MP25-05: Urinary Diversion With or Without Concomitant Benign Cystectomy for Radiogenic and Non-radiogenic Conditions: a Comparative Morbidity Assessment According to the Updated EAU Guidelines on Standardized Complication Reporting

Malte W. Vetterlein*, Hang Yu, Hamburg, Germany, Maria Buhné, Lübeck, Germany, Philipp Gild, Mara Kölker, Armin Soave, Roland Dahlem, Margit Fisch, Michael Rink, Hamburg, Germany

Introduction: As opposed to radical cystectomy for cancer, few studies have focused on morbidity after urinary diversion (UD) ± benign cystectomy (BC). We here provide an in-depth evaluation of 30-d morbidity in patients undergoing UD±BC using the updated EAU guidelines for standardized reporting.

Methods: We performed a chart review of patients undergoing UD±BC in 2009-17. We tabulated 30-d complications by a predefined catalog and graded them by the Clavien-Dindo classification (CDC) and each individual Comprehensive Complication Index (CCI®). Traditional morbidity endpoints were used to compare UD+BC vs. UD alone. By multivariable regression models we evaluated the impact of the ablative part (BC) vs. the reconstructive part (UD) on cumulative perioperative morbidity. Multivariable analyses were repeated in a subgroup of irradiated patients.

Results: Of 97 patients, 46 (47%) and 51 (53%) underwent UD+BC and UD alone, respectively. Patients with UD+BC were older (median 66 vs. 56 yr) and more comorbid (median Charlson index 4.0 vs. 3.0) vs. UD alone (p=0.020). Other baseline characteristics (gender, BMI, ASA status, kidney function, hx of radiotherapy) were comparable (all p=0.4). In 49 (51%) patients, surgery was indicated by radiogenic issues, neurogenic bladder (12%), interstitial cystitis (12%), and genital disorders (10%). Non-radiogenic incontinence (2.1%), fistula (3.1%), bladder contracture (5.2%), and outlet obstruction (4.1%) were rare. Overall, 69 (71%) received continent UD and 26 (27%) a Mitrofanoff procedure, of which 12 (46%) had augmentation cystoplasty. We found 390 complications in 97 patients (100%), with 7 (7.2%) major complications (CDC =IIIb), 3 (3.1%) readmissions, and no deaths. There was no difference between the groups regarding the incidence of complication subgroups (gastrointestinal, infectious, etc.; all p=0.05; Figure 1). The median CCI® was higher for UD+BC compared to UD alone (32 vs. 24; p=0.005). In multivariable analyses, neither BC in addition to UD (p=0.2) nor a hx of pelvic radiotherapy (p=0.2) were associated with a higher morbidity burden as measured by the CCI® after adjusting for confounders. Similar results were found in the subgroup of irradiated patients.

Conclusions: Neither the ablative part nor prior radiotherapy did impact morbidity in our series. Hence, BC should be considered in patients who might benefit from the procedure to avoid long-term sequelae of the retained bladder.

Source of Funding: n/a