To report survival for patients who undergo urinary diversion for benign indications and to identify risk factors for morbidity at 90 days.
This is a retrospective review of consecutive urinary diversions with or without cystectomy for non-oncological indications at a single institution. The indication for diversion was intractable incontinence, upper tract deterioration, urinary fistula, and unmanageable bladder pain. Patients were categorized according to their most severe complication within 90 days of surgery, using the Clavien-Dindo system. Multivariable analysis was performed to identify factors associated with high-grade complications. Survival analysis was performed.
Between 2007-2014, 141 patients underwent urinary diversion for non-oncological indications. The postoperative rate of high-grade adverse events (class III or greater) was 28%. Risk factors for class III or greater complications at 90 days included prolonged intra-operative mean arterial pressure below 75% of baseline, operative duration greater than 343 minutes, and postoperative vasopressor requirement. Kaplan-Meier survival analysis demonstrated a 1- and 5-year survival of 88.4% and 77.2%. The long-term survival of patients who experienced higher-grade complications was not statistically different from the survival of the rest of the group. Study was limited by retrospective design and sample size in identifying additional variables associated with increased risk of long-term mortality.
Urinary Diversion for non-oncological conditions has good 5 year survival in this cohort. Extended case duration and hemodynamic instability during or immediately after urinary diversion are associated with a high-grade complication within 90 days of the procedure.
Urology. 2017 Sep 15 [Epub ahead of print]
Y Santiago-Lastra, Michael R Mathis, Elizabeth Andraska, Aleda L Thompson, Bahaa S Malaeb, Anne P Cameron, J Quentin Clemens, John T Stoffel
Department of Urology, University of California - San Diego. Electronic address: ., Department of Anesthesiology and Critical Care, University of Michigan Hospital and Health System., University of Michigan Medical School., Department of Urology, University of Michigan Hospital and Health System.