Continent urinary diversion is a body image preserving alternative to the traditional ileal conduit (IC) for patients requiring a cystectomy. However, a catheterizable stoma (CS) is not suitable in every case. The objective of this study was to compare the functional outcome and complication rates in patients with refractory detrusor overactivity undergoing a salvage treatment cystectomy with a continent Yang-Monti urinary diversion and in those with an IC.

In this single centre retrospective study, we included all patients who had undergone a cystectomy between 02/2008 and 10/2016 due to refractory neurogenic or idiopathic detrusor overactivity. Postoperative complications (Clavien-Dindo-classification), stoma-related complications and functional outcome were evaluated after 1, 3 and 12 months postoperatively.

We report on 49 patients, 32 of them with an incontinent urinary diversion (IC) after a cystectomy, and 17 with a continent urinary diversion (Yang-Monti). There was no significant difference in patient characteristics between the two groups. There was also no significant difference in blood loss (310mL in Yang-Monti vs. 230mL in IC, p=0.28). However, the postoperative length of stay was significantly shorter in the Yang-Monti group (16.9 vs. 22.3 days, p=0.001). Early postoperative complications occurred in 20 of 32 (62.5%) patients with an IC and in 11 of 17 (64.7%) patients with a Yang-Monti with more Clavien IIIa or higher in the first group then in the second. Nevertheless, within the first 30 days postoperatively we could observe significantly more Clavien II complications, including urinary tract infections, in the Yang-Monti compared with the IC group (7 vs. 4, p=0.029).  
In the period of 90 days postoperatively we could observe a significantly higher rate of ureter stenosis in patients with a Yang-Monti urinary diversion then in those with an IC (4 v.s 1, p=0.043). 
Within the long-term follow-up we did not detect any Clavien IVa or higer grade complications in both cohorts.

Cystectomy with continent Yang-Monti urinary diversion as a salvage treatment offers satisfactory continence and can improve quality of life. However, the pouch is associated with a high rate of re-operations to achieve good outcomes.

The decision to perform a Yang-Monti urinary diversion instead of the traditional IC depends on patient’s ability to perform intermittent self-catheterization and on general health conditions (including cognitive and renal function). Therefore, the decision for a catheterizable stoma should be carefully discussed with patients.