Cancer medicine · 2026
Urinary Diversion-Specific Morbidity After Radical Cystectomy: A Ten-Year Institutional Experience.
СтатьяНазвание и аннотация: Перевод в очереди
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Hu Xuanhan, Miao Jia, Huang Yueyu, Yang Yunkai, Zhang Xinyu, Wang Yifan, Qian Lin, Zhang Dahong, Wei Haibin
Аннотация
INTRODUCTION: This study investigates the correlations and risk factors of complications associated with different urinary diversion methods after radical cystectomy (RC) for bladder cancer (BC).
METHODS: A retrospective analysis was conducted on 574 bc patients treated between 2012 and 2022. Complications were categorized as early or late occurrences. Multistate Cox regression and stepwise logistic regression models were employed to identify independent predictors. Heat maps were utilized to explore correlations among complications.
RESULTS: Patients undergoing ureterostomy were generally older, had a higher prevalence of comorbidities, and exhibited a greater propensity for late urinary tract infections (UTIs), nephrolithiasis, and anxiety/depression. Bricker conduits were linked to small-bowel obstruction and ureteroenteric strictures, while orthotopic neobladders were associated with incontinence and urinary retention. Diabetes increased risks of urolithiasis and mild bowel obstruction but decreased strictures and reflux. High pathological grade predicted strictures; low hemoglobin increased obstruction and late UTIs. Robot-assisted laparoscopy reduced early UTIs, reflux, and ostomy-related obstruction. Bowel obstruction risk was elevated in patients with higher body mass index or smoking history but was mitigated by robotic approaches. Late UTIs were strongly linked to ureterostomy and heavy smoking.
CONCLUSION: Ureterostomy raises the risk of UTIs, kidney issues, and psychological disorders, necessitating careful follow-up. Bricker conduits require monitoring for bowel complications, while orthotopic neobladders are linked to incontinence and metabolic problems, demanding careful patient selection. Advanced age, heavy smoking, T4 stage, and long hospital stays are key predictors of complications and should guide preoperative risk assessment. Robot-assisted laparoscopy lessens gastrointestinal and stoma-related events.
METHODS: A retrospective analysis was conducted on 574 bc patients treated between 2012 and 2022. Complications were categorized as early or late occurrences. Multistate Cox regression and stepwise logistic regression models were employed to identify independent predictors. Heat maps were utilized to explore correlations among complications.
RESULTS: Patients undergoing ureterostomy were generally older, had a higher prevalence of comorbidities, and exhibited a greater propensity for late urinary tract infections (UTIs), nephrolithiasis, and anxiety/depression. Bricker conduits were linked to small-bowel obstruction and ureteroenteric strictures, while orthotopic neobladders were associated with incontinence and urinary retention. Diabetes increased risks of urolithiasis and mild bowel obstruction but decreased strictures and reflux. High pathological grade predicted strictures; low hemoglobin increased obstruction and late UTIs. Robot-assisted laparoscopy reduced early UTIs, reflux, and ostomy-related obstruction. Bowel obstruction risk was elevated in patients with higher body mass index or smoking history but was mitigated by robotic approaches. Late UTIs were strongly linked to ureterostomy and heavy smoking.
CONCLUSION: Ureterostomy raises the risk of UTIs, kidney issues, and psychological disorders, necessitating careful follow-up. Bricker conduits require monitoring for bowel complications, while orthotopic neobladders are linked to incontinence and metabolic problems, demanding careful patient selection. Advanced age, heavy smoking, T4 stage, and long hospital stays are key predictors of complications and should guide preoperative risk assessment. Robot-assisted laparoscopy lessens gastrointestinal and stoma-related events.