Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy

Abstract

Study Type – Preference (case studies) Level of Evidence 4 OBJECTIVE To examine the rate at which patients undergo various types of urinary diversion (UD) and the reasons why they had the given reconstruction, analysed in the context of a standardized preoperative protocol for patients undergoing radical cystectomy (RC) at our institution, as there is wide variation in the distribution of patients undergoing continent (CUD) vs incontinent (ICUD) after RC. PATIENTS AND METHODS Between September 2004 and December 2008, 200 patients had RC with UD by one surgeon. Each patient was given standardized preoperative counselling; the charts were reviewed retrospectively to determine the relative frequencies of the various types of UD, and the reasons why patients had an ICUD assessed, including medical contraindications and personal choice. RESULTS During preoperative counselling, 149 patients (75%) were assessed as being eligible for a CUD, while 51 (25%) had one or more contraindication; 140 (70%) ultimately had a CUD, and the remaining 60 (30%) a ICUD. Of the 149 patients eligible for a CUD, only nine (6%) chose to undergo ICUD for personal reasons. CONCLUSION Few patients choose to have an ICUD in the absence of an absolute medical contraindication. Proper patient selection and thorough, standardized preoperative counselling result in a higher rate of CUD than ICUD after RC.

Orthotopic urinary diversion in the elderly

“…Indeed, in one study, all patients deemed eligible for orthotopic neobladder received standardized preoperative counseling. Of the 149 patients included, only nine selected an incontinent diversion [19]. Additionally, absolute and relative contraindications do exist as shown in Table 1, and these should be explained to the patient [20].…”

Prospective Evaluation of Continence Following Radical Cystectomy and Orthotopic Urinary Diversion Using a Validated Questionnaire

“…[1][2][3] While the orthotopic neobladder (ONB) most closely resembles the native bladder, continence outcomes are of particular interest to patients and contribute to the choice of urinary diversion made between physician and patient. 4 However, only a few studies, most of which are more than 10 years old, have prospectively reported continence data on these patients, and none are patient-reported based on validated pictorial questionnaires.…”

Short-term Change in Renal Function in Patients Undergoing Continent vs Noncontinent Urinary Diversions

“…This bias we believe is minimized given that only 11 patients from the entire cohort underwent an ileal conduit solely based on renal insufficiency and 3 based on surgeon discretion [10].…”

“…Indications for cystectomy and urinary diversion included underwent an ileal conduit solely based on renal insufficiency (SCr of > 1.8 mg/dL (159.12 umpl/L)) and 3 based on surgeon discretion due to comorbidities [10]. Looking at all patients undergoing conduit procedures, this group was significantly older than those undergoing continent diversions (71.4 vs 65.3, P < 0.001) and had lower mean preoperative eGFRs (63.8 vs 73.3, P < 0.001).…”