Temporal trends and clinical determinants of urinary diversion after radical cystectomy.
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Pellegrino Francesco, de Angelis Mario, Scilipoti Pietro, Longoni Mattia, Subiela José Daniel, Contieri Roberto, Afferi Luca, Zamboni Stefania, Suardi Nazareno, Musi Gennaro, Luzzago Stefano, D'Andrea David, Laukhtina Ekaterina, Soria Francesco, Gontero Paolo, Del Giudice Francesco, Fallara Giuseppe, Roupret Morgan, Grobet-Jeandin Elisabeth, Baudewyns Arthur, Tanaka Hajime, Matsumoto Shunya, Fujii Yasuhisa, Proietti Flavia, Simone Giuseppe, Schulz Gerald Bastian, Pyrgidis Nikolaos, Ploussard Guillaume, Antonelli Alessandro, Bertolo Riccardo, Roumiguie Mathieu, Bajeot Anne-Sophie, Resca Stefano, Beatrici Edoardo, Lambert Edward, Mottrie Alexandre, Mir Maria Carme, Umari Paolo, Teoh Jeremy, Wong Chris, Mertens Laura S, Pichler Renate, Mori Keiichiro, Ślusarczyk Aleksander, Poyet Cédric, Albisinni Simone, Aziz Atiqullah, Volpe Alessandro, Shariat Shahrokh, Pradere Benjamin, Karakiewicz Pierre, Necchi Andrea, Ferro Matteo, Montorsi Francesco, Briganti Alberto, Moschini Marco, European Association of Urology–Young Academic Urologists Urothelial Carcinoma Working Group (EAU‐YAU)
Аннотация
MATERIALS AND METHODS: We analysed 6469 patients who underwent RC between 2004 and 2024 at 23 international tertiary referral centres. Trends in UD type (cutaneous ureterostomy [UCS], ileal conduit [IC], and neobladder) were assessed using estimated annual percentage change (EAPC). Multivariable analysis (MVA) models identified preoperative predictors of UD type. EAPC was applied to evaluate temporal changes in the patient characteristics associated with UD type.
RESULTS: Overall, 882 (14%), 3611 (56%) and 1976 patients (31%) underwent UCS, IC, and neobladder procedures, respectively. IC remained the most common UD, without significant temporal change (P = 0.1). UCS use increased from 2% to 22% (EAPC 9.9%; P < 0.001), while neobladder use declined from 41% to 19% (EAPC -2%; P = 0.009). MVA showed that older age, comorbidities, and advanced disease were associated with higher rates of UCS and lower rates of neobladder use (all P < 0.005). Neoadjuvant chemotherapy (NAC) was inversely linked to UCS, while robot-assisted RC and male sex favoured neobladder use (all P < 0.005). EAPC showed rising proportions of male patients (EAPC 6.7%), patients aged >70 years (1.2%), patients with a Charlson Comorbidity Index ≥3 (8.3%), patients who received NAC (10.4%) and patients with cT2-cN0 disease (0.5%; all P < 0.05).
CONCLUSION: Over two decades, a marked increase in UCS use has been observed, alongside a decline in neobladder reconstruction. These trends coincided with a shift toward older, more comorbid patients undergoing RC. Evolving patient profiles and surgical practices underscore the need for tailored UD strategies and optimised peri-operative management.