Unilateral cutaneous ureterostomy with separate stomata vs ileal conduit after radical cystectomy

Table 1 Demographic and clinical characteristics of all patients, median (range)/n (%)

Variables	Value
Age (years)	61 (48-83)
BMI (kg/m2)	23.95 (19.2-30.2)
eGFR (mL/minute)	97.5 (16-117)
Hemoglobin (g/dL)	12.25 (9-16.3)
Serum creatinine (mg/dL)	0.9 (0.5-3.9)
Smoking	23 (71.9)
Medical comorbidities	12 (37.5)
Tumor stage
T1	8 (25)
T2	17 (53.1)
T3	7 (21.9)
Tumor histopathology
TCC	19 (59.4)
Squamous cell carcinoma	3 (9.4)
Adenocarcinoma	1 (3.1)
TCC with variants	9 (28.1)
Neoadjuvant therapy
Chemotherapy	7 (21.9)
Radiotherapy	2 (6.3)
Intravesical BCG	4 (12.5)
Comorbidities
Diabetes	7 (21.9)
Hypertension	5 (15.6)
Cardiac	1 (3.1)
COPD	2 (6.3)
Operative characteristics
Operative time (minutes)	357.5 (250-500)
Operative time for shunt (minutes)	100 (40-165)
Blood loss (cc)	925 (600-2000)
Blood transfusion (Units per patient)	2 (1-4)
Postoperative day-1 hemoglobin level (g/dL)	10.6 (7.7-13.6)
Postoperative day-1 serum creatinine level (mg/dL)	1.1 (0.6-3.3)
Number of retrieved lymph nodes	18 (4-39)
Incidence of perioperative complications	31 (96.95)
Complication grade
Low or no complications	25 (78.1)
High	7 (21.9)
Hospital stay (days)	12 (3-55)
Follow-up
Duration (months)	10 (6-24)
Serum creatinine (mg/dL)	1.1 (0.8-4.1)
eGFR (ml/minute)	74 (14-101)
Days between appliance base changes1	10 (5-25)
QoL score	71 (52-103)
Febrile UTI	9 (36)

¹The higher the number of days between changes of the appliance base, the lower the frequency of changes. This was an advantageous finding because it meant that the appliance is durable and long-lasting with lower costs.

BMI: Body mass index; eGFR: Estimated glomerular filtration rate; TCC: Transitional cell carcinoma; BCG: Bacillus-Calmette-Geurin; COPD: Chronic obstructive pulmonary disease; QoL: Quality-of-life; UTI: Urinary tract infection.

Table 2 Summary of perioperative complications (< 90 days), their grades, and management

Complication1	n (%)	Grade	Management
Rectal injury	1 (3.1)	3b	Intra-operative repair
Paralytic ileus	16 (50)	1; 2	Five patients underwent conservation; 11 patients required medications
Severe anemia	7 (21.9)	2	Blood transfusion
Lymphorrhea	5 (15.6)	1	Conservative management
Lymphocele	1 (3.1)	3a	Conservative management
Fecal fistula	3 (9.4)	3b	Re-exploration
Wound infection	22 (68.8)	1	Daily dressing with antiseptics
Burst abdomen	6 (18.8)	3b	Surgical re-closure
Pneumonia	1 (3.1)	2	Medical treatment
Early stent slippage	2 (6.3)	1; 3a	One patient had bilateral stent slippage POD 13 and underwent conservation (group B); one patient from group A showed left stent slippage POD 32, which was associated with a burst abdomen and fecal fistula, and underwent PCN insertion
Anastomotic urine leakage and intestinal obstruction	1 (3.1)	5	Death
Thromboembolism	2 (6.3)	4a; 5	One patient was entered in a vegetative state; one death
CVD	1 (3.1)	5	Heart failure and death
Fecal fistula and burst abdomen	3 (9.3)	5	Septicemia and death
Febrile UTI	1 (3.1)	5	Septicemia and death

¹Some patients experienced more than one complication.

CVD: Cardiovascular diseases; PCN: Percutaneous nephrostomy; POD: Postoperative day; UTI: Urinary tract infection.

Table 3 Comparison between the two groups for the preoperative, operative, and postoperative variables

Variables		Group A (CU)	Group B (IC)	P value
Age		62 (48-83)	61 (51-73)	0.59
BMI (kg/m2)		24.65 (19.2-29.5)	23.15 (20.8-30.2)	0.468
eGFR (ml/minute)		88.5 (16-113)	98.5 (48-117)	0.287
Preoperative hemoglobin (g/dL)		10.7 (9-14.7)	12.85 (10.5-16.3)	0.056
Preoperative serum creatinine (mg/dL)		1 (0.5-3.9)	0.85 (0.5-1.6)	0.361
Smoking		13 (81.25%)	10 (62.5%)	0.433
Medical comorbidities		6 (37.5%)	6 (37.5%)	> 0.999
Tumor stage	T1	5 (31.25%)	3 (18.75%)	0.445
	T2	5 (31.25%)	12 (75%)
	T3	6 (37.5%)	1 (6.25%)
Tumor histopathology	Urothelial	10 (62.5%)	9 (56.25%)	0.496
	Squamous cell carcinoma	2 (12.5%)	1 (6.25%)
	Adenocarcinoma	1 (6.3%)	0
	Urothelial with variant	3 (18.75%)	6 (37.5%)
Neoadjuvant chemotherapy		4 (25%)	3 (18.75%)	> 0.999
Neoadjuvant radiotherapy		2 (12.5%)	0	0.484
Intravesical BCG		3 (18.8%)	1 (6.3%)	0.6
Operative time (minutes)		360 (250-480)	350 (270-500)	0.985
Shunt time (minutes)		60 (40-110)	122.5 (90-165)	< 0.001
Estimated blood loss (cc)		950 (800-2000)	900 (600-1600)	0.171
Blood transfusion (units)		2 (2-4)	2 (1-4)	0.184
Postoperative hemoglobin level (g/dL)		10.15 (7.7-12.6)	11.05 (8.9-13.6)	0.029
Postoperative serum creatinine level (mg/dL)		1.2 (0.6-3.3)	1 (0.6-1.8)	0.11
Hospital stay (days)		10 (3-33)	13 (9-55)	0.08
Number of retrieved lymph nodes		15.5 (4-28)	20 (8-39)	0.08
Perioperative complications		15 (93.75%)	16 (100%)	> 0.999
Complication grade
No or low grades		11 (68.75%)	14 (87.5%)	0.394
High grades		5 (31.25%)	2 (12.5%)
Days between appliance base changes		15 (10-25)	7 (5-15)	< 0.001
Serum creatinine level at last follow-up (mg/dL)		1.15 (0.9-4.1)	1.1 (0.8-2.2)	0.12
eGFR (mL/minute)		70 (14-100)	78 (33-101)	0.186
Incidence of re-intervention		0.4 (0.699)	0.46 (0.66)	> 0.999
Febrile UTI		7 (63.63%)	2 (14.28%)	0.017
QoL score after 6 months		68 (52-90)	80.5 (62-103)	0.029

CU: Cutaneous ureterostomy; IC: Ileal conduit; BMI: Body mass index; eGFR: Estimated glomerular filtration rate; BCG: Bacillus-Calmette-Guerin; QoL: Quality of life; UTI: Urinary tract infection.

Table 4 The postoperative staging, histopathology, and adjuvant therapy for the remaining 25 patients

Primary tumor (T)	Regional lymph nodes (N)	Number of patients	Chemotherapy or radiotherapy (n)	Histopathology (n)
T0	N0	1	-	Necrosis
T1	N0	1	-	UC
T2	N0	3	-	UC
T2	N+	3	Two patients received chemotherapy	UC
T3	N0/Nx	7	Chemotherapy (2)	UC (6)
			Combined (4)	SCC (1)
			None (1)
T3	N+	1	Combined	UC
T4	N0/Nx	2	One received chemotherapy	UC (1)
				SCC (1)
T4	N+	7	Chemotherapy (2)	UC (6)
			Combined (5)	Adenocarcinoma (1)

SCC: Squamous cell carcinoma; UC: Urothelial carcinoma.

Table 5 Simple linear regression analysis of factors influencing the quality of life

Variables1	Unstandardized coefficients	Standardized coefficients (95% confidence interval)	P value
Age (years)	-0.555	-0.288 (-1.351 to 0.241)	0.162
Days between appliance base changes	-0.889	-0.310 (-2.095 to 0.316)	0.14
Number of re-interventions	-11.386	-0.506 (-19.751 to -3.020)	0.01
Serum creatinine level (mg/dL)	-8.148	-0.404 (-16.096 to -0.201)	0.045
eGFR (ml/minute)	0.339	0.544 (0.108-0.570)	0.006
Medical comorbidities	11.533	0.394 (-0.068 to 23.135)	0.051
Postoperative chemotherapy	0.176	0.006 (-13.080 to 13.433)	0.978
Postoperative radiotherapy	-8.967	-0.306 (-20.983 – 3.050)	0.136
Distant metastatic recurrence	-0.743	-0.024 (-13.996 to 12.511)	0.909
Febrile UTI	-13.354	-0.447 (-24.878 to -1.830)	0.025
Type of shunt	-12.773	-0.442 (-23.947 to -1.599)	0.027

¹This simple linear regression was used to withstand the large number of variables influencing the quality of life.

eGFR: Estimated glomerular filtration rate; UTI: Urinary tract infection.