Introduction: Radical cystectomy (RC) is a highly morbid procedure with room for improvement. The choice of urinary diversion between ileal conduit (IC) or cutaneous ureterostomy (CU) following RC is controversial and warrants investigation. In this study, we present our experience with IC and CU urinary diversions and their perioperative outcomes. Methods: We retrospectively reviewed patients who underwent IC or CU urinary diversion following RC. For CU, using a modified Ariyoshi technique, a single urostomy was created with eversion of the ureteral nipple over a triangular skin flap. Data were collected on patient demographics, pathology, operative details, and post-operative outcomes. Comorbidity was calculated using the Elixhauser-Index (EI). Primary objectives were length-of-stay (LOS) and operative time. Secondary objectives were 30-day post-operative Clavien-Dindo complications (Major: grades III-V) and 30-day readmissions. Results: Between 2020 and 2022, we identified 52 patients that had IC (50%) or CU (50%) following RC. The median (IQR) age was 71 years (62-77) with 77% men and 23% women. Age and sex were similar between both groups. The overall median EI was 4 (0-8.7). The median EI was higher in the CU group at 5 (2.3-10) compared to IC group at 3.5 (0-6.3) (p=0.06). The median BMI was lower in the CU group at 25 (22-29) compared to IC group at 29 (25-34) (p=0.03). The median operative time was shorter for the CU group at 237 minutes (198-282) compared to IC group at 326 minutes (289-395) (p < 0.01). The median LOS was shorter for the CU group at 3 days (3-7) compared to IC group at 4 day (4-6) (p=0.049). The 30-day overall complication rate was identical at 73%. The 30-day major complication rates were similar with CU group at 19% and IC group at 16% (p>0.99). The 30-day readmission rates were similar with CU group at 35% and IC group at 31% (p>0.99). Conclusions: Our results suggest that CU is a safe and feasible urinary diversion that compares favorably to IC. The advantage of decreased operative time and length of stay with CU may expand indications for RC in more comorbid patients while maintaining similar complication rates to IC. Further studies are expected to clarify these associations. SOURCE OF Funding: None.
