Perioperative complications of conduit urinary diversion with concomitant cystectomy for benign indications: A population‐based analysis

Abstract

AIMS Beyond single-institution case series, limited data are available to describe risks of performing a concurrent cystectomy at the time of urinary diversion for benign end-stage lower urinary tract dysfunction. Using a population-representative sample, this study aimed to analyze factors associated with perioperative complications in patients undergoing urinary diversion with or without cystectomy. METHODS A representative sample of patients undergoing urinary diversion for benign indications was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2011. Perioperative complications of urinary diversion with and without concomitant cystectomy were identified and coded using the International Classification of Diseases, version 9. Multivariate logistic regression models identified hospital and patient-level characteristics associated with complications of concomitant cystectomy with urinary diversion. RESULTS There were 15,717 records for urinary diversion identified, of which 31.8% demonstrated perioperative complications: urinary diversion with concurrent cystectomy (35.0%) and urinary diversion without concomitant cystectomy (30.6%). Comparing the two groups, a concomitant cystectomy at the time of urinary diversion was significantly associated with a complication (OR = 1.23, 95%CI: 1.03–1.48). Comorbid conditions of obesity, pulmonary circulation disease, drug abuse, weight loss, and electrolyte disorders were positively associated with a complication, while private insurance and southern geographic region were negatively associated. CONCLUSIONS A concomitant cystectomy with urinary diversion for refractory lower urinary tract dysfunction elevates risk in this population-representative sample, particularly in those with certain comorbid conditions. This analysis provides critical information for preoperative patient counseling.

Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database

“…Although not statistically significant, patients with RC+conduit UD were more likely to die than those undergoing conduit UD alone. This is consistent with previous work using the Nationwide Inpatient Sample (NIS), which showed that the addition of RC to UD for strictly benign etiologies led to higher rates of complications during the post-operative hospitalization (OR 1.23, 95% CI 1.03-1.48) (13).…”

Outcomes of continent and incontinent external urinary diversion in management of patients with refractory non-malignant lower urinary tract dysfunction

“…The management of such conditions is primarily achieved by conservative and/or minimally invasive measures. If these measures fail, surgical interventions are indicated (7,8,14,15). These surgical interventions, however, have a significant impact on patients' quality of life.…”

Salvage cystectomy and ileal conduit urinary diversion as a last‐line option for benign diseases—perioperative safety and postoperative health‐related quality of life

“…In selected cases cystectomy and urinary diversion has been described as a last resort for refractory lower urinary tract dysfunction secondary to neurogenic bladder (e.g., spinal cord injury, spina bifida, and multiple sclerosis are common indications), radiation cystitis, interstitial cystitis, or recurrent fistula formation 1,2 as well as devastated bladder outlet after prostatectomy. 3 The European Association of Urology (EAU) Guidelines describe urinary diversion as a reconstructive option for patients with intractable urinary incontinence after multiple pelvic procedures, radiotherapy or pelvic pathology leading to irreversible sphincteric incompetence or fistula formation.…”