Cutaneous ureterostomy versus ileal conduit as urinary diversion in patients with muscle-invasive bladder cancer undergoing radical cystectomy: A comparative analysis of high-risk cases

Abstract

Introduction:

Radical cystectomy followed by urinary diversion is the standard of care for patients with muscle-invasive bladder cancer (MIBC). Cutaneous ureterostomy has emerged as an alternative to ileal conduit diversion, particularly in high-risk patients. The present study aimed to evaluate the outcomes and complications of cutaneous ureterostomy versus ileal conduit in patients with MIBC.

Methods:

This was a retrospective, descriptive cross-sectional study performed at Shahid Modarres Hospital in Tehran between 2018 and 2021. The study population consisted of patients who underwent radical cystectomy with either ileal conduit or cutaneous ureterostomy. Baseline characteristics, operative data, and postoperative complications were compared between the two groups.

Results:

The results showed that cutaneous ureterostomy was significantly utilized in patients with high creatinine levels, renal failure, and metastatic disease (p < 0.05). Analysis revealed that 30-day, 90-day, and 6-month survival rates, as well as surgical complications, were not significantly different between the two groups. Multivariable regression analysis was performed to adjust for baseline imbalances, indicating that the choice of diversion was not an independent predictor of early mortality, though it was heavily influenced by preoperative frailty. One-year survival, the number of preoperative transfusions, length of hospitalization, and operation duration were significantly higher in the ileal conduit group.

Conclusion:

Cutaneous ureterostomy appears to be a viable and “hypothesis-generating” alternative for elderly and frail patients. It is associated with shorter surgery duration, less blood loss, lower transfusion rates, and shorter hospital stays. Although early mortality rates are comparable, cutaneous ureterostomy may offer a safer profile for high-risk individuals, though long-term comparative studies with multivariable adjustment are warranted.