Stanislas Rybikowski More articles by this author Antonio Granata More articles by this author Andrea Gregori More articles by this author Geraldine Pignot More articles by this author Jochen Walz More articles by this author Expand All Advertisement PDF downloadLoading ...

Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion

ABSTRACT Objectives To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates. Methods We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD. Results A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R2 = 0.96, P < 0.001), this was not associated with a change in the rates of CUD over the same period (P = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R2 = 0.33, P = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, P = 0.03), academic centres (OR 1.74, P = 0.001), and lower T stage (T4 vs T2; OR 0.78, P = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (P = 0.8). Conclusions There is significant nationwide increasing trend of adoption of RARC. This diffusion was not associated with a decline in CUD, which remains significantly underutilised in both ORC and RARC groups. Abbreviations CUD: continent urinary diversion; ICD-O: International Classification of Diseases for Oncology; ICUD: ileal conduit urinary diversion; (N)MIBC: (non-)muscle-invasive bladder cancer; NAC, neoadjuvant chemotherapy; NCDB: National Cancer Database; OR: odds ratio;(O)(RA)RC: (open) (robot-assisted) radical cystectomy

Ileal conduit versus neobladder: A propensity score-matched analysis of the effect on renal function.

To analyze the long-term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion. We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal conduit patients were matched in a 1:2 ratio and a propensity score-matched analysis was carried out. Data were summarized using descriptive analysis. Trend plots were generated using baseline and follow-up creatinine values to compare estimated glomerular filtration rate at 3 months, then annually for 5 years. Variables associated with estimated glomerular filtration rate were assessed using multivariate linear analysis. Our cohort consisted of 137 patients (neobladder n = 50 and ileal conduit n = 87) with a median follow-up time of 3 years (interquartile range 1-7 years). The ileal conduit group had shorter operative times (352 vs 444 min, P < 0.01), intracorporeal diversions were more common (66% vs 44%, P = 0.01), had prior abdominal surgery (66% vs 38%, P < 0.01) and had radiation (9% vs 0%, P = 0.03). The neobladder group more commonly had recurrent urinary tract infections (22% vs 3%, P < 0.01) and a steeper decrease in estimated glomerular filtration rate in the first year. On multivariate linear analysis, age/year (-0.59), body mass index per kg/m2 (-0.52), preoperative estimated glomerular filtration rate per unit (0.51), recurrent urinary tract infections (-14.03) and time versus day 90 (year 1, -7.52; year 2, -9.06; year 3, -10.78) were significantly associated with estimated glomerular filtration rate. Ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot-assisted radical cystectomy. Recurrent urinary tract infections were associated with a worse estimated glomerular filtration rate.

Predictors for Outcome and Complications Related to Urinary Diversion.

Predictors for complications such as insufficiency of intestinal anastomosis in urinary diversion and other risk factors are not well defined. We aimed to elucidate predictive factors for complications in urinary diversions based on preoperative comorbidities and major complications. A special focus was set on anastomosis insufficiency as a major complication. Preoperative comorbidities, postoperative complications, duration of hospital stay, and follow-up were analyzed in 317 patients with urinary diversion. The impact of preoperative comorbidities on diversion types was described and quantified as defined by the age-adjusted Charlson Comorbidity Index. Overall, 14.8% of patients showed anastomosis-related complications, most within the ileal conduit group (15.9% in the cohort). Severe complications (Clavien-Dindo Classification Score >IIIa) were found in smokers (p=0.046), and in patients with vascular diseases (p=0.007), a high American Society of Anaesthesiologists (ASA)-score (p=0.047), a R1- (p=0.009), as well as a pN1 (p=0.007) status. Several independent predictors for several postoperative complications in urinary diversions were identified, which were independent of the diversion method.

Favorable surgical outcomes and perioperative complication rates after robotic radical cystectomy and intracorporeal urinary diversion at a single, low-volume center: Initial experience with 65 consecutive cases

1.1. Purpose: This study aimed to evaluate the surgical outcomes and perioperative complications among patients who underwent robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD). 1.2. Methods &amp; materials: We retrospectively reviewed the clinical and pathological records of 65 consecutive patients who underwent RARC with ICUD between November 2018 and June 2021 at Gifu University. The patients were divided into three groups according to the type of urinary diversion: ureterocutaneostomy (UC), ileal conduit (IC), and ileal neobladder (NB). The endpoints of this study were surgical outcomes and perioperative complications according to the type of UD. 1.3. Results: There were no significant differences between the IC and NB groups with respect to the total operation time. TwentyPage -01 World Journal of Clinical Surgery Open Access https://www.wjclinicalsurgery.com seven complications were registered in the first 90 days. The most frequent early complication was urinary tract infection in 11 patients. 1.4. Conclusion: Our initial experience with RARC followed by ICUD was favorable, with acceptable surgical outcomes and perioperative complications.

Quality of Life and Renal Functional Status In Patients With Cutaneous Ureterostomy and Ileal Conduit Urinary Diversion after Radical Cystectomy

Introduction: Radical cystoprostetectomy in male patients and anterior pelvic exenteration in female patients coupled with en-block pelvic lymphadenectomy and urinary reconstruction or diversion remains the gold standard surgical approach to muscle invasive bladder cancer in the absence of metastatic disease. In Bangladesh, commonly performed urinary diversions are Cutaneous ureterostomy and Ileal conduit. Types of urinary diversion have a great impact on different aspects of quality of life (QoL) as well as post -operative renal function. Aims and Objectives: This study was designed to compare the Quality of Life and Renal Function in between Cutaneous ureterostomy and Ileal conduit urinary diversion after radical cystectomy. Methodology: This was a hospital based Quasi Experimental study in which patients were selected by purposive sampling and, conducted from July, 2017 to September, 2018 in the department of Urology Bangabandhu Sheikh Mujib Medical University. This study was performed among the patients with muscle invasive bladder cancer treated by radical cystectomy with cutaneous ureterostomy or Ileal conduit fulfilling the exclusion and inclusion criteria. Total 34 patients were taken for the study, among them 17 for cutaneous ureterostomy and, 17 for Ileal Conduit Group. Quality of Life was assessed through EORTC-QLQ-C30 questionnaire both pre and post operatively (3 months after operation). Renal function was assessed before and 1st POD, 7thPOD, one month and three months after operation by measuring eGFR. Result: Mean age of the patients was 59.00 ± 8.60 years and 53.35 ± 8.43years in group- A (Cutaneous ureterostomy) and group-B (Ileal conduit) respectively. Three months after operation, overall QoL in all scales were improved in both group but, more improvements were noted in group-B than group-A which were statistically significant (p&lt;0.05). The mean pre-operative eGFR was significantly lower in group-A than group-B (p&lt;0.001). Three months after operation, statistically significant differences in eGFR, were observed within, and in between two groups (p&lt;0.05). Percentage of eGFR changed (renal function deterioration) were significantly more in group-A than group-B (p=0.001). Conclusion: Quality of life, after radical cystectomy with ileal conduit is better than cutaneous ureterostomy and, post- operative renal function deterioration significantly less in ileal conduit group than cutaneous ureterostomy group. So, ileal conduit is an appropriate option of urinary diversion for the patient those who permit prolong operative procedure. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.142-150

The impact of orthotopic neobladder vs ileal conduit urinary diversion after cystectomy on the survival outcomes in patients with bladder cancer: A propensity score matched analysis.

BackgroundBladder cancer (BCa) is the most common urinary malignancy. The standard surgical treatment for patients with muscle‐invasive BCa is cystectomy plus urinary diversion. Ileal conduit (IC) or orthotopic neobladder (ON), which have different indications, are the most commonly performed urinary diversions.Methods and materialsWe sampled 5480 BCa patients from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Kaplan‐Meier method with the log‐rank test was used to assess cancer‐specific survival (CSS) and overall survival (OS). Univariate and multivariate Cox's proportional hazard model was conducted to evaluate the hazard ratio of cancer‐specific mortality and all‐cause mortality before and after propensity score matching (PSM).ResultsWe identified 5480 patients who received radical cystectomy (RC) plus IC (n = 5071) or ON (n = 409) with a median follow‐up period of 33 months (interquartile range, 13‐78 months). Patients in the ON group tended to be male and younger, with a higher percentage of married individuals, early pathological T stage, lymphadenectomy, and non‐radiotherapy (all P < .05). After 1:1 PSM, 409 matched pairs were selected. Univariate and multivariate analysis showed that the ON group had better CSS and OS probabilities than the IC group in the overall cohort [hazard ratio (HR): 0.692, 95% confidence intervals (CI): 0.576‐0.831, P < .001; HR: 0.677, 95% CI: 0.579‐0.793, P < .001 respectively]. However, subgroup analysis revealed that only patients with pathological T2 stage benefited from ON diversion after PSM in the context of CSS (P = .016) and OS (P <.001).ConclusionsYoung, married, and male patients with early pathological T stage, especially T2 stage, were more suitable to receive RC plus ON surgery, which could improve their probability of survival.

Febrile Urinary Tract Infection after Radical Cystectomy with Urinary Diversion: Different Characteristics in Patients with Ileal Conduit and Orthotopic Neobladder

Background and ObjectiveTo compare the incidence of febrile urinary tract infection (UTI) and bacterial identification between patients with orthotopic neobladder (ONB) and ileal conduit (IC). Materials and MethodsData of 164 patients who underwent radical cystectomy with ONB and IC for bladder cancer between January 2009 and January 2018 at our institution were analyzed. Febrile UTI observed was listed and subsequently compared. Incidence of febrile UTI, clinicopathological characteristics, and microorganisms identified were reported at 3 months interval; and preoperative predictors of febrile UTI were evaluated with Cox regression analysis. Patients were divided into ONB and IC. ResultsThe study cohort included 52 patients with ONB and 112 patients with IC. Febrile UTI was diagnosed in 49 (29.9%) patients. Compared to IC group, ONB group had significantly higher incidence of young age (p=0.00), lower cancer stage (p=0.013), longer hospital stay (p=0.049), longer operation time (p=0.00), and higher incidence of febrile UTI within the first 3 months after surgery (p=0.006). On univariable and multivariable analysis, factors associated with significantly increased febrile UTI risk were diabetes (odds ratio [OR]: 4.52; p=0.002) and ONB diversion (OR: 1.27; p=0.031). Forty-four (89.8%) patients were culture positive. However, significant difference in microorganisms was not detected between patients who under-went ONB or IC diversion. ConclusionDiabetes and ONB diversion were associated with higher risk symptomatic UTI following radical cystectomy.

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

The relationship between type of urinary diversion and quality of life after radical cystectomy: Ileal conduit versus orthotopic bladder.

ObjectivesWe aimed to compare health‐related quality of life (HrQoL) in patients who underwent ileal conduit (IC) vs orthotopic neobladder (ONB) as a method of urinary diversion (UD) after radical cystectomy (RC) for invasive bladder cancers.MethodsThe questionnaires of the Functional Assessment of Cancer Therapy‐Bladder Cancer (FACT‐BL) were used to evaluate and compare the HrQoL in 113 patients with 1 year follow‐up.ResultsForty‐nine patients were included in the ONB group and 64 patients in the IC group. Patients with IC showed superior scores in all domains of the FACT‐BL questionnaire and this reached statistical significance in physical well‐being (PWB), functional well‐being (FWB), over all FACT‐G, Bladder‐Specific Subscale and FACT‐BL total scores (P‐values = .01, .01, .001, .001, and .001, respectively).ConclusionsOur findings demonstrate marginally improved HrQoL in IC patients when compared with patients undergoing ONB which may be attributed to an increased morbidity and postoperative complications in the ONB group.

MP24-15 RENAL MORBIDITY FOLLOWING RADICAL CYSTECTOMY IN PATIENTS WITH BLADDER CANCER

INTRODUCTION AND OBJECTIVE: For patients diagnosed with muscle invasive bladder cancer, baseline kidney function plays a significant role in selecting chemotherapy regimens and the type of urinary reconstruction at the time of cystectomy. We sought to characterize baseline kidney function among patients undergoing radical cystectomy, as well as long term kidney function following surgery. METHODS: We identified patients diagnosed with bladder cancer between 2004 and 2018 in the Veterans Health Administration. We linked cancer registry entries with diagnosis and procedure codes to characterize the type of reconstruction (ileal conduit vs. neobladder). We measured baseline kidney function using outpatient serum creatinine values within one year prior to surgery. We estimated post-operative kidney function using outpatient creatinine values starting 30 days after surgery to minimize the effect of surgical complications or acute kidney injury following cystectomy. RESULTS: We identified 3,361 bladder cancer patients that underwent radical cystectomy with 2,983 (89%) undergoing ileal conduit reconstruction and 378 (11%) undergoing neobladder reconstruction. Comorbidity was similar by reconstruction type (Charlson Comorbidity Index 2.4 +/- 2.0 in neobladder vs. 2.8 +/- 2.3 in ileal conduit cohorts). Mean baseline eGFR was 70.2 for neobladder patients vs. 66.7 in the ileal conduit group. Kidney function declined at 3 months post surgery to 55.1 and 54.2 for neobladder and ileal conduit groups, respectively. The median time to reach clinically significant renal disease (eGFR <30) was shorter in the ileal conduit group at 14.8 months vs. 20.1 months in the neobladder cohort. For patients with normal baseline kidney function (eGFR>60) 73% of neobladder and 67% of ileal conduit patients experienced at least one eGFR <60, raising concern about eligibility for cisplatin-based adjuvant chemotherapy after radical cystectomy. CONCLUSIONS: Kidney function declines after radical cystectomy with either neobladder or ileal conduit urinary diversion. Many patients experience renal morbidity that may increase their risk of cardiovascular events and affect adjuvant treatment selection.Source of Funding: none

Effect of ileal orthotopic neobladder and ileal conduit diversion on patient's quality of life after cystectomy: a Meta-analysis

Objective To compare quality of life(QOL)in patients undergoing ileal orthotopic neobladder(IONB) or ileal conduit(IC)after radical cystectomy (RC), through a systematic review and Meta-analysis. Methods All relevant published studies about the comparison between IONB and IC using validated QOL questionnaires were searched, including CBM Disc, CNKI, VIP, Wanfang Data, Pubmed, Medline, Embase, The Cochrane Library, dated from January 2005 to April 2018. Results Twelve controlled studies and 1207 cases were included. Five validated scales were Specific Scale(FACT-BL, EORTC QLQ-C30, EORTC QLQ-BLM30, BCI), General Scale(SF-36). The Meta-analysis outcomes: IONB showed a signifcantly better QOL in patients versus IC (SMD=0.27, 95%CI=0.13-0.41, P=0.0002). Further comparison between dimension scores , pooled effects sizes of all FACT-BL aspects only a significant better PWE and FWB in patients with IONB. There were no significant differences in EWB, SWB and BSS. Also no significant differences in aspects of future perspective, abdominal bloating and flatulence, body image between IC and IONB groups using EORTC QLQ-BLM30. Analyzing BCI aspects, urinary function was significantly better in IC patients(P=0.003), no significant in urinary bother. Analyzing EORTC-QLQ-C30 aspects, only CF(P=0.03) was significantly better in patients with IONB. There was no significant in PF, RF, EF, SF and GQOL. Compared with all aspects of SF-36, there was only significant higher scores in PF(P=0.003) , IONB was superior to IC. Conclusions According to the not-random evidence, QOL after cystectomy undergoing IONB is superior than IC in some aspects. Key words: Cystectomy; Urinary Diversion; Quality of Life; Meta-Analysis

Comparison of Health-Related Quality of Life Between Japanese and American Patients with Bladder Cancer as Measured by a Newly Developed Japanese Version of the Bladder Cancer Index.

The aim of this study is to characterize health related quality of life (HRQOL) in Japanese patients after bladder cancer surgery and to perform cross-cultural comparison between Japanese and American patients. Firstly, we cross-sectionally assessed HRQOL of 371 patients in Japan using the Bladder Cancer Index (BCI-Japanese). HRQOL of the four groups of patients (native bladder without intravesical therapy, native bladder with intravesicaltherapy, cystectomy with ileal conduit, and cystectomy with neobladder) were assessed. Secondly, we compared the Japanese with the American cohort (n = 315) from the original BCI paper. After adjusting for age and gender, the differences in each BCI subdomain score was analyzed. Among Japanese patients, the urinary domain function score was significantly lower among the cystectomy with neobladder group, compared to the cystectomy with ileal conduit group (p < 0. 01). Despite this, the urinary bother was comparable between the two groups. Although there were apparent differences between Japanese and American patients, there were few differences in Urinary and Bowel HRQOL. In three of the four treatment groups (other than native bladder with intravesical therapy), Japanese patients were more likely than Americans to report poor sexual function (p < 0.05). However, Japanese patients were less likely than Americans to be bothered by their lower sexual function, regardless of treatment (p < 0.05). HRQOL outcomes following treatment of bladder cancer in Japan are comparable to those in the USA, except for sexual functioning and sexual bother. The BCI can be used for cross-cultural assessments of HRQOL in bladder cancer patients.