Presented by: Amir Buchler MD
Department of Urology, Rabin Medical Center, Petach Tikva, Israel

Introduction

Urinary diversion, with or without cystectomy, is a final option for individuals experiencing end-stage lower urinary tract dysfunction caused by non-malignant bladder conditions. Our objective was to delineate the perioperative complications and assess the postoperative quality of life (QOL) in patients undergoing this procedure.

Materials

 A retrospective analysis was conducted by scrutinizing the medical records of patients who underwent surgical intervention for benign conditions from 2016 to Jan. 2023. We used the Clavien-Dindo scale to evaluate postoperative complications which were categorized into early (< 30 days) and late (> 30 days) complications. To estimate the impact on QOL, we used the validated EORTC QLQ-C30 questionnaire (questions 1-5) and the QLQ-BLM30 questionnaire (questions 38-43). Higher scores were indicative of bothersome QOL symptoms. Furthermore, the overall QOL was assessed by the QLQ-C30 global health status questionnaire (questions 29-30), with higher scores indicating improved QOL.

Results

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During the study period, 23 patients underwent surgical interventions. Demographic and clinical profiles are presented in table 1.

The median operative time was 310 (IQR 239-353) minutes. Intraoperative complications consisted of bleeding requiring blood transfusion in 5 (22%) patients, each receiving 2 units of PBC. The mean hemoglobin decrease was 1.6±1.3 mg/dL. The median inpatient stay was 14 (IQR: 12-18) days.

In a median follow-up of 19.4(IQR 14-46) months, postoperative complications were observed in 14 patients with a median onset of 10 (IQR 6-17) days from surgery.

Clavien-Dindo's postoperative complication rate was ≤2 in 86.9% of the patients. Two patients suffered late complications on postoperative days 32 and 52. One of these patients mourned from recurrent septic events and died three months postoperatively.

The mean scores on the QLQ -BLM30 (range 6-24) and QLQ-C30 (range 5-20) were 10.2±3 and 10.5±4.3, respectively. The mean scores (range 2-14) on the QLQ‐C30 global health status were 9.9±3.

Conclusion

Urinary diversion with or without cystectomy for benign conditions is a viable and safe procedure that preserves a high postoperative QOL. Therefore, we advocate for considering and including this intervention as a last-resort treatment option for patients with refractory non-malignant lower urinary tract dysfunction.

Funding

None

Co-Authors

Roi Babaoff, MD
Department of Urology, Rabin Medical Center

Hadar Tamir, MD
Department of Urology, Rabin Medical Center

Daniel Kedar, MD
Department of Urology, Rabin Medical Center

Jack Baniel, MD
Department of Urology, Rabin Medical Center

Shachar Aharony, MD
Department of Urology, Rabin Medical Center