Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective :
There are limited studies evaluating outcomes following urinary diversion for benign indications. We sought to analyze complications following urinary diversion for non-malignant conditions, with specific focus on early and delayed complications over long-term follow-up.
We performed a retrospective review of patients undergoing urinary diversion for benign indications between January 2000 and December 2017. Data were collected including patient demographic and clinical characteristics, with focus placed on surgical characteristics and post-operative complications. Complications were graded according to the Clavien-Dindo classification and were classified as early (≤90 day post-operatively) or delayed (>90 days post-operatively). Logistic regression was used to assess for predictors of developing complications after urinary diversion.
A total of 73 patients were identified for study analysis with median follow-up of 24 (6-71) months. 70% and 23% of patients underwent diversion for neurogenic bladder and complications related to pelvic radiation, respectively. A majority (93%) underwent ileal conduit with the remainder undergoing continent diversion. A total of 133 complications were identified, comprising 56 early and 77 delayed. Accordingly, 77% of patients had at least one complication during the follow-up period. 51% and 75% of patients experienced early and delayed complications, respectively. Complications of Clavien-Dindo Score ≥IIIB were seen in 48% of patients. The most common early complications included wound infection (15%), prolonged ileus (8%), and urinary tract infection (UTI) (7%). Urinary tract infection (39%), nephrolithiasis (31%) and uretero-enteric anastomotic stricture (17%) were the most frequent delayed complications. Univariate followed by multivariate logistic regression modeling found BMI and operative length (hr) to be independent positive predictors of complication (OR 1.16 and 2.49, respectively, p=0.01).
Conclusions : Our study demonstrates that urinary diversion for benign etiologies is associated with a significant rate of complication. A large percentage of these occur in the delayed period and are classified as serious complications. BMI is an independent predictor of complication in this population.