Can ureteral stents be omitted from radical cystectomy with continent diversion? An ACS-NSQIP analysis of the early postoperative outcomes.

PURPOSE: Radical cystectomy with continent diversion is the standard treatment for muscle-invasive bladder cancer. Evidence supporting the necessity of ureteral stent use after this procedure is limited. This study compares 30-day postoperative outcomes of radical cystectomy with continent diversion using neobladder reconstruction in patients managed with and without ureteral stents.

METHODS

A retrospective cohort study using the 2019-2022 ACS-NSQIP database included 1,318 patients who underwent radical cystectomy with continent diversion using neobladder reconstruction. We compared baseline characteristics and perioperative factors between the stented (n = 1,216) and stentless group (n = 102). Univariate and multivariate analyses assessed the relationship between stent use and perioperative outcomes, as well as 1:1 propensity score matching.

RESULTS

Patient demographics and comorbidities were comparable between the two groups. Similarly, preoperative and intraoperative factors showed no significant differences, except for a higher drain placement rate in the stented group (98.6% vs. 89.2%, p < 0.001). Postoperatively, the stented cohort exhibited higher odds of minor complications (CD grade 1-2; OR 1.66, p = 0.018), and an increased incidence of progressive renal insufficiency (8.7% vs. 1.3%, p = 0.024) and bleeding requiring transfusion (29.8% vs. 19.6%, p = 0.030). Ureteral obstruction, urinary leak, anastomotic leak rates, hospital stay, and readmission and reoperation rates remained similar between the two groups. Propensity score matching (1:1) for patients with and without stents supported the results of the multivariate logistic regression.

CONCLUSION

Stent omission after radical cystectomy with continent diversion using neobladder reconstruction was not associated with significant differences in major complications, ureteral obstruction, readmission, or reoperation rates. It is potentially a safe alternative associated with fewer minor complications.