Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion

Abstract

Background: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged > 75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. Methods: We conducted a retrospective analysis of elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel’s recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. Results: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications.

External validation of Pentafecta in patients undergoing laparoscopic radical cystectomy: results from a high-volume center

“…In our study, 50.9% patients received cutaneous ureterostomy, whereas previous Pentafecta studies involved only patients who received ileal conduit and neobladder [ 12 , 17 – 19 ]. The cutaneous ureterostomy might improve surgical tolerance in the elderly patients, which cloud result in a reduced rate of perioperative and postoperative complications [ 21 ]. However, the remarkable long-term complication related to cutaneous ureterostomy was ureteral strictures, which occurred at a higher rate than those associated ileal conduit and neobladder [ 22 ], contributing to the high risk of urine diversion-related sequelae.…”

Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19

“…The caregivers in the control group received conventional care instructions ( Fuschi et al, 2021 ). Briefly, they were provided knowledge on stoma care and postoperative care of patients who underwent surgery for malignant bladder and were instructed how to change the stoma bag.…”

Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis

“…Most of the studies reported a higher duration of hospitalization in the IC group [11][12][13][14][15][16][17]. Four other studies reported no significant difference in duration of hospitalization in the IC and TUU groups.…”