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Is Cutaneous Ureterostomy an Option for Urinary Diversion With Radical Cystectomy?

By: Sarah Lynch
Posted: Wednesday, November 22, 2023

A group of researchers aimed to collect and report perioperative outcomes of a series of patients undergoing radical cystectomy with cutaneous ureterostomy urinary diversion for the treatment of bladder cancer. According to Stephen A. Boorjian, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues, “the use of cutaneous ureterostomy was associated with expeditious surgery and postoperative recovery...and represents an option for urinary diversion in high-risk patients undergoing radical cystectomy.” They reported their findings in the journal Urology.

“Radical cystectomy remains a standard-of-care definitive local therapy for patients with muscle-invasive as well as high-risk non–muscle-invasive bladder cancer. Nevertheless, radical cystectomy has been associated with considerable perioperative morbidity, which is compounded by the often elderly and comorbid demographic of patients with bladder cancer,” the investigators noted.

The research team identified patients who underwent radical cystectomy with cutaneous ureterostomy at the Mayo Clinic between 2016 and 2021 and analyzed clinicopathologic and perioperative characteristics. The group of 31 patients represented a highly comorbid cohort, and 14 experienced a high-grade complication within 30 days of surgery. A total of 13% of patients with complications experienced sepsis, which was the leading cause of readmission 90 days after surgery. In this same time frame, three patients required reoperation, including one from stomal ischemia, and one patient died of unrelated causes. The study authors believe the higher rate of postoperative ureteral obstruction may be “preemptively addressed with chronic stent placement.”

To evaluate contributors to perioperative complications, the researchers aim to observe the outcomes of a cohort of patients who underwent radical cystectomy with cutaneous ureterostomy and were managed postoperatively using modern enhanced recovery after protocols.

Disclosure: The study authors reported no conflict of interest.

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