A Propensity Score-Based Comparison regarding Renal, Functional, and Surgical Outcome of Continent Cutaneous Urinary Diversions in Patients with Benign Chronic Bladder Diseases and Patients with Bladder Cancer

Abstract

Introduction: Continent cutaneous urinary diversion (CCUD) post-cystectomy is an established approach addressing both oncological and functional indications. However, there is a noticeable gap of evidence when it comes to comparing outcomes between these indications, especially concerning the technique of Main Pouch I (MPI). This study aims to close the gap by analyzing the long-term functional and renal outcomes of patients with MPI after cystectomy due to both benign and malign bladder pathologies. Methods: In this retrospective study, we examined 173 patients, who underwent MPI surgery between 2000 and 2022. Patients were categorized into a study group (benign conditions, n=26) and a control group (bladder cancer, n=52) using propensity-score matching. Clinical demographics, surgical outcomes, and functional/renal parameters were analyzed using unpaired t-tests and chi-square tests. Results: Patients undergoing cystectomy with MPI due to benign bladder pathologies were significantly younger and had lower comorbidity burden compared to those with bladder cancer. In contrast to a significant higher incidence of chemotherapy in the oncological cohort, the long-term renal function was comparable between both populations. Surgical outcomes, revisions and postoperative complications did not differ significantly between both groups. Nearly 90% of patients in both groups showed full continence. Conclusion: This study demonstrates the efficacy and safety of MPI surgery in both benign and malignant conditions, proving favorable long-term renal and functional outcomes.