Cystectomy with continent urinary diversion versus ileal conduit: Functional outcome and postoperative complications of a salvage treatment for refractory detrusor overactivity

Bywater M1, Fröhlich M2, Schmid D M2, Kessler T M1, Eberli D2

Research Type

Clinical

Abstract Category

Neurourology

Abstract 416
Open Discussion ePosters
Scientific Open Discussion ePoster Session 21
Thursday 30th August 2018
13:25 - 13:30 (ePoster Station 11)
Exhibition Hall
Detrusor Overactivity Surgery Retrospective Study
1. Department of Neuro Urology, Balgrist University Hospital, University of Zürich, Zürich, 2. Department of Urology, University Hospital of Zürich, University Zürich, Zürich
Presenter
M

Mirjam Bywater

Links

Poster

Abstract

Hypothesis / aims of study
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.
Study design, materials and methods
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.
Results
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.
Interpretation of results
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.
Concluding message
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.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Kantonale Ethikkommission Zürich Helsinki Yes Informed Consent Yes