Cutaneous ureterostomy versus ileal conduit – outcomes and cost implications post-cystectomy

Abstract

Background: Following radical cystectomy (RC), most centres reserve cutaneous ureterostomy (CU) for frail patients. The concern of ureter and stoma stenosis limits CU to a secondary choice despite potentially being a safer and faster option. Ileal conduit (IC) remains the most popular choice of urinary diversion in most centres. We aim to compare the complications and costs related to CU and IC after RC.

Methods: This is a retrospective study of 40 patients (20 CU, 20 IC) between April 2019 and January 2021 at Groote Schuur Hospital, South Africa. All patients underwent RC intended to treat bladder cancer. We compared perioperative, clinical outcomes and hospital costs between CU and IC.

Results: Both groups showed similar preoperative risk profiles. For the CU group, the intraoperative cutting time (p = 0.01) and blood loss (p = 0.12) were lower than the IC group. Postoperatively, the CU group had fewer ileus days (1.44 vs 4.65) (p = 0.09), total parenteral nutrition (TPN) days (1.58 vs 4.35) (p = 0.23), wound complications (1 vs 8) (p = 0.02), and shorter admission (p = 0.14). The CU group also required fewer second-line antibiotics than the IC group (10% vs 55%) (p = 0.003). Hospital costs were 40.32% more expensive in the IC group, accumulating an extra 89 431.37 ZAR (5 489.96 USD) per patient (p = 0.03).

Conclusion: Our study suggests that CU is faster, cheaper, and has fewer early postoperative complications. In our literature research, many studies show success with modifying surgical techniques of CU to decrease stomal and ureteric stenosis to acceptable rates. We believe CU may have a role as a primary incontinent urinary diversion and is not reserved for frail patients. However, larger-scale trials implementing these surgical modifications are needed to validate these findings.