In patients with neurogenic bladder dysfunction due to spinal cord injury or multiple sclerosis, the impact of drainage methods on quality of life and cost-effectiveness remains uncertain.We choose to compare patients who underwent cystectomy with ileal conduit (CT) and those who received long term suprapubic catheterization (KT). We'll assess healthcare the impact of both procedures from medical and economic perspectives.

The data were sourced from the national health data system (Programme de médicalisation des systèmes d'information - PMSI) over an 11 year period spanning from 2010 and 2021, leaving at least 2 years of follow-up for each patient. We included patients aged 18 years old and above, diagnosed with multiple sclerosis  or spinal cord injury who unerdewent cystectomy with ileal conduit derivation  or suprapubic catheter. The suprapubic catheter group comprised patients with a minimum of 4 suprapubic catheter implantation at least 3 months apart. We performed sensitivity analysis to assess the impact of changing the inclusion criteria. For the medical impact we compared overall rehospitalization rates, urology specific rehospitalisations (mainly stones and infections) rehospitalization-free survival. For the economic impact we compared the total healthcare expenses between groups, but also urology specific expenses.We stratified the assessment by disease type and at 1 year because the Kaplan Meier curves crossed at this point. We also performed generalized linear regression (with gamma distribution, log link) with adjustment on the following factors: the follow-up, age, sex, and disease)

Among 2430 patients 1841 were in the cystectomy  group and 589 in the suprapubic catheter group. There was 1024 (42%) multiple sclerosis and 1406 (58%) spinal cord injury. Sensitvity analysis did not show any difference.
In cystectomy’s group, patients were slightly younger , mainly females. The mean follow up was about 5 years and comparable in the two groups 5.2 years, 4.8 years). There was no difference in comorbidities except for obesity, cardiovascular disease and tobacco and alcohol intoxication.
The survival curve shows a better survival of the suprapubic catheter group the first year, then the survival is better in the cystectomy group. 
The number of hospitalisation is similar in the two groups however there there was less hospitalisions for UTI in the cystectomy group (p=0.0002) after one year. 
The total cost per patient were higher in the CT group. ( 47, 293 € vs 34,225€, as well as the cost per year per patient(9,444€ vs 7,903€).

Cystectomy group showed a better long term survival after one year of follow-up. However the cost in cystectomy’s group are higher. There was less hospitalisations for UTI for patients who underwent cystectomy with ileal derivation after one year.

These findings should be balanced with quality of life assessment and patients’ preferences evaluation, to enhance the shared-decision making process.