Comparison of complications in our extraperitoneal radical cystoprostatectomy with orthotopic urinary diversion cases and the intraperitoneal approach reported in the literature

Abstract

Objectives:

This study aimed to evaluate the postoperative complications of extraperitoneal radical cystoprostatectomy (EPRC) with orthotopic urinary diversion performed in our clinic. Because no contemporaneous intraperitoneal control group was included, outcomes were compared indirectly with those reported in previously published series of intraperitoneal radical cystoprostatectomy (IPRC). Although IPRC remains the standard approach, the extraperitoneal technique has attracted increasing interest due to its potential to reduce bowel manipulation and thereby lower gastrointestinal complication rates.

Methods:

Over a 4-year period, 24 male patients with muscle-invasive bladder cancer underwent EPRC with orthotopic urinary diversion. Clinical records and digital data were retrospectively reviewed to assess early (⩽1 month) and late (>1 month) postoperative complications. No contemporaneous intraperitoneal control group was included; therefore, comparisons were made against previously published intraperitoneal series.

Results:

The mean operative time was 260 ± 25 min, and the length of hospital stay was 7 ± 2 days. Overall early and late complication rates were 44.2% and 38.3%, respectively. Gastrointestinal complications were the most frequent early events; importantly, no mechanical ileus was observed, and all instances of bowel distension resolved with conservative management. No urine leak, intra-abdominal abscess, or pelvic lymphocele developed. One patient developed distant metastasis during follow-up, and no local recurrence occurred. Daytime continence was largely maintained, whereas nocturnal incontinence was detected in 41.6% of patients.

Conclusions:

EPRC with orthotopic urinary diversion appears to be a safe and feasible alternative to the intraperitoneal technique. In indirect comparison with previously published intraperitoneal series, it may offer an advantage in reducing gastrointestinal and intra-abdominal complications. The absence of mechanical ileus in our cohort may suggest a potential perioperative advantage associated with preservation of peritoneal integrity, although this observation should be interpreted cautiously given the indirect nature of the comparison. Larger prospective studies are required to validate these findings across broader patient populations.