Can Urinary Diversion Type Affect Postoperative Complications Following Radical Cystectomy in Female Patients?

To assess the impact of urinary diversion (UD) type on complications following radical cystectomy (RC) in female patients.We retrospectively reviewed our RC database for all female RCs between 2003 and 2024. Patients were categorized by UD type: ileal conduit (IC), neobladder (NB), and continent cutaneous diversion (CCD). Postoperative complications were compared across UDs. The contemporary sub-cohort (2012-2024) was assessed to identify the determinants of genitourinary (GU) complications.A total of 531 female patients underwent RC with UD (IC: 263 [49.5%], NB: 206 [38.8%], and CCD: 62 [11.7%]). The overall 30 (NB: 54.9%, CCD: 51.6%, IC: 61.6%) and 90 day (NB: 65.5%, CCD: 64.5%, IC: 70.3%) complication rates were comparable (p = 0.195, and 0.456, respectively). All 90 day complication subtypes-including infectious, gastrointestinal, and cardiac-were comparable, except for GU complications, which were significantly more frequent in CCD compared to IC and NB (32.3%, 13.3%, and 14.6%, respectively, p < 0.001). Assessment of the contemporary sub-cohort (n = 320 with IC: 187 [58.4%], NB: 99 [30.9%] and CCD: 34 [10.6%]) confirmed these findings (90 day GU complications rate: CCD: 41.2%, NB: 21.2%, and IC: 17.7%; p = 0.009). After adjusting for age, comorbidities, and surgical approach, CCD UD remained associated with higher odds of 90 day GU complications (ref: IC; odds ratio: 3.79, 95% CI: 1.58-9.10, p = 0.011).UD type had minimal impact on overall 30 and 90 day postoperative complications in female RC patients. However, CCD was associated with significantly increased odds of 90 day GU complications.

Duke Scholars

Author Alireza Ghoreifi