Topic Paper

World Journal of Urology

, Volume 27, Issue 1, pp 45-50

First online:

Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy

  • John L. GoreAffiliated withVA Greater Los Angeles Healthcare SystemRobert Wood Johnson Clinical Scholars Program, University of California-Los AngelesDepartment of Urology, David Geffen School of Medicine at UCLA Email author 
  • , Mark S. LitwinAffiliated withDepartment of Urology, David Geffen School of Medicine at UCLADepartment of Health Services, School of Public Health, University of California-Los AngelesJohnson Comprehensive Cancer Center, David Geffen School of Medicine at UCLARAND Corporation
  • , The Urologic Diseases in America Project

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Quality-of-care indicators have not yet been defined for patients with bladder cancer. Nonetheless, certain aspects of bladder cancer care can be evaluated to quantify the quality of care delivered. We sought to determine trends in continent urinary diversion to evaluate the adoption of this more optimal reconstruction.


Subjects who underwent radical cystectomy for a primary diagnosis of bladder cancer were identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. We identified covariates independently associated with utilization of continent urinary diversion after radical cystectomy using multivariate logistic regression modeling. We then examined trends in diversion type based on patient and hospital characteristics and examined the impact of hospital volume on use of continent reconstruction.


Our weighted sample included 5,075 subjects (14.3%) who underwent continent urinary diversion and 30,295 subjects (85.7%) who underwent an ileal conduit. Independent correlates of continent diversion included younger age, male gender, having private insurance, and undergoing surgery at an urban teaching hospital. Hospitals performing continent diversions on more than 40% of their cystectomies had a yearly cystectomy volume of 0.8 surgeries. Subjects treated at high-volume hospitals trended toward lower rates of comorbid conditions.


We identified substantial disparities in continent diversion which, based on yearly trends, are unlikely to improve in the near future. Continent reconstructions are not the exclusive domain of high-volume cystectomy centers. Yet efforts to increase rates of this complex reconstruction must concentrate on technique dissemination and better definition of the quality-of-life detriments incurred by cystectomy patients.


Bladder cancer Quality of care Urinary diversion