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Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

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Ahmed A. Hussein, Paul R. May, Zhe Jing, Youssef E. Ahmed, Carl J. Wijburg, Abdulla Erdem Canda, Prokar Dasgupta, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini, John Kelly, Alexandre Mottrie, Jihad Kaouk, Ashok Hemal, Peter Wiklund, Khurshid A. Guru, Andrew Wagner, Matthias Saar, Joan Palou Redorta & 17 more Michael Stockle, Lee Richstone, Franco Gaboardi, Ketan Badani, Koon-Ho Rha, Hijab Khan, Omar Kawa, Francis Schanne, Vassilis Polakis, Alon Weizer, Douglas Scherr, Giovannalberto Pini, Wei Shen Tan, Thomas J. Maatman, Adam Kibel, Bertram Yuh, Taylor C. Peak

Original languageEnglish
JournalJournal of Urology
Early online date21 Dec 2017
DOIs
Accepted/In press7 Dec 2017
E-pub ahead of print21 Dec 2017
Published5 May 2018

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Abstract

Introduction and Objective This study aims to provide an update and compare perioperative outcomes and complications of Intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following RARC from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). Methods A retrospective review of 2125 patients from 26 institutions was performed. ICUD was compared with ECUD Multivariate (stepwise variable selection) logistic regression models were fit to evaluate preoperative, operative, and postoperative predictors of receiving ICUD, operative time, high grade complications and 90-days readmissions after RARC. Results 51% (n=1094) patients underwent ICUD in our cohort. ICUD patients demonstrated shorter operative times (357 vs 400 minutes, p<0.001), less blood loss (300 vs 350 ml, p<0.001), and fewer blood transfusions (4% vs 19%, p<0.001). ICUD patients experienced more high grade complications (13 vs 10%, p=0.02). Utilization of ICUD increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after ICUD decreased significantly over time (p<0.001). On multivariable analysis, higher annual cystectomy volume (OR 1.02, 95% CI (1.01-1.03), p<0.002) and year of RARC 2013-2016 (OR 68, 95% CI 44-105, p<0.001) and ASA score <3 (OR 1.75, 95% CI 1.38-2.22, p<0.001) were associated with receiving ICUD. ICUD was associated with shorter operative time (27 minutes, p=0.001). Conclusion Utilization of ICUD has increased over the past decade. Higher annual institutional volume of RARCs was associated with performing ICUD. ICUD was associated with shorter operative times. Although ICUD was associated with higher grade complications compared to ECUD, they decreased over time.

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