Comparison of Ileal Conduit and Transureteroureterostomy with Ureterocutaneostomy Urinary Diversion

Abstract

Introduction: We compare the postoperative early and late complications of patients who had undergone ileal conduit (IC) urinary diversion and transureteroureterostomy (TUU) with ureterocutaneostomy (UC) urinary diversion during the same interval and by the same surgeons. Materials and Methods: Between 1992 and 2004, we performed TUU with UC urinary diversion in 27 men and 7 women (group I) and ileal conduit urinary diversion in 57 men and 10 women (group II). The mean age of the TUU with UC diversion and the ileal conduit patients was 57 ± 11.2 (range 51–76) and 64 ± 12.6 (range 54–76) years, and the mean follow-up was 37 (range 14–52) and 56 (range 14–72) months, respectively. The 6F or 8F stents were used routinely. Results: Of 34 TUU with UC cases 8 (23.52%) had early postoperative complications and 2 (5.88%) had early reoperation rates, whereas 11 (16.42%) of 67 ileal conduit cases had early postoperative complications and 4 (5.97%) had early reoperation. The mean hospital stay was 7 (range 5–25 day) and 11 (range 7–34 day) days for each group, respectively. Of the TUU and UC cases, 6 (17.64%) had late complications and 3 had (8.82%) late reoperation, whereas 14 conduit cases (20.89%) had late complications and 6 had (8.9%) late reoperation. Early postoperative complications were defined as those that occurred before hospital discharge or within 30 days from the date of surgery and late complications were defined as those occurring greater than 30 days from the date of surgery as previously described. In group I, the mean operative time was 170 min (range 120–325) compared with 260 min (range 170–473) in group II. The mean blood loss in group I was 474 ml (range 250–1,400) and 589 ml (range 300–1,700) in group II (p > 0.05). Conclusions: Our results suggest that patients undergoing a TUU and UC diversion have no additional risk of reoperation and the TUU with UC urinary diversion is a safe procedure with postoperative early and late complications.

Peri‐operative morbidity and mortality related to radical cystectomy: a multi‐institutional retrospective study in Japan

“…Although we do not have data available about the precise reason for the decision regarding the type of urinary diversion in each patient, it was assumed that the preoperative physical status of patients or the surgeon ' s preference infl uenced the decision. Our observation of lower complications in a diversion where the ileum was not involved was consistent with previous studies [21,22] . In a comparison of the complication categories between ileal conduit/neobladder and cutaneous ureterostomy, gatrointestinal, infectious and genitourinary complications were more frequent in patients who were undergoing ileal conduit/neobladder (data not shown).…”

Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?

“…However, UCC looks to have less morbidity than IC. Kilciler et al reported less hospital stay, perioperative blood loss and late complications for UCC than IC [21]. Also, the use of current stents minimized the stoma problems.…”

Heterotopic Continent or Incontinent Urinary Diversion:making the Optimal Choice

“…В альтернативных случаях используются уретеро-кутанеостомы, нефростомы, деривация в непре-рывный толстый кишечник или создание гете-ротопического мочевого кишечного резервуара. Некоторые исследователи рекомендуют урете-рокутанеостомы использовать у больных пожи-лого возраста с потенциально высоким риском возможных периоперационных осложнений, обосновывая преимущество сокращением про-должительности и морбидности операции [2,6]. Гетеротопические инконтинентные кишеч-ные уродеривации (Bricker) наиболее часто используются ввиду более короткого времени операции и непродолжительной кривой обуче-ния методике.…”