National trends in urinary diversion over the past 20 years: an Australian study

Abstract

Background To investigate the trends in urinary diversion (UD) in Australia over the past 20 years, to correlate with patient demographics and to compare with international data. Methods A retrospective analysis of Medicare Australia data was performed using the relevant Medicare Benefit Schedule procedure codes over the past 20 years. Included diversion procedures were ureterocutaneous, ureterocolonic, intestinal conduit and continent reservoir. All patients aged older than 15 years were included in the analyses. Results Over the past two decades, 6124 cystectomies and 7166 UDs were subsidized by Medicare Australia. The median age group for UD was 65–74 years old and 71.8% were male. Intestinal conduit accounted for the majority of UDs (84.9%), followed by continent reservoirs (11.8%). Ureterocolonic and ureterocutaneous accounted for small proportions (2.9% and 0.4%, respectively). The absolute numbers of UD procedures increased over the past 20 years but the proportion of different methods remained constant. The rates of continent reservoir UD were significantly higher in men and people aged less than 55 years old (P < 0.001 for both). Over the course of the study, the proportion of people aged greater than 75 years undergoing UD increased significantly (P < 0.001). Conclusion In contrast to major international academic institutions, the proportion of continent reservoir UDs performed in Australia has not changed over the past two decades. Intestinal conduit remains the most common UD procedure.

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

“…Nonetheless, ONB has been less frequently used in women and women are less likely to receive a continent UD than males (64,65,69). Current rates for continent UD in females range around 4-15% (65,(69)(70)(71). Across all patients with bladder cancer, there has been a decreasing use of ONB reconstruction (10-30%), with only single centers exceeding this range (63)(64)(65)69,72,73).…”

Variation in ureteric re‐implantation for Australian children

“…The use of Medicare rebate data has recently been validated for use in assessing epidemiological trends, 39 and to identify significant unexplained variation in surgical management of breast cancer between states 40 . Similar to other studies using comparable methodology, our understanding is that rebate data is representative of privately insured patients who had operations in public or private hospitals 40–44 . Interestingly, some studies report that these data are all inclusive of both public and privately insured patients 45,46 .…”

Robotic-assisted radical cystectomy with complete intracorporal diversion: Initial experience in a tertiary teaching hospital

“…The demographic and preoperative characteristics of this cohort are comparable to other Australian as well as international series. 11–14 Our utilisation of neo-adjuvant chemotherapy in this series – 34.9% of patients overall and 71.4% of patients with muscle-invasive urothelial cancer – is towards the higher end of rates reported in other series that range from 0% to 41%. 4,6,11,12 For patients who did not receive neoadjuvant therapies for muscle-invasive urothelial carcinoma, semi-emergent cystectomy was the most common reason due to intractable symptoms or significant obstructive uropathy.…”

“…Of note, the utilisation of neo-bladder in this series of 20.9% is higher than the rate previously reported in Australia (11.8%). 13 This is like because of the slightly younger patient age compared to other cohorts and the fact that all surgeons performing RARC in this series had experience with intra-corporal neo-bladder construction during previous international fellowships. Intra-corporal neo-bladder construction is both time-consuming and technically very challenging though, with one of the main difficulties we encountered being getting the neo-bladder to reach the urethra in the presence of a short small-bowel mesentery.…”